فهرست مطالب

Neonatology - Volume:8 Issue: 2, Spring 2017

Iranian Journal of Neonatology
Volume:8 Issue: 2, Spring 2017

  • تاریخ انتشار: 1396/04/24
  • تعداد عناوین: 12
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  • Sunny Oteikwu Ochigbo, Jacob Jackson Udo, Anthony Chidibere Nlemadi, Kudirat Omololuolaniyo Pages 1-4
    Background
    Microalbuminuria and serum creatinine are the specific markers of acute renal injury. Perinatal asphyxia is responsible for 50% of all neonatal deaths and nonoliguric acute renal injuryis one of its complications. This study was undertaken to determine the efficacy of serum creatinine and microalbuminuria for early diagnosis of renal injury in severely asphyxiated neonates in Calabar, Nigeria.
    Methods
    This prospective cross-sectional study was performed among severely asphyxiated newborns admitted into the neonatal wards of the University of Calabar Teaching Hospital (UCTH). Standard methods for the determination of blood urea and electrolyte were executed. Micral-test strips have been applied using urine dipstick and the result of the test was negative only for albumin. The developed colors have been compared five minutes after the first test.
    Results
    Fifty full-term newborns were enrolled and their serum electrolytes, creatinine and the creatinine clearance were essentially normal. Six neonates demonstrated positive results in the microalbominuria assessment, while the rest were negative in this regard. The test has 0% sensitivity and 100% specificity, while the positive and negative predictive values were 0% and 88%, respectively.
    Conclusion
    Microalbuminuria is not a useful marker for early diagnosis of acute renal failure in the newborns with severe prenatal asphyxia, but further studies are recommended.
    Keywords: Acute Kidney Injury, Apgar, Birth asphyxia, Micral test strip, Newborn
  • Mahboobeh Namnabati, Fariba Taleghani, Maryam Varzeshnejad, Arezoo Yousefi, Zohre Karjoo, Simin Safiri Pages 5-12
    Background
    All nursing cares require decision-making, and the ability to make the best decisions impact upon the quality of nursing care. Moreover, authenticity and accuracy of the best cares may be questioned if not recorded and reported properly and in a standard manner. We aimed to design and implement an electronic nursing management system and then evaluate satisfaction of nurses with the designed electronic system.
    Methods
    This technical action research was conducted in four phases of a) designing an electronic nursing process decision support system, b) designing an electronic nursing care documentation system, c) integrating these two systems and developing an electronic nursing information management system, and d) implementing the system and system satisfaction evaluation using quantitative methods (satisfaction questionnaire).
    Results
    The results of this project led to design and development of an electronic nursing information management system for neonatal intensive care units, which enables nurses to carry out standard care and documentation with high level of nursing satisfaction.
    Conclusion
    In order for an electronic system to support nurses in their care process, it must be accepted by nurses. If nurses are satisfied with the performance and nature of this system, they are much less likely to develop workaround solutions and much more likely to spend their efforts focusing on the professional aspects of nursing care.
    Keywords: documentation, electronic system, Nursing process
  • Somayyeh Hashemian, Ashraf Mohammadzadeh, Ahmadshah Farhat, Mohammad Ramezani, Seyed Javad Seyedi Pages 13-17
    Background
    Approximately 60% of term neonates and 80% of preterm ones suffer from hyperbilirubinemia in their first week of life. This study sought to characterize the therapeutic effect of oral zinc sulfate on neonatal hyperbilirubinemia.
    Methods
    In this randomized, double-blind, placebo-controlled clinical trial, 70 term neonates with total serum bilirubin (TSB) level ≥ 20 mg/dl were enrolled. Thirty-four cases were treated with phototherapy and zinc (10 mg/day, single dose) as case, while the remainder received phototherapy plus placebo. TSB level was measured at the onset of the intervention, as well as 12, 24 and 48 h after the intervention and compared with each other.
    Results
    The mean TSB levels were significantly lower in the zinc group after 12, 24 and 48 h (P=0.038, 0.005, 0.001, respectively). The mean durations of phototherapy in the case and control groups were 2.03±0.174 and 2.33±0.478 days, respectively, being significantly less in the case group (P=0.002).
    Conclusion
    This study revealed that oral zinc sulfate at a single dose of 10 mg/day diminished TSB level and duration of phototherapy.
    Keywords: Hyperbilirubinemia, Neonate, Treatment, Zinc Sulfate
  • Noushin Beheshtipoor, Fatemeh Bayani, Mitra Edraki, Shahnaz Porarian, Alireza Salehi Pages 18-23
    Background
    A Premature infants undergo multiple painful procedures during treatment; thus, it must be tried to limit complications caused by diagnostic and treatment procedures using simple and practical methods. This study was performed to evaluate the effect of spike lavender lakhlakhe on pain intensity due to phlebotomy in hospitalized premature infants.
    Methods
    This single-arm, randomized clinical trial was performed on 30 infants chosen through convenience sampling method. Each newborn was considered as its own control. For the test group, one drop of pure (100%) spike lavender lakhlakhe was taken by a standard dropper and diluted with 4 ml of warm distilled water by the research assistant. This mixture was stirred at 2-3 cm distance of the newborns’ nose from 60 minutes before until 2 minutes after phlebotomy, such that it could be smelled by the newborns. In both groups, heart rate and blood oxygen saturation were measured by a standard portable device, and the corresponding data was recorded in data collection sheets. Moreover, the infants’ facial expression changes were recorded by a camera and the intensity of pain was measured by Premature Infant Pain Profile before and after the procedure. Finally, the data was analyzed by paired comparison analysis test in SPSS, version 17.
    Results
    Comparison of mean pain intensity caused by phlebotomy in the control and test groups showed a significant difference (7.667±0.311 vs. 4.882±0.311; P
    Conclusion
    Spike lavender lakhlakheh can be used as an easy, available, and safe method to decrease infants’ pain during phlebotomy procedure.
    Keywords: Lakhlakhe (extract) of spike lavender, Pain intensity, premature infants, Vein blood collection, Vein blood sampling
  • Leila Valizadeh, Majid Mahallei, Abdolrasoul Safaiyan, Fatemeh Ghorbani, Maryam Peyghami Pages 24-30
    Background
    Considering the susceptibility of preterm infants to disturbances of vital signs, this study was conducted to investigate the effects of using plastic covers on regulation of vital signs in preterm neonates.
    Methods
    This randomized, cross-over, clinical trial was carried out on 80 preterm infants admitted to neonatal intensive care unit (NICU) of Taleghani Hospital, Tabriz, Iran. The study was conducted in two days (on the second and third days of the infants’ life). In group 1, plastic cover was used during the first day followed by the use of blanket on the second day, while the order was reversed in group 2. Digital thermometer was used to measure the infants’ axillary temperature. Heart rate and oxygen saturation were measured through monitoring. To analyze the data, descriptive (Mean and SE, 95%CI) and inferential statistics (repeated measurement and ANCOVA tests) were used in SPSS version 13 and MiniTab software.
    Results
    Fourteen infants who were covered with blanket were found to suffer from hypothermia, while no infant with a plastic cover encountered this problem. The percentage of arterial blood oxygen saturation in the group with plastic covers was higher, and as a result, the infants received less oxygen supplements. However, no statistically significant differences were observed in heart rate between the groups.
    Conclusion
    Use of plastic cover during NICU stay prevented hypothermia in premature infants, with the arterial blood oxygen saturation being within the normal limits. Yet, it did not seem to have a significant effect on other vital signs.
    Keywords: Body temperature, HR, Neonatal intensive care unit, Polyethylene wrap, Preterm infants, SpO2
  • Yadollah Zahed Pasha, Mousa Ahmadpour-Kacho, Mahmood Hajiahmadi, Behnaz Mirzaee Pages 31-35
    Background
    Several modalities have been proposed to reduce procedural pain in neonates. This study was conducted to determine whether heat of a non-human source might help with pain management in infants.
    Methods
    In this clinical trial, 40 full-term healthy neonates in their first hours of life were randomly divided into two groups of intervention and control. The control group was put under a radiant warmer using the servo-controlled method for four minutes and the temperature was set to 35.5°C. The intervention group was put under the servocontrolled mode with the temperature of 35.5°C for two minutes, then two minutes in manual mode with 100% power. Vitamin K injection was performed. The severity of pain in infants was measured by an independent observer by means of Neonatal Infant Pain Scale (NIPS) before the injection, 20 seconds during the injection, as well as 60 and 120 seconds after the injection. The difference in pain score was compared between the two groups using Chi-squared test, repeated measures analysis of variance, and independent t-test.
    Results
    The two groups were similar in terms of gestational age, birth weight, Apgar score, and maternal age. The mean of NIPS scores was 2.9 in intervention group and 4 in the control group during injection, which was significantly different (P=0.001). No significant difference was recorded in skin temperature and pain scores before and after injection.
    Keywords: heat, Iran, Newborn, Pain, Vitamin K1
  • Vahideh Banna Zadeh, Gholamreza Khademi, Forugh Rakhshanizadeh, Bahareh Imani, Nooshin Abdollahpour, Majid Sezavar Pages 36-43
    Background
    Hyperglycemia is an independent risk factor for mortality in neonatal intensive care units (NICU). Herein, we aimed to investigate the relationship of hyperglycemia duration with mortality and ventilator dependence in infants admitted to NICU.
    Methods
    In this original retrospective study, data was collected between October 2015 and December 2015 from NICU of Dr. Sheikh Children’s Hospital in Mashhad, Iran. The studied samples (n=112) were 0-3 month old infants who were admitted to this hospital and were followed up until discharge. Information related to blood sugar was collected based on the samples routinely taken using a glucometer every six hours and were recorded in each patient's blood sugar chart.
    Results
    Of the subjects, 46.4% (n=52) had blood sugar ≥ 126 mg/dl and 53.6% (n 60) had blood sugar ≤ 40-125 mg/dl. Mann-Whitney and logistic regression tests were used to analyze the data. In this study, we controlled the effect of confounding variables; a significant association was observed between mortality and duration of hyperglycemia (P=0.002). In addition, a significant association was observed between duration of hyperglycemia and ventilator dependence (P=0.02).
    Conclusion
    Our study showed that the duration of hyperglycemia is positively associated with mortality and ventilator dependence in infants admitted to NICU.
    Keywords: Duration of hyperglycemia, Hyperglycemia, Infants, Length of stay, Mortality, Neonatal intensive care unit, ventilation
  • Golnaz Rezaeizadeh, Fatemeh Nayeri, Maryam Mahmoodi, Mamak Shariat, Shahrbanoo Nakhaei Pages 44-49
    Background
    Pediatric medicine in Iran has been known as a specialty for more than 50 years; nevertheless, the neonatal-perinatal medicine is still in the first decades of its life. Regarding this, the present study was conducted toprovide an overall view of the current situation of the neonatal medicine, its challenges, and prospects in Iran.
    Methods
    For the purpose of the study, a questionnaire was sent to 62 neonatologists via post or email. The collected data included the current condition of available equipment, facilities, and human resources in the neonatal wards. Furthermore, the neonatologists were asked about the most important step to be taken in terms of the neonatal health.
    Results
    Out of the 62 neonatologist, who received the questionnaire, 38 (61%) cases filled out the instrument. Based on the collected data, the presence of some services in the hospitals under investigation was reported to be indicative of some defects in the neonatal health system. These services included neonatal and pediatric development evaluation clinics (39.3%), psychology counseling sessions (25%), and access to placental and fetal pathology (53.3%). Significant shortage of human resources were mainly related to the lack of certain breast feeding consultant (25.7%), absence of social workers (24.1%), clinical pharmacists (75.9%), and genetic specialists (50%).
    Conclusion
    As the findings of the present study indicated, the most important deficiency in our health system was the incomplete establishment of perinatal regionalization system.
    Keywords: Equipment, supplies, Health services, hospital, Intensive Care Units, Neonatal
  • Reza Saeidi, Mahboobeh Gholami Pages 50-52
    Background
    Simulation is used for teaching neonatal resuscitation; however, studies assessing the impact of simulation-based neonatal resuscitation education (SBE) have produced variable results. In this study, we aimed to assess the effect of SBE on nursing students’ knowledge.
    Methods
    This experimental study was conducted at Faculty of Nursing of Neishabour University of Medical Sciences on 80 nurses selected through convenience sampling method. The data was collected using a standardized questionnaire for neonatal resuscitation designed based on the Neonatal Resuscitation Program (NRP; 7th Ed, 2016). To analyze the data, we performed independent samples t-test, Mann-Whitney U test, Pearson correlation coefficient, and paired t-test in SPSS, version 16.
    Results
    There were no significant differences in the level of knowledge of neonatal resuscitation between the two groups at pre-test (P=0.452). However, comparison of the two groups at post-test reflected that the mean score of the students in the SBE group was significantly higher than the traditional group (P
    Conclusion
    SBE was significantly more effective than traditional neonatal resuscitation education.
    Keywords: Neonatal resuscitation, Simulation-based education (SBE), Traditional resuscitation
  • Abdolreza Malek, Mohammad-Saeed Sasan, Narges Afzali, Somayeh Ghahremani, Sara Ghahremani Pages 53-56
    Background
    A common type of chronic arthritis in children and adolescents is juvenile idiopathic arthritis (JIA). According to the International League of Associations for Rheumatology (ILAR) classification, JIA diagnostic criteria include age under 16 years and disease duration of six-weeks. Based on the number of involved joints in the first sixmonths of disease onset, JIA is categorized into oligoarticular or polyarticular subtypes. Age is a characteristic factor in the diagnosis of disease subsets; it is worth mentioning that cases younger than six months of age are seldom found in any of the subtypes.
    Case report: In this report, we present a rare case of JIA in an infant, presenting at 20 days of age. Effusion of the right hip joint was one of the primary manifestations of the disease. During hospitalization, she went through sepsis workup and a four-week antibiotic therapy for management of lower limb pseudoparalysis. In spite of antibiotic therapy, she developed effusion of a second joint. According to the course and duration of symptoms and ILAR classification for JIA, oligoarticular JIA was diagnosed and treated.
    Conclusion
    In this case, infectious diseases, such as tuberculosis and brucellosis, and malignancies were ruled out as a cause of inflammation through bone marrow aspiration, culture, and tests; ultrasound and magnetic resonance imaging showed no lytic and sclerotic lesions or a fracture. Our experience showed a rare case of JIA and suggested that JIA must be considered in children with joint inflammation at any age
    Keywords: Chronic arthritis, juvenile idiopathic arthritis, Neonate
  • Ahmad Shah Farhat, Shadi Noorizadeh, Ashraf Mohamadzadeh, Reza Saeedi Pages 57-59
    Background
    Collodion baby is a rare condition (i.e., 1:300000 birth), which is referred to a neonate covered with a tight and shiny membrane desquamating within two weeks. This condition takes place as a result of the epidermal cornification disorder. Given the impairment of the skin barrier function, these neonates are at the risk of several complications, including hypernatremic dehydration, hypothermia, skin infections, fissures, conjunctivitis, sepsis, dehydration, and constrictive bands of the extremities resulting in vascular compromise and edema. This condition has a high mortality rate; accordingly, the majority of the collodion babies die within the first few weeks of birth due to the secondary complications depending on the type of mutations. Although the collodion membrane is a transient condition, it can lead to a number of complications in 45% of the newborns and result in 11% mortality rate in the first few weeks of the neonatal life. However, in the recent years, the mortality rates have been declined owing to the introduction of systemic retinoids to the clinical practice and the advanced care methods, which are used in the intensive care units. Harlequin ichthyosis has been associated with the mutation in the ABCA12 gene; therefore, genetic counseling and mutation screening of this gene should be considered.
    Case report: Herein, we reported a case of a collodion baby with favorable evolution, who developed hypernatremia and suffered from some complications having aroused from the condition.
    Conclusion
    Infection prevention and supportive care of collodion babies mainly with incubator, serum therapy, and feeding support can be effective in preventing complications.
    Keywords: Collodion baby, Harlequin fetus, Hypernatremia, Sepsis
  • Seyedeh Fatemeh Khatami, Pouya Parvaresh, Abbas Boskabadi, Hassan Boskabadi, Gholamali Mamori Pages 60-66
    Background
    Incontinentia pigmenti (IP), also known as Bloch-Sulzberger syndrome, is a rare X-linked dominant genodermatosis that presents at the time of birth or soon after birth with cutaneous manifestation. This disorder may also affect the ectodermal tissues, such as the central nervous system, skeletal system, eyes, hair, nails, and teeth. The dermatological findings occur in four successive phases.
    Case report: Herein, we presented the case of a two day-old female newborn with inflammatory vesiculopustular lesions on the right forearm and lower limbs, who was in a good general condition. The patient had a history of similar disease in three other members of her family, who had dental abnormalities as the most common non-cutaneous manifestation. This case report highlighted the importance of a detailed diagnostic workup for the newborns with pustular skin disease.
    Conclusion
    IP is a rare, x-linked dominant genodermatosis with multiple organs involvement. Dermatological abnormalities are the most prominent manifestation. The diagnosis is based on the clinical findings, the presence of positive family history of skin vesiculopustular lesions support the diagnosis. The skin lesions do not require specific treatment and prognosis depend to other organs involvement.
    Keywords: Bloch-Sulzberger syndrome, Incontinentia pigmenti, Newborn, Pus tular lesions, X-linked