mohammad heidarzadeh

One of the biggest problems of premature babies is oral feeding problems and delay in reaching independent oral feeding. The aim of the present study is to investigate the effect of non-oral stimulation with massage on the time of starting and achieving independent oral feeding and weighing in premature infants.

Randomized clinical trial, 60 premature babies of 28-32 weeks in the NICU department of Ommolbanin Hospital, Mashhad met the criteria for entering the study, were selected and placed in two groups of field massage and control by simple random allocation. In the intervention group, infants received field massage (twice a day) for 15 minutes for 7 days, and the control group received the usual care. The two groups were compared with each other in variables of starting oral feeding, achieving independent oral feeding, and weight gain rate with statistical tests (T test, Manvitny & Covariance). A significance level of 0.05 was considered.

The mean and standard deviation of the gestational age of the infants in the intervention group was 29.0±1.1 and in the control group was 29.1±1.0 weeks. The results showed that the intervention group compared to the control group had a statistically significant difference in the beginning of oral feeding (p = 0.01) and the weight difference on the first and seventh days (p = 0.001), but even though nutritional progress to eight times of oral feeding in the intervention group was two days faster than the control group, but this difference was not significant (p = 0.17).

Since non-oral stimulation with field massage can be effective in speeding up the time of oral feeding and weight gain of premature infants; it is recommended to be used by nurses in neonatal intensive care units to improve the quality of nursing care.

Neonatal mortality remains a critical global challenge, with preventable instances prevailing. The initial stride in mitigating neonatal mortality involves elucidating its underlying causes.

This study utilized an umbrella review approach to discern factors associated with neonatal mortality. Five international databases, namely Pub Med, Web of Science, Scopus, CINAHL, and EMBASE, were meticu-lously searched to achieve this.

The initial search yielded 12,631 articles using a search strategy centered onkeywords related to factors contributing to neonatal mortality. Ultimately, 95 articles met the criteria incorporated into this study.

This study endeavors to identify the primary risk factors contributing to neonatal mortality. The discerned risk factors have been systematically categorized into four groups: maternal factors, neonatal factors, aspects linked to healthcare systems, and socio-economic factors. As such, it is imperative for policymakers to take heed of these identified risk factors and formulate comprehensive strategies encompassing both long-term and short-term initiatives. Effective interventions spanning various sectors are crucial for the prevention of ne-onatal mortality.

 The COVID-19 pandemic has profoundly affected healthcare systems worldwide, with significant collateral damage to vulnerable populations, including the perinatal population. This study sought to compare pregnancy-related complications before and during the COVID-19 pandemic in Iran.

 This retrospective data analysis was performed from February 20 to August 20, 2019 (prior to the onset of the COVID-19 pandemic) and from February 20 to August 20, 2020 (during the pandemic), encompassing the initial wave of the pandemic and the subsequent lockdown. To collect data, we utilized the medical records of 168,358 women obtained from the Iranian Maternal and Neonatal Network, which is a comprehensive electronic health record database management system specifically designed to store information pertaining to maternal and neonatal health.

 A total of 168,358 medical records were analyzed, with 87388 (51.9%) and 80970 (48.1%) before and during the pandemic, respectively. The occurrence of pregnancy complications was found to be significantly more frequent during the pandemic compared to the pre-pandemic period. Notably, there was a higher likelihood of experiencing preeclampsia (odds ratio [OR]=1.14, 95% confidence interval [CI]: 1.07‒1.22, P=0.0001) and gestational diabetes (OR=1.14, 95% CI: 1.09‒1.19, P=0.0001) during the pandemic. Furthermore, cesarean section (CS) became more prevalent during the pandemic in comparison to vaginal delivery (OR=1.19, 95% CI: 1.17‒-1.22, P=0.0001).

 Our findings demonstrated a significant association between the COVID-19 pandemic and an escalation in adverse pregnancy outcomes, notably preeclampsia, gestational diabetes, and CS deliveries. However, further research is warranted to gain a richer understanding of the intricate interplay between the COVID-19 pandemic and pregnancy complications. This is particularly crucial in light of the evolving landscape of new coronavirus variants.

Neonatal intensive care unit (NICU) is one of the accident‑prone settings in the health‑care system. There is a series of structural and process threats to the safety of infants hospitalized in this unit, which can be prevented by taking the right actions. For this purpose, developing standards based on current knowledge, available resources, and the context that provides care can determine patient injury prevention requirements. Likewise, it can be a source for national development and application of related guidelines and protocols. This study aims to develop patient safety standards in the NICUs of Iran.

This mixed‑methods study will apply the exploration, preparation, implementation, and sustainment framework to develop patient safety standards. In each phase of this framework, a set of activities take place. Exploration is based on the world health organization model to develop standards. Determining the validity and applicability of standards will be done in Phase 2 (Preparation) and Phase 3 (Implementation), respectively. Since the long‑term effects are not desired, the fourth phase (Sustainment) will not be considered.

Patient safety standards from this study will contribute to efficient and effective, equitable, and high‑quality health‑care delivery. The application of them will further promote patient safety and the quality of medical care in Iranian NICUs.

Premature neonates are at greater risk of developmental problems such as cerebral palsy, developmental delays, and hearing and vision problems. The challenge of healthcare professionals who support preterm neonates and their parents is not only ensuring neonates’ survival but also optimizing infant development. Interventions to reduce adverse health outcomes are very important. The present study was focused on exploring the effect of the Creating Opportunities for Parent Empowerment (COPE) schedule on the developmental outcomes of premature infants 

The randomization process was done using a randomized block design, and neonates were assigned randomly to the treatment (n=20) and control (n=20) groups. Neonates in two groups were matched in gestational age, birth height, head circumference at birth, birth weight, Apgar scores (1 min, 5 min), prematurity, and new Ballard score. So, there was not a significant difference between them at the baseline. In the intervention group, the parents received a COPE schedule in a set of CD’s in conjunction with written instruction and supplemental activities (guidebook). COPE schedule was performed in 5 steps. In the control group, neonates received only routine services and interventions, and the research therapist performed no additional interventions. New Ballard examination was done in all neonates at the time of enrollment, followed by administration of Ages and Stages Questionnaire (ASQ) by an occupational therapist, who was double-blinded for the study, to any available parent (mostly mothers) at 6 months of corrected age. 

The results showed more maturity in “communication”, “gross motor”, “problem-solving”, and “personal-social” in the intervention group, and the observed differences between the two groups in these outcomes were statistically significant (P<0.05).

This educational-behavioral intervention program could promote mothers’ knowledge about their neonates and improve the developmental aspects of premature infants during their first months of life.

Among the written sources related to the history of the Sasanians, they have survived in various languages, including Greek, Latin, Syriac, Arabic, Middle Persian, and Chinese, remaining works by Byzantine historians are essential. Despite the hostilities between the Sassanian Empire and the Roman Empire, these resources contain much information about the Sassanid history and culture. One of these sources is the New History by Zosimus. Despite the critical and valuable information in this work, Zosimos has become less of an interest in the research of this field, and the place of its absence is tangible in Persian research. Zosimus, a historian of the fifth and sixth centuries, wrote the New History to find out the reasons for the collapse of Rome and narrated the history of the Roman Empire from the 27th BC to the end of the year 410 AD. Zosimus presented essential and valuable reports in his book on political and military relations between the Sassanians and Roman and the internal organization of the Sassanid empire. This study discusses the significance and position of the New History in Sassanian studies.

Several researchers of the history of Sassanid era believe that when Christianity was accepted as the official religion by Roman Empire during the ruling period of Constantine I, Shapur II as well took Zoroastrianism as the official religion with the help of Adurbad-i Mahrspandan and suppressed the Christians of his empire and tried to persecute them. Since most of the historical documents that the researchers refer to, are Syriac sources, it is not clear that the suppression methods mentioned in these documents reflect the current martyrologis developed from the Roman “saint biography writing” tradition or the martyrologies of Shapur II era are authentic stories of killing Christians in that era. The Syriac sources that report the religious persecution in Shapur II era exaggerate. Their aim is not reporting the historical facts, so one cannot be sure of their content. Probably the persecution in the era had because of economic and political reasons, and had nothing to do with being Christian. Syriac Christians were mostly in west parts of the empire and their lands were important as the lands were fertile and close to the common borders with Roman Empire. The lands of Syriac people were among the greatest producers of agricultural productions in Sassanid Empire and the loyalty of the residents of the regions to Sassanid kings was so important. The study tried to explore the reasons of religious persecution of Christians by Shapur II and criticize the narratives of Syriac Christians of the era on the persecutions.

The rate of neonatal mortality is one of the main indices of health, treatment, and development in societies. It reflects the quality of nutrition and life of mothers as well as the rate of healthcare services that mothers and children are provided with by societies. This study aimed to identify the factors affecting neonatal mortality by using a bagging neural network in Rapidminer Software.
The study was conducted on 8053 births (including 1605 death cases and 6448 control cases) all over Iran in 2015. Factors such as maternal risk factors, mother’s age, gestational age, child gender, birth weight, birth order, and congenital anomalies were utilized as the predictor variables of the bagging neural network. Some criteria, including the area under the ROC curve, as well as the property and sensitivity of the bagging neural network, were compared with the neural network model. The bagging neural network with 99.24% precision rate enjoyed better results in predicting the factors affecting neonatal mortality.
Our suggested method revealed that gestational age is the most significant predictor factor of a neonate's status at birth time. Besides, 1-minute Apgar, need for resuscitation, 5-minute Apgar, birth weight, congenital anomalies, and birth order, as well as diabetes and preeclampsia in mothers were identified as the most significant predicting factors after the gestational age.
Factors discovered in this study can be considered to decrease neonatal mortality. This can help the health of mothers’ community, optimize healthcare services, and development of societies.

Estimation of the survival of very preterm infants is necessary to make decisions and design interventions in order to improve their quality of care. This survey aimed to estimate the survival of very preterm infants born at 23 up to 33 weeks of gestational age (GA) in Iran.

This population-based retrospective cohort study included 8536 infants born before 33 weeks of GA, from March 21st to December 22nd  2013 in Iran. The primary data were extracted from the Iranian national maternal and neonatal registration network (IMAN). All infants who have been discharged alive, followed up by telephone contact up to one year after birth. The Kaplan-Meier and Log-rank tests were performed to estimate survival and to compare survivals, respectively, using SPSS version 26 and R 3.5.2 softwares.

The overall survival was estimated at 56.70% (95% C.I: 55.60%-57.80%) at the end of the follow-up period. Total death rate was estimated at 43.30% and was significantly decreased with increasing birth weight (p<0.0001). Survival was increased significantly with increasing GA (p<0.0001), from 5.7% at 23 weeks to 79.6% at 32 weeks. The estimated cumulative proportion of death until the end of the neonatal period had a decreasing trend and then had a steady trend until the end of the follow-up period. The hazard ratio of quadruple or more birth and GA were 1.46 (p=0.021) and 0.83 (p<0.001), respectively.

The overall estimated survival of very preterm infants was not high. Even with modern perinatal technology and care, early deaths of very preterm infants were still common.

The heart rate characteristic (HeRO score) is a figure derived from the analysis of premature neonate’s electrocardiogram signals, and can be used to detect infection before the onset of clinical symptoms. The United States and Europe accept this diagnostic technique, but we require more tests to prove its efficacy. This method is not accepted in other developed countries so far. The present study aimed to investigate changes in the heart characteristics of two neonates in Akbar Abadi Hospital in Tehran. Experts chose one newborn as a sepsis case, and the other neonate was healthy. The results were analyzed and compared with previous studies. In this research, a group of five neonates was selected randomly from the neonatal intensive care unit, and cardiac leads were attached to them for recording heart rates. We selected two neonates from the five cases, as a case (proven sepsis) and control, to analyze heart rate variability (HRV). Then, we compared the differences in the heart rate of both neonates. Analysis of HRV of these two neonates showed that the pattern of HRV is compatible with reports from US studies. Considering the results of this study, heart rates and their analysis can provide useful indicators for mathematical modeling before the onset of clinical symptoms in newborns.

Kangaroo mother care (KMC), as a complement to incubator care, is one of the ten recommendations of the World Health Organization (WHO) for the care of preterm infants. The KMC stabilizes the heart rate, improves oxygen saturation, makes weight gain better, and reduces crying in the infant. In order to launch KMC unit, the barriers for implementing this type of care should be recognized.

This qualitative research was conducted using a focus group discussion and individual semi-structured interview with nurses, doctors, executive and management staff of a neonatal unit of a third level teaching hospital in Tabriz, northwest Iran. The participants were selected using purposeful sampling. Content analysis was used for analyzing data. Data were analyzed by MAXQDA 10 software.

After analyzing data, four main themes were extracted including mother-related barriers, father-related barriers, physician- related barriers, and system-related barriers.

Based on the findings of the research, it seems that in order to facilitate practicing continuous KMC, much emphasis should be placed on training the parents and health care providers. Furthermore, in some cases, reforming the payment system for physicians, providing an instruction for performing continuous KMC, and continuous assessment of hospitals annually are necessary.

Pain management is especially important for infants who are not able to verbally express their pain. The objective of this study was to promote pain management in Neonatal Intensive Care Unit (NICU). The present study was conducted using an action research based on Kemmis and McTaggart’s action research cycle on 35 participants including nurses, physicians, and center managers involved in the care of neonates. Four qualitative methods including interviews, focus group discussions, strategic meetings, and field notes were used for data collection. The content analysis approach was also used to analyze the data. Two action cycles were designed, with four stages of “identification, planning, implementation, and observation and reflection”. Based on the results of this study, the source of the challenges was categorized into four areas of human resources management, pain control policy, workplace conditions, and management factors. The steps for the follow-up and implementation of the proposed solutions and strategies included training workshops, preparation of pain control policy, provision of facilities and equipment, and participation of senior managers in the implementation of neonatal pain management. The results of data analysis in the final evaluation revealed two themes of “comfort” and “improvement” in pain management in the NICU. The results of this study showed positive experiences of the participants on implementation of pain management in the NICU. The results also demonstrated that pain management problems in NICU can be reduced, without imposing high costs, by forming multidisciplinary teams and engaging various disciplines in the process of neonatal pain management.

Nurses and specialists face serious challenges, including nasal necrosis and infection at intensive care units for premature infants. Considering that therapeutic continuous positive airway pressure (CPAP) is necessary for premature infants needing respiratory support, nasal masks, and prongs transfer positive end-expiratory pressure. The infant’s skin is highly delicate, and such products exert pressure on the nose and make nasal necrosis, in which case premature infants may suffer from infection and loss of nasal septum. Thus, prong support (Cannulaide CPAP) is employed to reduce the pressure. Each infant should use a specific prong since infants’ noses vary in size and shape.

Computer-aided design (CAD) and additive manufacturing (AM) for medical 3D printing were implemented using soft materials (silicone). Accordingly, non-plastic and soft materials were implemented for infants at the neonatal intensive care unit because silicone is a fluid that hardens gradually.

The setting ranges were transferred to the three-dimensional (3D) printer. Different prototypes were printed after applying these settings.

AM rises to meet this challenge by making ergonomic products. This study addresses the innovation and production of liquid silicone prong support through AM. This prototype was tested at Al-Zahra hospital in Tabriz, Iran, and the results turned out to be satisfactory

Congenital malformations are one of the most important and common types of anomalies in infants, which are one of the main causes of disability and mortality in children.

This study aimed to investigate the risk factors affecting the incidence of congenital malformations, as well as the number of different infant anomalies recorded in neonatal health data in Khoy, Iran, during 2017.

In this study, all neonates born in the maternity wards of hospitals in Khoy, Iran, during 2017 were evaluated in terms of gender, weight, and parental consanguinity. Hurdle and Zero-inflation approaches were utilized for the double Poisson model. Moreover, the data werecollected using some checklists, and the analyses were performed in R-3-6-1 software.

According to the results of the present study, the Hurdle approach was better than Zero-inflation. The birth weight and parental consanguinity affected the incidence of congenital malformations in infants.

Given that a significant proportion of infants are born without any congenital malformations, it is important to use count regression models based on excess zero approaches to assess congenital malformations. It is also necessary to take steps to reduce consanguineous marriages and the number of infants with low-birth-weight to prevent congenital malformations.

The aim of this study was to explain the examples of "the Jurisprudential Rule of "Osr o- Haraj" or Denegation of Intolerable Hardship in the occurrence of congenital anomalies and genetic disorders and show that according to the current laws of the country, more of these diseases can be prevented.

Data for occurrence of congenital anomalies were derived from two major regional and national epidemiological studies based on 6,465,849 births in the country. A comprehensive review of literature was carried out on the details of ‘Denegation of Intolerable Hardship Rule. The details of medical termination of pregnancies diagnosed for congenital anomalies and the role of ‘Denegation of Intolerable Hardship’ principle in the prevention of birth defects were explored in several Focused Group Discussions formed by peditricians, geneticists, psychiatrists, neotatalogists and expert jurisprudents.

The statistical estimates indicate that there are now nearly 100,000 births with one of the birth defects occurring every year in Iran. The total prevalence of the anomalies has more than tripled in the last 18 years.

The occurrence of congenital anomalies and genetic disorders will undermine the gene pool of the population if preventive measures are not properly implemented in the community genetics services to control those disorders. According to the current law on therapeutic abortion, disorders that lead to the hardships of father, mother, family, community, as well as future generations may be diagnosed by the three specialists (before the 16th week of pregnancy, the time of onsetting the soul). They can then be referred for medical abortion. A minimum of 70,000 birth defects may be avoided using the therapeutic termination of pregnancies diagnosed for congenital anomalies if the ‘no hardship and negation of distress and constriction’ principle is suitably explored in maternal, pediatric, neonatal settings and for public health authorities.

Premature birth is a crisis for mothers and affects resilience. Premature babies are atrisk for developmental disorders. The Kangaroo Mother Care (KMC) can reduce maternal stress andimprove the growth of the baby. This study aimed at assessing the effect of home visit based on thecontinued KMC on maternal resiliency and development of premature infant. This randomized controlled trial conducted on 50 pairs of mothers and premature babieswith gestational age of 26-32 weeks who were admitted to Neonatal Intensive Care Unit of Om-al-Banin Hospital, Mashhad, Iran in 2019. The KMC is practiced routinely for all eligible newborns in thishospital. The experimental group continued the KMC one month after discharge at home and receivedtwo home visits. Resiliency of the mothers was assessed in admission, discharge, and one monthafter discharge with the Connor and Davison questionnaire and the development of the newborns wasassessed in two months of adjusted age with Ages and Stages Questionnaire (ASQ). Data analysis wasperformed using SPSS software version 16 and t-test, Mann-Whitney, ANOVA, Friedman, Chi-square,Fishers exact. The significance level was set at p <0.05. The resiliency score of the mothers one month after discharge was112.50±5.50 and 76.40±5.60in the experimental and control groups, which was significantly different (p <0.001). The ASQdevelopment score of the newborns in two months of adjusted age was also significantly higher in theexperimental than the control group (280.40±15.60vs223.80±22.00) (p <0.001). The results showed that the home visit program based on the continued KMC was effectivein increasing maternal resilience and the development of premature infants.

Apnea leads to respiratory arrest in premature infants, which decreases through the administration of caffeine by increasing the heart rate (HR). Nowadays, using electrocardiogram (ECG) signals, along with studying and comparing heart rate characteristics (HRC) in premature infants is considered as the most critical claim in the early detection of diseases, especially sepsis. Accordingly, this study investigated the effect of caffeine on HRC.

To this end, the raw ECG data of infants were collected from the Akbarabadi neonatal intensive care unit section and then processed in time and statistical domain. Next, the effect of caffeine on their HRC was investigated, and finally, HRC signals were analyzed fifteen minutes before and immediately after caffeine administration.

Before caffeine administration, the probability distribution of inter-beat (RR) intervals and the probability distribution of the R2 /R1 ratio were close to the normal distribution. According to previous studies, the irregularity of the signal in the diagram of the beat to beat RR interval indicates the infant health. However, these diagrams showed an abnormal distribution, and a specific uniformity was observed in the RR interval diagram after the administration of caffeine.

Based on the results of this study, changes in the infant’s HRC and its pattern should be identified after drug administration in order to evaluate the status of newborns, primarily through new methods of sepsis prediction in preterm infants. Eventually, the findings of this study enable clinicians to consider the drug effect as a confounding factor with a specific pattern in the signal without disconnecting diagnostic devices from infants for drug administration.

Preterm deliveries and premature babies are among challenges for families and communities. A family-centered care model is a model that helps families become less challenged by preterm birth and learn how to care for their premature infants. The aim of this study was to evaluate the implementation of family-centered care in the Iranian neonatal intensive care units (NICUs).

This national cross-sectional study was conducted on a total of 23 NICUs of 9 universities of medical sciences, where students were trained in the neonatology fellowship course, in seven provinces of Iran. Family-centered developmental care was assessed in six different domains, including the philosophy of nursery, family communication, family support, family resources, admission and discharge planning, and decision-making. In addition, a total of 29 items were asked. The data were analyzed using Stata software (version 13) using descriptive statistical tests.

The mean scores in all domains were weak, and the total score for all domains was 34.18 (95% CI: 33.75-34.60) out of 100. The mean scores were 30 in the philosophy of nursery, 43.47 in family communication, 26.71 in family support, 35 in family resources, 45 in admission and discharge planning, and 25 in decision-making. The lowest score was reported for decision-making, and the highest score was reported for admission and discharge planning.

Since family-centered developmental care in Iran is not favorable, the obtained findings suggest the development of a suitable plan to upgrade family-centered developmental care as well as comprehensive NICU care, including developmental care, with regard to other domains.

The regionalization is a suitable approach to reduce the cost of health services and to increase the number of patients covered by special services. Since the establishment of the Neonatal Intensive Care Unit (NICU) needs expensive equipment and experts, it is critical to find the optimal number and location for NICU beds and referral networks.

The geographical access to NICU beds was investigated by collecting the annual demand and the distance between cities at first. The demand consisted of the number of neonates that were born under 32 weeks of gestational age or having less than 1500 gram birth weight in one province of Iran. Next, the location of the available hospital has defined on the map. A maximizing coverage model was developed to find the optimal location for NICUs by ArcMap software. Scenarios of reducing NICU centers were built to simulate real situations for policymakers. Coverage and average traveled distances were then calculated for each scenario. The results were compared with the natural journey of pregnant women and the available distribution of resources in the province.

The results revealed that reducing the number of NICU centers has had no direct impact on average traveled distance. A comparison of the optimal result with the natural journey of pregnant women represented a long distance traveled. The data also showed that 64% of neonates were born outside of their residential cities, and 31% of them were born outside of their provinces, although the occupation rate of available NICU was less than 50% on average.

The effect of reducing NICU centers on total coverage and average transportation was studied in this paper. The proposed methodology with the objective of equity in access can be used as a referral model to other resource allocation cases in health care.

Under Every Newborn Action Plan (ENAP), stillbirth rate in every country should be reduced by 12 or fewer per 1000 total births by 2030. The aims of this study were to determine stillbirth rate at national and subnational levels and to investigate its associated risk factors in Iran.

Using all data from Iranian Maternal and Neonatal Network (IMaN), we calculated stillbirth rate of Iran from 2014-2016. This network registers information of almost all births across the country. The logistic regression was used to estimate the adjusted odds ratio (aOR) with 95% confidence intervals (CIs) for stillbirth.

In 2014, still birth rate was 7.40 per 1000 births. In 2015 and 2016, stillbirth rates were 7.22 per 1000 births and 7.63 per 1000 births, respectively. The most important related factors of stillbirth were preterm birth (aOR= 62.53, 95% CI; 60.77-64.34), sexual ambiguity (aOR= 14.51, 95% CI; 12.76-16.50), and post term birth (aOR= 3.31, 95% CI; 2.66-4.13).

Under Every Newborn Action Plan (ENAP), stillbirth rate in every country should be reduced by 12 or fewer per 1000 total births by 2030. Iran has achieved stillbirth target of ENAP at national level. It is important for the health care system to establish and improve specific and focused policies, interventions, and programs for achieving this target even in the most deprived areas.

Premature neonates are at great risk for cerebral palsy, developmental delays, hearing problems and visual impairments. Interventions to reduce the morbidities and adverse health outcomes in these neonates and improve parent-infant interaction are highly important. This study was conducted to determine the effect of the Creating Opportunitiesf or Parent Empowerment (COPE) program on the perceived mat ernal parenting self-efficacy of premature parents

This was a randomized controlled trial with equal randomization (1:1:1 for 3 groups) and parallel group design. Forty-five preterm neonates were randomly allocated into treatment (n=15), supervision (n=15), and control (n=15) groups. COPE program was provided for a 4-phase educational-behavioral intervention program to the treatment and supervision groups. Primary outcome was parental self-efficacy, which was assessed with the Perceived Maternal Parenting Self-Efficacy. All measurements were taken before and after completion of the study with the valid equipment and by the blind assessors.

COPE mothers reported significantly stronger beliefs regarding their parental role and have more confidence to their ability in caring of neonates compared with control mothers (P-value <0.001).

An educational-behavioral intervention program would strengthen mothers’ beliefs and knowledge about their neonates and would remove barriers to enhance their ability for caring of neonates and enhance parent-infant interaction.

Quality assessment of newborn care is essential to achie desirable and affecting future health outcomes. This study aimed to review the criteria used to evaluate the quality of healthy newborn care in different studies systematically based on the Donabedeian model.

PubMed, Google Scholar, Scopus, Science Direct, Iranmedex, Magiran, and Scientific Information Database (SID) databases were searched oncerning relevant studies with the keyword of "healthy newborn" and "quality of care" and "quality assessment" and their equivalent in Mesh and Persian synonyms. All quantitative, qualitative, English, and Persian-language articles ranging from the beginning of 1998 to the end of September 2019, which examined quality in healthy neonatal care, were included in the study. Of the 2219 articles obtained, 25 were finally included.

After reviewing the studies, the criteria for quality assessment of healthy newborn care were divided into three groups according to the Donabedian model: structure (physical infrastructure, essential drugs and equipment, competent human resources, policies, and clinical guidelines), processes (immediate newborn care and first two hours of birth, delayed newborn care, and neonatal resuscitation), and outcomes (maternal satisfaction, reduction of newborn mortality and complications).

The results of these systematic review showed that currently, there is not a defined comprehensive quality assessment method to take care of a healthy newborn. The development of a comprehensive and reliable tool to assess the quality of these care, which encompasses all the criteria extracted from this study, is essential as a health system requirement to improve the quality of care for healthy newborns.

Background The first hours and days of birth are considered as the most sensitive time for mothers and newborns which require complete and high-quality care and services. To improve the quality of cares, recognizing the needs of service receivers is considered one of the most important approaches. We aimed to identify the unmet needs of healthy newborns' mothers in hospitals. This qualitative study was carried out through recording and implementing 14 in-depth, semi-structured interviews at the discharge time with healthy newborns' mothers about their most important expectations and unmet needs in terms of newborns’ care in several hospitals in Tehran, Iran. Purposeful sampling was used. Then, directional content-analysis was performed using the Grundheim and Lundman approach and the main research themes were identified. Unmet needs of mothers in terms of cares provided for their newborns in hospitals were included in two main themes: 1) Unmet services required for mothers of healthy newborns including three categories: mental, and psychological services and cares, the continuous presence of companion patience and the need for proper and timely services; and 2) Required information for healthy newborns’ mothers including two categories of the need for receiving complete information about health status of the newborn and the need for receiving additional information and more training related to healthy newborn care. According to the study, healthy newborns' mothers have unmet needs in hospital including support services and sufficient information. Therefore, appropriate services and information should be provided to mothers to care for their healthy newborns. This not only increases the satisfaction of mothers but also improves the quality of healthy newborn care in hospital.

The high rate of neonatal mortality is a major problem in health care systems all around the world. The accurate estimation of neonatal mortality is a prerequisite for the development of future health strategies that leads to the improvements in neonatal health. Providing a predictive model is, therefore, essential to reduce the neonatal mortality rate and reducing health care costs. The purpose of this study was to produce a model based on the data mining techniques to increase the accuracy of the prediction of the outcome of the neonatal mortality using a bagging neural network model in Rapidminer software.

This study was conducted on 8053 births (including 1605 cases and 6448 controls) across the country in 1394. The study variables including maternal diseases, mother age, gestational age, child gender, birth weight, birth order, abnormalities were selected as predictive factors for bagging neural network method. We compared bagging neural network with neural network, decision tree and nearest neighbor. Some criteria including the area under ROC curve, precision, accuracy and classification error rate were considered in comparing with other data mining models.

The comparison of bagging neural network with other data mining models showed that the bagging neural network gives better results compared to other models: precision (99.21), accuracy (99.17), classification error rate (0.83) and AUC value (0.992).

We conclude that the bagging neural network may help to reduce the cost of health care system, and to improve the community health by preventing the mortality and adverse outcomes in neonates.

Construction of a dam cut-off wall is one of the most challenging tasks in dam engineering given the deep excavations involved and the complex interactions between stiff cut-off walls and soft surrounding soils. Here, we present innovative solutions for the development of the Karkheh dam’s complementary cut-off wall in southwest Iran which is among the largest structures of this type worldwide with a maximum depth of 115 m. Due to excessive water seepage and high hydraulic gradient following the reservoir impoundment, additional measures were considered among which was the extension of the existing cut-off wall. The main goal was to decrease the hydraulic gradient of the seepage through the dam foundation. The construction of this new wall, which is called as the complementary wall here, was associated with a number of technical challenges among which were: the connection between the new and old walls; trenching and placing of plastic concrete wall through different dam body zones; and slurry loss during trenching through the dam body zones. The complementary wall was constructed successfully producing invaluable engineering experiences including: design of a U-shaped panel as the connecting panel; design of a new method for grouting through uniformly distributed filter/drain materials; and adding cement-based grouts to the cut-off wall panels to prevent slurry loss. The complementary wall helped to decrease both total seepage and the hydraulic gradient; for instance, in the right abutment, total seepage was cut for 25% and the hydraulic gradient was reduced from 0.2 to 0.095.