یدالله زاهد پاشا

Children with cholestasis experience a wide spectrum of disease, ranging from transient liver function abnormalities to life-threatening conditions. These children may require hospitalization or specialized care at various times due to liver enzyme disorders and associated clinical issues. In severe cases, liver damage can lead to acute liver failure, necessitating liver transplantation or resulting in death. Early diagnosis of the etiology of cholestasis can be crucial for improving prognosis. This study aimed to determine the frequency, causes, and outcomes of cholestasis in infants referred to Amir Kola Children's Hospital.

This retrospective descriptive study included all infants with cholestasis admitted to AmirKola Children's Hospital between 2012 and 2022. Inclusion criteria were infants under 2 years of age diagnosed with cholestasis. Infants with incomplete medical records were excluded from the study. Hepatic cholestasis was diagnosed based on the infant's medical history and confirmed by a pediatric gastroenterologist. All infants underwent diagnostic evaluation tests and abdominal ultrasound. Liver biopsy was performed when necessary to assess liver pathology. Short-term outcomes of hepatic cholestasis, including length of hospitalization, frequency of hospitalization, need for special care, liver transplantation, and mortality, were evaluated. Demographic information, along with the causes and outcomes of cholestasis, were reported using measures of central tendency (mean) and dispersion (standard deviation), or as frequencies and percentages.

During the study period (2012-2022), 3,650 infants under 2 years of age were admitted to Amir Kola Children's Hospital. The frequency of cholestasis among hospitalized children was 54 (1.47%). The most common symptom of cholestasis was hepatomegaly, observed in 35 (64%) infants. The leading causes of cholestasis included biliary atresia in 21 (38.8%) infants, idiopathic hepatitis in 17 (31.4%) infants, and congenital metabolic disorders in 7 (12.96%) infants. Of the children in the study, 23 (42%) were hospitalized at least once, and 10 (18.5%) were hospitalized twice. Liver biopsy was performed in 32 (60.4%) of the 54 children; 11 had neonatal cholestasis, 7 had normal ultrasound results, and 13 had giant cell hepatitis and neonatal hepatitis (10 with normal ultrasound results), with 2 showing normal pathology reports. Additionally, 20 (37%) of these children died, 24 (44%) recovered, and 9 required liver transplantation.

According to the results of this study, more than one-third of children with cholestasis died, with biliary atresia and idiopathic hepatitis identified as the most common causes. Biliary atresia was also the most frequent indication for liver transplantation. These findings highlight the need for timely diagnostic examinations, testing, and specialized evaluations to support early diagnosis and treatment in infancy.

Ethical sensitivity is one of the criteria regarding the professional competence of researchers, which affects the ethical performance of the researcher. Since compliance with the principles and rules of ethics is an effective factor in providing high quality research results, the present study was conducted to investigate the ethical sensitivity and its associated components on the quality of research among academic personnel of universities of medical sciences in metropolitan area No. 1 in Iran.

This cross-sectional study was conducted on 320 academic personnel of universities of medical sciences in metropolitan area No. 1 (Guilan, Mazandaran, Golestan, Babol, Shahrud, and Semnan) who were selected by stratified random sampling. Data were collected using ethical sensitivity and research quality questionnaires. The ethical sensitivity questionnaire includes 50 questions and two dimensions of "functional and individual", each of which includes 4 fields. The researcher-made questionnaire of research quality includes 31 questions and 4 fields. The questionnaires were rated from 1 to 5 according to Likert scale. Ethical sensitivity was compared between researchers based on work experience, academic degree and gender. Then, the effect of each component of ethical sensitivity on the quality of the research was evaluated.

Out of 320 studied samples, 223 were male (69.7%) and 97 were female (30.3%). In people with experience of less than 10 years, the mean score of honesty was 15.74±3.21, ethical behavior was 30.50±5.74, accountability was 33.81±5.64, decision-making was 23.62±4.28, and interpersonal communication was 18.66±3.56, indicating higher values compared to people with an experience of more than 10 years (p<0.01). Among the dimensions of ethical sensitivity, the dimensions of honesty and discipline showed positive and significant effects on the quality of research. However, the effect of respect for the client, ethical behavior, professional knowledge, accountability, decision-making and interpersonal communication was not statistically significant despite the effect on the quality of the research. Discipline had the greatest effect on research quality (β=0.293). The R2 value (0.489) shows that about 49% of the variance of the research quality score is explained by the dimensions of ethical sensitivity. Ethical sensitivity with a standard coefficient of 7.758 had an effect on the quality of research.

The results of the present study showed that ethical sensitivity, especially the dimensions of honesty and discipline, has an effect on the quality of research.

Infant mortality is an important health indicator. In order to reduce infant mortality, its causes should be considered in each region so that steps can be taken to improve the quality of health care and treatment. Therefore, this study was conducted in order to determine the causes of infant mortality in Babol, northern Iran.

This cross-sectional study was conducted on all infants who died in public and private hospitals of Babol. The cause of infant death was extracted and analyzed based on the International Classification of Diseases 10th Revision (ICD-10) and also based on laboratory, clinical and paraclinical evidence recorded in the files.

Out of a total of 16,005 live births in Babol, 123 infants (7.6%) died, of which 53 (43.1%) died in the first 24 hours of life. The mean gestational age of the deceased cases was 31.4±5.5 weeks, the mean birth weight was 1705.4±1045.3 grams, and their mean life span was 5.4±6.6 days. The most common causes of infant mortality were prematurity (30%), congenital anomalies (25.3%), sepsis (17.1%) and respiratory distress syndrome (13%).

The results of the study showed that the most common causes of infant mortality are prematurity and congenital anomalies.

The mortality in children aged 1-59 months is one of the important indicators in assessing the general health status of a community. The death control system for children aged 1-59 months is used to record and review this indicator in Iran. This study was performed to investigate the mortality rate in children aged 1-59 months in affiliated healthcare centers of Babol University of Medical Sciences based on ICD10.

In this cross-sectional study, all cases of death in children aged 1-59 months registered in affiliated healthcare centers of Babol University of Medical Sciences in 2009-2020 were collected by referring to the reports recorded in the death control system for children aged 1-59 months. Then, information about the cause of death and the trends of mortality during the years 2009-2020 were reviewed.

Out of a total of 303 cases of death in children aged 1-59 months, 179 cases (59.07%) were boys, the mean age of children was 13.08±15.12 months and with 175 cases (57.75%), the highest mortality rate was related to urban areas. The general trend of mortality was declining; from 41 cases in 2009 to 14 cases in 2020 (p≤0.001). Congenital and chromosomal abnormalities in 100 cases (34%), endocrine, nutritional and metabolic diseases in 56 cases (18.48%), nervous system diseases in 23 cases (7.59%) and cancers in 22 cases (7.26%) were respectively the most common causes of death.

The results show a declining trend in the mortality of children aged 1-59 months.

Professional assistants are among the learners whose ability in terms of professional ethics and commitment influences their future performance after graduation so that, as an excellent physician, they can combine patient care with confidence and desirable medical skills. Considering that no comprehensive assessment of the national guideline on regarding of establishment of medical residents to the professional ethics has been published, so far this study aimed to evaluate the activities of medical universities to conduct this program.

This cross-sectional study was conducted to assess the activities of the major medical universities in region one, where had medical residents, during 2015-2018. Information on the formation of committees related to the evaluation of feedback, teaching the basics of professional ethics and how to respond to residents by asking managers of different levels of the university in the Medical Ethics Council, the Vice Chancellor for Education, medical School, department heads and departments Educational and medical centers with assistants.

Four universities of medical sciences (80% of the target population) with 4 faculties, 8 educational hospitals and 8 educational departments were evaluated. The implementation and activities of committees to investigate the professional ethics of assistants in the educational departments and hospitals of different universities has not been exactly in accordance with national guidelines. The hospital committee and the medical school committee have been established in accordance with the national guideline only at one university. None of the universities in the region had a fourth-level university committee.

This study shows the establishment of a national program of commitment of medical assistants to the principles of professional ethics in the majority of macro medical universities in region one and the attention of different levels of universities, including senior administrators, faculties, educational centers and clinical departments in different dimensions of this program especially training for assistants to commitment to professional principles in these universities.

Prematurity and low birth weight are one of the major health problems and the most common causes of infant mortality. Infant massage is potentially beneficial for physiological and psychological health. The present study was conducted to compare the effect of massage with coconut oil and sunflower oil on the growth of premature infants.

This clinical trial was performed on 100 premature infants admitted to the neonatal intensive care unit of Amirkola Childrenchr('39')s Hospital in 2018 in four groups of 25 infants. Infants of the intervention groups with one cc of sunflower oil and coconut oil and the oil-free massage group were massaged for 15 minutes three times a day for seven days with the help of a research assistant, and the control group received only routine care. The weight, height, and head circumference of infants were collected using a personal profile questionnaire and compared in four groups at the beginning and end of the intervention.

Comparison of mean weight and head circumference changes at the end of the first week between coconut oil massage group (0.134±0.334 cm, 6.81±3.04 g), sunflower oil massage group (0.239±1.172 cm, 6.35±2.69 g), oil-free massage group (1.061±1.534 cm, 2.95±2.65), and control group (0.663±1.174 cm, 3.52±4.38 g) showed significant difference (p<0.05). Comparison of mean height changes in different groups (0.413±0.739, 0.448±0.747, 0.458±0.693, 0.429±0.611 cm, respectively) did not show any significant difference.

The results of the study showed that oil massage is recommended as it increases the rate of changes in weight gain and head circumference in premature infants.

Mothers with premature infants often experience a lot of anxiety, and since music has positive effects on anxiety, the present study was conducted to investigate the effect of music on the anxiety of mothers of infants admitted to the neonatal intensive care unit.

This clinical trial was performed on 120 mothers with infants admitted to the neonatal intensive care unit of Rouhani Hospital in Babol and Bu-Ali Sina Hospital in Sari. Samples were randomly divided into two groups of experimental and control each consisting of 60 patients. In the experimental group, relaxing music was played daily through mobile phones and headphones for each mother individually for 10 minutes in 10 sessions. No intervention was performed for the control group. Both groups of mothers completed the Spielberger State-Trait Anxiety Inventory (STAI) before the start of the study and on the tenth day and were compared.

The mean age of mothers was 27.8±5.71 years and the mean age of infants was 3.92±3.88 days. In this study, anxiety was relatively severe or severe in 60% of mothers before the intervention. Levels of overt anxiety and covert anxiety in mothers of music groups before the intervention (59.48±13.66), (55.62±12.26) showed a significant decrease compared to after the intervention (31.27±6.57), (33.08±8.66), respectively (p<0.0001).

The results of the study showed that music is effective in reducing the anxiety of mothers with infants admitted to the neonatal intensive care unit.

Safe inter-hospital transfer of high-risk neonate is a part of hospital care. Due to the high rate of inter-hospital transport and the importance of family presence as a key element in infant care (family-centered care), this study aimed to determine the extent of carrying out family-centered care during the inter-facility transport of high risk neonates.

In this descriptive cross-sectional study, 150 parents of neonates transferred from the hospitals of the Mazandaran Province, Iran, to neonatal intensive care unit (NICU) of the only children's subspecialty center in this province, and 150 members of the neonatal transport team were selected using non-random sampling convenient method in 2018. The data were collected using a researcher-made questionnaire about the implementation of family-centered care during the inter-facility transport with 8 questions for transport team and 12 for parents with yes or no answer, and analyzed using SPSS software.

 88% of transport team members (132 case) and 66.7% of the parents (100 case) stated that family-centered care during the transport of neonates was desirable; and there was a significant difference between them (P = 0.001). In contrast, 30 parents (20%), 91 members of the transport team (60.7%) acknowledged that it was possible for the parents to make skin to skin contact during and before the transfer of the baby; the imbalance of responses in the parent group and transport team was significant, too (P = 0.001).</div>

Although from the viewpoint of most the members of the transport team and the parents, family-entered care during the inter-hospital transport was optimal, but both groups stated that the skin contact between the parents and the baby was not well provided; this need more education.

Due to lack of physical, emotional and psychological preparation, premature birth may cause a lot of stress for parents and may have consequences for both parents and infants. Since some parents have difficulty participating in face-to-face training programs, this study was conducted to determine the effectiveness of a training program based on virtual participation on stress and anxiety of parents with premature infants

This quasi-experimental study was performed among 80 parents of premature infants admitted to Amirkola Children's Hospital and Ayatollah Rouhani Hospital, who were randomly assigned to intervention and control groups with 40 participants in each group. The parents of the intervention group received the content of the virtual participation training program asynchronously in the form of Telegram groups within four days. The control group received no intervention other than the usual methods and support of the ward. Then, the State-Trait Anxiety Inventory (score 40-160) and the Parental Stress Scale (score 31-155) were completed and compared on the third and seventh days for both groups and on 13th day for the intervention group.

Results showed that parental stress score decreased from (97.118±21.68) to (86.27±00.27) (p<0.001) in the intervention group. In the control group, it changed from (76.103±30.44) to (91.99±31.82), which was not significant. In investigation of the effect of time on parental stress subscales, the mean scores of the questionnaires showed a significant difference from day 3 to day 13 in regard with the components of stressful parental experiences, relationship with the infant and parental role, parental experiences about behavior, appearance and treatment of the infant, and environmental stress (p<0.001). The parental state anxiety score in the intervention group changed from (45.68±4.63) to (46.63±3.54) and in the control group from (46.25±6.38) to (46.83±5.21), and the parental trait anxiety score in the intervention group changed from (43.88±5.91) to (43.97±5.59) and in the control group from (43.18±5.62) to (42.17±6.63), which was not significant.

The results of the study showed that training program based on virtual participation reduces the stress of parents with premature infants.

Mothers with premature infants experience high levels of psychological stress.Considering the importance of maternal mental health as a parent-child care provider,this study was conductedto evaluate the effectiveness of Kangaroo Mother’s Care of premature infant on mother’s mental health.
In this quasi-experimental study,60mothers with premature infants admittedto Ayatollah Rohani Hospital, Babol University of Medical Sciences,were selected by non-random sampling method.They divided into 2 study groups marked as experimental group&control group. Data were collected using thedemographic questionnaire&General Health of Goldberg&Hiller questionnaire.The 28-item questionnaire consisted of4 sub-scales:physical symptoms, anxiety and sleep symptoms, social function, and depression symptoms.A score of over 22 indicates a symptom of the disease.In the intervention group, mothers spent at least 2 hours, 3to 4 times a day for one week.The control group had the current process in the care.The questionnaire was completed at the beginning and one month after the admission of the newborn in both groups and the data were compared.
Finding showed that the overall mental health score in the intervention group before and after maternal care was (28.77± 13.09)to (13.66±6.5)and in the control group (30.86±15.97)to(20.99±8.89) that this difference was significant (P0.05).
Regarding the results of this research,use of KMC for improve of premature infant on mother’s mental health is step for health family

Insufficient knowledge of preterm mothers in infant care affects their normal growth & development. Therefore their attention to mothers is necessary. This research carried out in order to determine the effect of Educational intervention on awareness of Practice of mothers in care of premature infants.
In a quasi-experimental study 100 mothers of low birth weight infants were selected by convenience sampling method and assigned randomly to two study groups, Data from 100 mothers were collected by means of questionnaires, containing: family demographic characteristics, newborn whole information form & knowledge and practice. Knowledge and practice questionnaire was given to both the control and intervention groups of mother to determine their baseline knowledge & practice of how to care of premature infants. Only the intervention group of mothers received the individualized educational program, while the control group had taken only ordinary care from their personnel of hospital. After three months, all mothers were given a posttest to determine the degree of knowledge & practice of how to care of premature infants.
FINDINGS: Mother's awareness scores in the experimental group increased from 53.15 ± 4.99 before the intervention to 62.5±3.73 after the intervention (p AS the results showed, educational intervention can increase mother's knowledge & skill in regarding to care of low birth weight and premature infants

Many activities and interventions performed in neonatal intensive care unit (NICU) cause pain. Recurrent and untreated pain can lead to severe and harmful complications for neonates. Provision of pain management solutions is one of the duties of nurses. This study aimed to evaluate the barriers to use of non-pharmacological pain management methods in NICU from perspective of nurses.
This cross-sectional study was conducted on all nurses (N=57) working in NICU of hospital affiliated to Babol University of Medical Sciences, Babol, Iran selected by census method. Data were evaluated using a researcher-made questionnaire consisting of three parts and a three-point Likert scale. Barriers and suggested solutions were evaluated in the questionnaire, and the obtainable scores of the questionnaire related to the items of barriers and problems in application of non-pharmacological pain management methods and solutions were 17-51 and 12-36, respectively.
FINDINGS: According to the opinions of nurses, the most important barriers to the application of non-pharmacological pain management methods were shortage of personnel in each work shift (2.0±54.6), shortage of time and heavy workload (2.0±40.6), unawareness of pain complications (2.0±40.6) and long working hours and fatigue (2.0±35.6), respectively. Among the most important strategies mentioned by nurses were regularizing non-pharmacological pain management methods (2.0±63.6), regular holding of training classes (2.0±58.5), using matrons as tutors (2.0±53.6) and increasing the number of nurses in each shift or each ward (2.0±44.5).
According to the results of this study, inadequate nursing staff and insufficient knowledge about pain complications were the most important causes for lack of application of pain management methods for neonates.

Hereditary metabolic diseases are individually rare disorders, early diagnosis and treatment are very important which can prevent from permanent damage to the nervous system and mental retardation and other irreparable injury and even death in these patients. This study was done to evaluate the prevalence of hereditary metabolic diseases in children admitted to Amirkola children hospital 1384-94.
In this cross-sectional study, medical records of patients with hereditary metabolism disorders from 1384 to 1394 were studied. Related information to age, gender, family relationship, family history, disorder type, diagnostic criteria and disease outcome were extracted and analyzed.
FINDINGS: In this study, 65 children were diagnosed with different types of metabolic disease research. The common disorders were maple syrup urine disease 14 patients (21.5%), methylmalonic acidemia 10 (15.3%), mitochondrial 8(12.3%) galactosemia 6(2.9%), respectively. Among children, 36 cases (55.4%) were male and positive family history of metabolic disorders was observed in 15 children (23.1%). Mortality of metabolic disorders was in 26 children (40%) and the rest of the 19 children (54.2%) had developmental delay.
In this study 19 different types of hereditary metabolic diseases were detected that more than 25% of patients had a positive family history of this disorder.

The first year of life in the provision of health infrastructure and improvment of the life quality is very important. Because the mortality in the neonatal period and infancy is unclear in Babol, this study aimed to determine the prevalence of neonatal and infancy mortality in Babol from 2010 to 2014 in rural areas.
This cross-sectional study was done based on existing and registered data over a period of 5 years in rural areas. In this study, all deaths to 28 days and one month to one year of live births were examined in rural areas covered by Babol University of Medical Sciences based on reason and gender.
FINDINGS: The number of live births in rural areas of Babol in years of 2010 to 2014 was 2895, 2844, 2951, 3080 and 2801, respectively. The number of deaths under one year during the years of 2010 to 2014 was 19, 32, 24, 21 and 20, respectively. The lowest neonatal mortality rate in years of 1392 and 1393 was 3.57 in 1000 and the highest rate was in 1391, about 5.42 per 1,000 live births, respectively. The highest mortality during infancy was in year of 2011 about 5.89 and the lowest mortality was in year of 1389 about 2.76 per thousand people.
The results showed that the neonatal and infancy mortality rate in Babol has been relatively stable and favorable.

Childbirth is a natural phenomenon and physiological and risky process done in two ways: natural and caesarean. Since the majority of cesarean section reasons are the request of pregnant women and fear of labor pain of natural delivery, this study aimed to investigate the effect of relaxation on reducing the fear of childbirth and increasing natural delivery.
This quasi-experimental study was done on 112 nulliparous pregnant women 37-20 weeks, with no particular problems in the two trained relaxation and untrained groups. One group received routine care and another group that participate optionally in relaxation classes received 8 sessions of 90-minute relaxation training. Data were collected and analyzed by using a standard questionnaire of childbirth fear, demographic information and pregnancy outcome.
FINDINGS: In the trained group the average of fear score decreased from 48.5±13.9 to 40.5±12.4 (p=0.000) and in the untrained group rose from 58.5±14.2 to 58.7±14.9. The mean difference of childbirth fear in first and second stages between trained group was 7.9±1.8 and untrained group was 0.9±0.2 (p=0.000). In relaxation group 28 cases (49.1%) and in untrained group 18 cases (32.7%) had natural delivery (p=0.033).
The results showed that the relaxation by reducing the fear of childbirth increases natural childbirth

Hyperbilirubinemia is a common problem in the neonatal period. Phototherapy is regarded as the most important treatment for this condition. Several factors affect the duration of phototherapy in newborns with jaundice. Considering the scarcity of research on the impact of kangaroo mother care (KMC) on phototherapy duration, in this study, we aimed to determine whether KMC can influence the duration of phototherapy in icteric infants.
In this clinical trial, 106 term neonates with hyperbilirubinemia were selected and randomly divided into intervention and control groups. Conventional phototherapy was performed following the same procedure for all the neonates. The subjects were matched in terms of age, sex, and weight and the two groups were breastfed at least every three hours. In the intervention group, KMC was applied during breastfeeding at least six times over 24 h. On the other hand, KMC was not applied in the control group during phototherapy. Bilirubin level was measured at 24, 48, and 72 h after phototherapy. The mean duration of phototherapy and length of hospital stay were compared during the treatment (IRCT: 201505231760N40).
FINDINGS: Age, sex, and the mean bilirubin level at the beginning of the study did not significantly differ between the groups (16.75±0.75 mg/dl in the intervention group and 16.53±0.95 mg/dl in the control group). However, phototherapy duration and the mean length of hospital stay in the intervention group (64.25±17.54 h) were shorter than the control group (91.12±16.26 h) (p=0.000).
Concurrent application of KMC and phototherapy can reduce the length of hospital stay among infants treated with phototherapy.

Neonatal resuscitation training for healthcare workers can prevent pregnancy-related mortality and reduce disability among birth asphyxia survivors. Since the participation of nurses in workshops is not always possible for recertification, in this study, we aimed to investigate the impact of self-learning, using the new edition of neonatal resuscitation textbook on the improvement of nurses’ skills and knowledge in this area.
In this cross-sectional study, 58 nurses at Babol hospitals, who had received the neonatal resuscitation certificate less than two years ago, were provided with the new edition of neonatal resuscitation textbook (published in 2011). Practical training was performed under the supervision of a trained instructor at the skill laboratory. After eight weeks, a knowledge test was performed based on the textbook, and Megacode skill test was carried out, using the skill assessment checklist in the textbook. The scores were rated as follows: poor ( 19). Afterwards, the mean scores of the previous workshop and self-learning were compared.
FINDINGS: The comparison of knowledge scores revealed that 39.4% and 56.9% of the subjects obtained favorable scores in the previous workshop and self-learning (p=0.27), 10.4% and 36.2% obtained acceptable scores (p=0.05), and 44.8% and 6.8% had poor scores (p=0.0002), respectively. Moreover, the comparison of skill scores showed that 48.3% and 34.5% of the subjects obtained favorable scores in the previous workshop and self-learning (p=0.33), 34.5% and 43.1% had acceptable scores (p=0.052), and 17.2% and 22.3% obtained poor scores (p=0.56), respectively.
Based on the obtained results, self-learning is more effective in improving theoretical knowledge rather than practical skills. Therefore, participation in skill workshops is recommended for the improvement of neonatal resuscitation skills.

Early discharge requires the close follow-up of outpatients in the clinic or at home within 48 hours after discharge. Given the importance of follow-up after early discharge of infants and also lack of accurate statistics on the rate of early discharge in our country, this study aimed to determine the rate of early discharge of newborns in Babol-Clinic Hospital from March 2013 to March 2014.

This cross-sectional study was conducted on all the neonates born in Babol Clinic Hospital in Mazandaran, Iran in 2013. Newborns were selected via census sampling. In addition, a questionnaire was used to collect the data on the length of hospital stay, mode of delivery, gender, birth weight, Apgar scores, gestational age, method of anesthesia, need for resuscitation, and maternal diseases for each infant. Early discharge and very early discharge were defined in newborns released before 48 and 24 hours after birth, respectively. Data analysis was performed in SPSS V.20 using T-test, Chi-square, Fisher's exact test, and Cox regression analysis, and P value of less than 0.05 was considered significant.

In total, 2,562 infants born in Babol Clinic Hospital were enrolled in this study, 2,451 of whom (96%) were discharged before 48 hours, and 1,829 newborns (71.5%) were discharged before 24 hours after birth.In normal delivery method groups, 9 (4.25%) neonates routine discharged, 36 (16.98%) neonates early discharged and 167 (78.77%) neonates were very early discharged. Elective and emergency cesarean group, 68 (3.9%) neonates and 34 (5.62%) neonates normal discharge, 428 (24.53%) neonates and 158 (26.12%) neonates early discharged and 1 249 (71.58) neonates and 413(68.26%) neonates were very early discharged respectively (p=0.02). 92% of deliveries were by Caesarean section and 8% were the normal vaginal delivery.

According to the results of this study, almost all the neonates born in Babol Clinic Hospital had early or very early discharge, and only a few cases (4%) were hospitalized for more than 48 hours. Therefore implement of close follow-up or home visitis recommended.

Maintenance of temperature at normal range by supplying heat and reducing its loss is an important part of neonatal care. This study aimed to investigate the effectiveness of in-service training for nurses on maintaining normal body temperature and eliminating heat stress and to compare the care practices to the current standards in term new-borns, before and after training on neonatal hypothermia care in hospitals affiliated to Babol University of Medical Sciences, in 2014. This descriptive-intervention study was performed on 98 newborns to evaluate the nursing care provided for prevention of neonatal hypothermia in the operating rooms, maternity and neonatal wards, and NICUs before and one month after training on neonatal hypothermia care. The data were obtained using a self-regulated checklist, which was designed according to the relevant standards of care for prevention of hypothermia. The checklists were scored based on the number of provided nursing care practices. The intervention included speech, educational posters, leaflets, and slides. The mean scores of nursing care before and after the intervention were 4.6±1.1 and 7.0±1.4 (out of 10), respectively, in the delivery rooms the respective mean sores were 8.4±1.4, and 11.1±0.7 (out of 13), for the operating rooms they were respectively 5.9±1.8, and 7.3±0.8 (out of 11), and in the NICUs they were 8.0±1.5, and 9.8±2.0, respectively (out of 14; p=0.0001). The prevalence of mild hypothermia at birth in the operating and delivery rooms was 38.1% and 21.5% before and after training, respectively. The highest level of care for the preservation of warm chain was provided in operating rooms and the lowest level of care was observed in delivery rooms. To prevent hyperthermia, health policy-makers are recommended to focus more attention on maintaining temperature in and providing facilities for this purpose

Chickenpox is a very contagious viral disease that caused by varicella-zoster virus, which appears in the first week of life secondary to transplacental transmission of infection from the affected mother. When mother catches the disease five days before and up to two days after the delivery, the chance of varicella in neonate in first week of life is 17%. A generalized papulovesicular lesion is the most common clinical feature. Respiratory involvement may lead to giant cell pneumonia and respiratory failure. The mortality rate is up to 30% in the case of no treatment, often due to pneumonia. Treatment includes hospitalization, isolation and administration of intravenous acyclovir. The aim of this case report is to introduce the exogenous surfactant replacement therapy after intubation and mechanical ventilation for respiratory failure in neonatal chickenpox pneumonia and respiratory distress. A seven-day-old neonate boy was admitted to the Neonatal Intensive Care Unit at Amirkola Children’s Hospital, Babol, north of Iran, with generalized papulovesicular lesions and respiratory distress. His mother has had a history of Varicella 4 days before delivery. He was isolated and given supportive care, intravenous acyclovir and antibiotics. On the second day, he was intubated and connected to mechanical ventilator due to severe pneumonia and respiratory failure. Because of sever pulmonary involvement evidenced by Chest X-Ray and high ventilators set-up requirement, intratracheal surfactant was administered in two doses separated by 12 hours. He was discharged after 14 days without any complication with good general condition. Exogenous surfactant replacement therapy can be useful as an adjunctive therapy for the treatment of respiratory failure due to neonatal chickenpox.

Neonatal jaundice is a major problem among infants in the first weeks of life. Research on several indicators of severe neonatal jaundice including alpha-fetoprotein and umbilical cord bilirubin level has indicated contradictory results. Therefore, the aim of the present study was to evaluate the significance of umbilical cord bilirubin level as a predictive indicator of severe neonatal jaundice.

This prospective, cross-sectional study was performed on 102 healthy infants, born to healthy mothers at Babol Clinic Hospital, Babol, Iran. After birth, 2 cc blood samples were obtained from the umbilical cord and the bilirubin level was measured in the hospital laboratory. The infants were followed-up after hospital discharge in terms of jaundice presentations. In case jaundice was diagnosed in infants, they were compared in treated and untreated groups.

Clinical jaundice was not detected in 54 cases (52.94%). Overall, 48 neonates (47.05%) suffered from clinical jaundice and 10 cases (8.9%) presented with severe jaundice, requiring treatment based on the criteria proposed by the American Academy of Pediatrics (AAP). The mean umbilical cord bilirubin level was 1.82±0.42 mg/dl in the untreated group and 2.36±0.56 mg/dl in the treated group (P=0.000). The area under the ROC curve for umbilical cord bilirubin level was 0.722 in the treated group, based on the AAP criteria. The cut-off point of 2 mg/dl showed 80% sensitivity and 73% specificity in predicting severe jaundice (requiring treatment), based on the AAP criteria.

As the results indicated, measurement of umbilical cord bilirubin level and determination of a suitable cut-off point could be valuable in predicting severe jaundice in newborns.

Abdominal colic during infancy is a common complaint of parents within the first three months after the child’s birth. As the intestinal microflora in these infants is different from non-colic newborns, we aimed to determine the effects of probiotics on the balance of intestinal microflora and reducing restlessness in infants with colic. This randomized clinical trial was performed on 44 breastfed infants (20-60 days old), with a birth weight of > 2500 g, suffering from colic, based on Wessel’s definition. These infants received 1-5 drops of placebo (label 1) per day for five consecutive days. Afterwards, they were administered 2-5 drops of Lactobacillus reuteri (label2) (17938 DSM) per day for 14 consecutive days. The parents were contacted twice on a daily basis and the duration of cramps and restlessness in infants was recorded and evaluated (IRCT=2014012713489). Among 44 infants, 36 cases completed the study. The mean period of restlessness after 5 days of receiving placebo and L. reuteri was 275±142.8 and 172±88.3 min, respectively (p<0.001). Also, after 14 days of L. reuteri administration, the mean period of restlessness was 106±53.67 min. The results showed that probiotic L. reuteri reduced crying and restlessness duration in infants with colic.

Several adverse effects including hypocalcemia have been reported for phototherapy in the treatment of neonatal hyperbilirubinemia, but less have been reported regarding the effect of phototherapy on serum magnesium level. This study was carried out to determine the effect of phototherapy on serum Mg level in term neonate with hyperbilirubinemia. In a cohort study in 2012 all term neonates admitted for the treatment of hyperbilirubinemia, according to the local protocol, included. All sick babies and those who required exchange transfusion excluded. A blood sample for magnesium level assessment was taken before and also after 72 hr of conventional phototherapy. The serum magnesium levels before and after phototherapy were compared and a P- value less than 0.05 was considered being significant. Overall one hundred and twenty neonates studied. The mean gestational age was 39.01± 0.974 weeks and the mean birth weight was 3359.17 ± 426 grams. The mean serum magnesium level before the phototherapy was 2.869 ± 0.367 mg/dl and 72 hrs after the phototherapy decreased to 2.604±0.292 mg/dl (p value =0.001). No sign and symptom attributable to hypomagnesemia were observed. Phototherapy could decrease the serum magnesium level in term neonate with hyperbilirubinemia and the amount of this decrease could not cause any sign and symptom.

Several risk factors like prematurity, hyperoxia, hyperglycemia, duration of mechanical ventilation and supplemental oxygen use have been attributed to the occurrence of retinopathy of prematurity (ROP) in low birth weight infants. Clinical Risk Index for Babies (CRIB) score have been used to assess the severity of the newborn's disease and neonatal mortality. The relation between the CRIB score and the incidence of retinopathy of prematurity is less assessed. This study was carried out to determine the relation between the CRIB score and retinopathy of prematurity in preterm infants. In a cross-sectional study all preterm infants admitted to NICU from March 2009 to November 2012, with a birth weight less than 1500 grams and gestational age less than 28 weeks and other premature infants with birth weight 1500 to 2000 grams and gestational age 29 to 34 weeks with an unstable clinical condition, were included. The CRIB score was recorded in firs 12 hours of admission to the NICU. Ophthalmologic examination was done by a retinologist unaware of CRIB score. ROP classification was done according to the international classification of ROP. The CRIB score compared with presence or non-presence of ROP and its stage, progression or regression of disease. A P-value less than 0.05 are considered significant. One hundred and eighty (70%) neonates out of 256 neonates developed ROP. In 124 (68.88%) neonates it resolved spontaneously on serial ophthalmologic examination, but fifty-six (31.11%) neonates were required treatment for ROP which 42 (75%) received Avastin and 14 (25%) neonates treated with Laser. The Mean±SD for CRIB score in ROP group was 4.79±2.74 and in a group without ROP it was 3.78±2.00 (P=0.004). No correlation was found between the severity of ROP and CRIB score (P=0.152). The CRIB score can predict the occurrence of ROP, but cant predict its severity and progression or regression.

Jaundice is the most common cause of neonatal readmission. In Amirkola children's hospital, discharge of term neonates with hyperbilirubinemia is done after phototherapy when the total bilirubin level decreases to less than 10 mg/dl. In order to decrease the hospital stay, we increased the discharge bilirubin level from 10 mg/dl to 12 mg/dl and then assessed the effect of this measure on readmission rate. In a cohort study in the neonatal ward at Amirkola children's hospital during the December 2012- June 2013, all term neonates with hyperbilirubinemia with good general condition after phototherapy were discharged when their total serum bilirubin was decreased to less than 10 mg/dl. To decrease the length of hospital stay, in another comparable group the serum bilirubin was increased to12 mg/dl. The readmission rate and also the serum bilirubin level 48 hours after discharge were compared between the two groups. Two hundred and fifty-eight neonates were studied. Serum bilirubin level 48 hours after discharge was 10.46±1.54 mg/dl vs. 11.75±1.78 mg/dl (p< 0.001) and the readmission rate was 2 (1.4%) vs. 9 (8%) (p=0.002) in the group who discharged with bilirubin less than 10 mg/dl and less than 12 mg/dl respectively. Neonates who discharged with a bilirubin less than 12 mg/dl had 6.2 times higher chance of rehospitalization in comparison with neonates discharged with a bilirubin less than 10 mg/dl. Elevating the amount of the discharge bilirubin level from 10 mg/dl to 12 mg/dl in hyperbilirubinemic term neonates, lead to high rate of readmission