Iranian Journal of Neonatology
Volume:3 Issue: 3, Autumn 2012

Nosocomial Infections (NI) are frequent and relevant problem and it is responsible for mortality especially in pediatric ICU and NICUs. Healthcare- associated infections are of important wide-ranging concern in the medical field. In the neonatal intensive care unit population the Nosocomial infection rate is highest in the lowest-birth-weight infants. It is this group of infants who require the most therapeutic interventions to support them leading to frequent invasive procedures and the longest exposure to the hospital environment. However، infection rates vary from one unit to another، suggesting that there are differences in either how infection rates are determined or the care provided in the various units. The purpose of this study was assessment of knowledge of care givers who work in NICU about Nosocomial infections. we prepared a questionnaire about knowledge of medical staff in Nosocomial infections and gave it to personnel’s of NICU، they answered the questions then we have corrected the answers. The knowledge of them divided into 4 groups based on the score of this exam. >75% correct answers: Excellent، 50-74%: good، 25-49%: moderate، <25%، weak. Between 30 personnel who worked in NICU and enrolled in this study 20 of them were nurses and 10 were residents. 5%of nurses achieved low score،45% achieved good score and 50%achieved excellent score. 20%of residents achieved moderate score، 50% good score and 30%achived excellent score. According to these results it is necessary to increase the education and awareness of care givers about Nosocomial infections and its importance in mortality especially in neonates. Healthcare-associated infections are a major public health problem. A recent CDC report estimated the annual medical costs of healthcare-associated infections to U. S. hospitals to be between $28 and $45 billion، adjusted to 2007 dollars. Hospitals have sanitation protocols regarding uniforms، equipment sterilization، washing، and other preventive measures. Thorough hand washing and/or use of alcohol rubs by all medical personnel before and after each patient contact is one of the most effective ways to combat Nosocomial infections. We have to increase knowledge and awareness of caregivers (Nurses and residents) about NI to improve prevention and decrease mortality and costs.

Pain may be described as a feeling of hurt or strong discomfort and is the body''s way of sending a message to the brain that an injury has occurred. Pain medicine blocks these messages or reduces their effect on the brain. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a child’s and family’s reaction to current and future medical care. The purpose of this study was to assess pain management in children in our emergency department. In this study we have evaluated relief of pain and anxiety in 100pediatric patients who referred to our Emergency Department in Mashhad. The AAP recommendations about pain management in children were assessed in these patients. In these patients the main procedures have done include: IV Line 97%, Intubation 5%, Lumbar Puncture 28%. We evaluate AAP criteria about pain management in painful diagnostic and therapeutic procedures in children. Training has been provided to 70% participants in the Emergency Department. Nonpharmacologic stress reduction was used in 35%.Family presence was allowed in only 5% of cases. Prehospital pain assessment was began for 20% and continued in ED in 40%, when they were discharged 40% have received analgesic administrations. Administrations were painless in only 3%. Only 7% of neonates and young infants have received pain prophylaxis for procedures. Administration of pain medication was done for 45% of patients with abdominal pain. Sedation and pain prophylaxis has been provided for 10% patients undergoing painful or stressful procedures in the ED. According to results pain management in our Pediatric Emergency Department was inadequate. Physicians and prehospital EMS providers should be aware of all the available analgesic and sedative options.

To determine common clinical symptoms, admission length, and treatment outcomes of infants with Immune Thrombocytopenic Purpura. analysis of 132 infants with Immune Thrombocytopenic Purpura admitted to the emergency and hematology ward of Dr. Sheikh Hospital, with reference to age, gender, immunization history (preceding six weeks), presenting clinical features, treatment, outcome, platelet count at admission and discharge time, admission length, and records of respiratory infections, diarrhea and vomiting in the past month. 82 male and 50 female infants aged from five day to 2 years, with the median age of 163 days were observed. 49 percent of the patients had positive vaccination records during past 6 weeks. Presenting clinical symptom in order of commonality include: petechial rash (75%), gastrointestinal bleeding (8%), epistaxis (7%), gum bleeding (4%), and brain hemorrhage (2%). The average platelet count at admission time and discharge time was reported 10,000 ml. and 135,000 ml. respectively. 47% of the patients were treated with intravenous methylprednisolone, 16% with oral prednisolone, 12% with intravenous gamma globulin (IVIG), 7.5% with intravenous dexamethasone, 5% with IVIG. 6% received IVIG plus oral prednisolone, and for 5% IVIG and intravenous dexamethasone was administered. 93% of the patients completely recovered, 3% developed recurrent ITP, and 4% developed chronic ITP. Average admission length was reported to be 4 days. 34% of the patients had upper respiratory tract infection history, and 4.5% had positive diarrhea record. infants with ITP aged under 2 years respond favorably to treatment, and compared to older age groups, are less likely to develop recurrent and chronic ITP.

Empowering parents give them the opportunity to show their ability and competence to meet the needs of their child with new approach if necessary. One important element to empower parents is the promotion of knowledge. This study was done to evaluate the effectiveness of training in order to improving the awareness of parents. In this descriptive study have been used surveys forms for mothers referred to health units” Included questions on breastfeeding, prevention of accidents and injuries in children and the necessary measures when symptoms were at risk”. Data analysis software IMCI (child monitoring software) was used. Percentage of mothers knowledge in issues were respectively: «Breastfeeding» in 2010, 92. 7 percent and 91. 6 percent in 2011, «Accidents and injuries Prevention» in 2010, 62. 5 percent in 2011, 83. 2 percent and «the necessary measures when symptoms were at risk» in 2010, 88. 1 percent in 2011, 90. 8. The mothers'' knowledge about the training received has increased،except about breast feeding.

The increasing number of pregnancies can be dangerous for mother and baby. And third and fourth pregnancies, increases risks for pregnancies. But given the lack of studies in this field, present study aimed «Comparison pregnancy Rating with neonatal Characteristics in women with preeclampsia» to do. This study is descriptive analytical. The research samples the available sampling method of women with preeclampsia, admitted in government hospitals of Mashhad, 100 persons were selected and on the basis, pregnancy rating, with neonatal characteristics were compared. Neonatal characteristics questionnaire in the first 24 hours after delivery and two weeks after the delivery was completed. Data analysis by spss software and chi-square, Anova and Turkey''s tests were performed. 52% of subjects first pregnancy, 20% second pregnancy and 28 percent had high third pregnancy. pregnancy rating with neonate NICU admission and Satisfaction mother and wife of the baby''s gender is a significant relationship (p< 0. 05). But with sex and birth weight, infant feeding method, Satisfaction feeding, the first and fifth minute APGAR score was not correlated. Dissatisfaction of the mother and wife from baby''s gender, with pregnancy rating was significantly relationship. Frequency of dissatisfaction in women third multiparous and higher, was most and in nulliparous women was lower. Most babies admitted to the NICU were to mothers who were experiencing their second pregnancy.

Diabetes is the most common medical complication in pregnancy. Various risk factors have been mentioned for gestational diabetes, but just a few studies have assessed a relationship between periodontal disease and gestational diabetes. This study was conducted to determine the relationship between periodontal disease and gestational diabetes in clients of selected health- care centers in Mashhad in 2011. this historical cohort study was conducted on 91 women affected to periodontal disease (case group) and 186 healthy women (control group) coming to selected health- care centers in Mashhad. Data gathering method included interview and examination and convenient sampling method was used. Both groups were matched in interfering factors (the number of pregnancies and parities, body mass index before pregnancy and gestational age). demographic and obstetrical characteristics were similar in two groups, just participants'' age in periodontal group was more than healthy one. Affecting to periodontal disease was related to gestational diabetes (P<0.05). Affecting risk ratio to diabetes in women with periodontal disease was 5.7 times more than people without it. According to the present study''s findings, affecting to periodontal disease (disseminated chronic priodontitis) can be a risk factor for affecting to gestational diabetes.

The health of a mother and her fetus is one of the most challenging issues in a health system in all societies. Information is the primary subject in health and a key for empowering mothers. The objective of this study is to identify information-seeking behavior and information needs of Mashhad’s pregnant women. In this study the initial results are reported. This study is cross-sectional and the data is gathered through a questionnaire. Appearance and content validity of the questionnaire has been determined by a couple of gynecology obstetrics and medical informatics specialists. And the reliability of the questionnaire is measured by test retesting. 30 questionnaires are distributed in governmental health centers: Omolbanin hospital, Sarvar clinic and Ghaem special clinic and the results are extracted. The average age for mothers was 26.4 and 27% had unwanted pregnancy. The results showed that most of pregnant women look for information when they encounter a problem. More than half of mothers didn’t know that they shouldn’t use soft-boiled eggs and liver during pregnancy and 37% of them have experienced toothache during pregnancy. 70% of mothers were not aware of the correct count of the fetus movements, and 60 % of them were not aware of the infant’s care. 80 % of women tend to have a natural childbirth. Looking for information when coming up with a problem is not a good pattern and may lead to using the primary information source found that is not necessarily valid. The results of this study show that mothers need to get information about pregnancy care and fetus health care. Also, it is necessary to pay more attention to the imbalance of the preference of women to natural childbirth and high prevalence of cesarean.

Jaundice is the most common cause of hospitalization of infants in the first month of life. Delivery and maternal and neonatal risk factors may affect the progression of complications of jaundice. This study aimed to investigate the problems of pregnancy and delivery in neonates with jaundice. This descriptive study was performed on 2796 full term 3 to 29 day infants with jaundice in Ghaem hospital in Mashhad during the 2003 to 2012. After confirming the diagnosis of jaundice in newborns, according to pediatrician and laboratory results, a questionnaire containing maternal demographic information, neonatal characteristics, maternal complications during pregnancy and delivery were completed. Data was analyzed using the T-Test, Chi-square with spss software. Of the 2796 term infants with jaundice 21% of newborns with jaundice had a history of pregnancy problems and 79% had a history of normal pregnancy. The most frequent problems in the history of pregnancy was hypertension (4.7%), vaginal bleeding (3.3%), diabetes (2.78%), premature rupture of membrane (2.7%) and urinary tract infection (0.8%). 57% of infants with a history of pregnancy complications had cesarean section delivery and 43% of them had vaginal delivery. The study results showed that pregnancy problems including vaginal bleeding, hypertension, diabetes, premature rupture of membrane, urinary tract infection, and also cesarean delivery is associated with neonatal jaundice. So if these problems occur in pregnancy, should be followed neonates in terms of jaundice.

Birth weight is considered as an important health indicator. since there is a meaning full relationship between LBW and neonatal death it is necessary to program some useful Interventions to diminish LBW. In this study we assess the relation between the birth weight and the supplementary usage (folic acid, iron, multivitamins), This is a case -control study which accomplished in two groups (666 persons for each group)in maternity hospitals affiliated to Mashhad University of medical sciences. A questionnaire with 15 questions was filled for every mother with a LBW and premature labor(case) and also for every mother with a delivery of a term neonate with a weight more than 2500 gr (control). The interval between two deliveries was the least. According to collected data about folic acid in case group: 339 mothers (%50.9) complete use, 258 (%38.7) incomplete and 69 mothers (%10.4) with no usage: In control group respectively, 414 mothers (%62.1), 215 mothers (%32.3) and 37 mothers (%5.6), About multivitamin usage in case group respectively: 504 cases (%77) -98 (14.7%) -64(%9.6). And in control group: 545 (%82) -77 (%12) and 44 (%6. 6). About iron tablet in case group, respectively: 543 (%81.5) -95 (%14.3)- 28 (% 4.2) and in control group:574 (%86.2) - 68 (%10.2) - 24 (%3.6). P value for folic acid and multivitamin and iron are respectively (0.025)-(0.03)-(0.033) There is a meaningful difference between supplementary usage and LBW preterm labor. Thus it is necessary to educate mothers to use supplementary completely.

Drug addiction causes many complications for mother and fetus. Iran statistics on drug addicted pregnant women to 2.2 percent. Given the negative consequences of drug use can have on growth fetal growth, birth. This study aims to investigate the growth process of birth is done in the first 6 months of life. The study is a Cross-Sectional study was done on 40 pregnant women 18-35 years old addicted to drugs that referred for delivery to maternity hospital of mobini during 2011. Measuring instruments were: observing and checklist includes various sections were related on the aims. Data Analysis was done using spss software. The average age of pregnant women addicted to 29.1 ± 0.7 years and the mean gestational age 37.2 ± 0.8 weeks and mean head circumference at birth, 32.32 ± 2.6, at 2 months 38.4 ± 4.7, at 4 month 40.3±1.5 and at6 month 42.3 ± 1.4. The average weight at birth was 3117.4 ± 543.7, at 2 months, 4494.2 ± 871.5, 4 months, 6102.94 ± 969.1 and 6 months, 7268.1 ± 965.4, and the average height newborn at birth 48.4 ± 5.7, at 2 month 56.2±6.2, at 4months 61.1±3.5, at 6 month 65.57±2.9. The numbers indicate poor growth in infants of mothers with addiction. 9.8% intrauterine growth retardation, and 1.2% of congenital abnormalities were found. Statistical association between neonatal jaundice, convulsions, stillbirth, intrauterine growth retardation showed significant with maternal addiction. These findings indicate the need for more attention to prenatal care, detection and tracking is addicted mothers. Emphasis on medical care in the prenatal period and help the mother to leave the second trimester of pregnancy can improve pregnancy outcomes and neonatal anthropometric indices to be effective.

Birth weight is one of the most important determinants of survival and growth is associated with child health. In addition to the high mortality rate, incidence of mental retardation, paralysis, spinal cord injury, deafness, cerebral hemorrhage in low birth weight are more.The aim of this study was to evaluate the prevalence of infants born weighing less than 2,500 g (LBW) in women referred to health centers of the city of Mashhad in 2011. This study was retrospective descriptive study. Information was collected from 38,823 birth mothers in urban and rural health centers in Mashhad city in 2011, were analyzed using Excel software. A total of 32,556 records, 38,823 mothers who had given birth in urban and rural was 6267. The number of babies born weighing less than 2500 grams were 1815 cases, 1489 in urban and 326 in rural areas. Therefore the percentage of babies born weighing less than 2,500 grams is equivalent to 4.67% of the entire city of Mashhad, the index equals 4.5% in urban areas and 5.2 percent in rural areas. Pregnant women at high risk should be identified and provided with the necessary training to prevent low birth weight infants.

Multiple Sclerosis (MS) is primarily a disease of women in their childbearing years. Risk for postpartum relapse is increased in the first 3 months after delivery. Previous studies of breastfeeding and postpartum relapse showed little or no benefit, but none examined exclusive breastfeeding. In this review article, electronic searches were undertaken in PubMed, Scholar Google and up to date since 2009. Women with multiple sclerosis had a 60% reduction in postpartum relapses when they breastfed exclusively for at least two months after giving birth. Exclusive breastfeeding also was associated with a significantly later return of menses (P =. 001), and lactation-associated amenorrhea had a significant association with fewer postpartum relapses. The findings suggest that women with MS should be encouraged to breastfeed exclusively for at least the first two months postpartum in lieu of starting immunomodulatory treatment shortly after delivery. These findings highlight the need to critically evaluate the efficacy of early postpartum treatments in MS, especially if they are not compatible with lactation.

Happiness is accounted for one of the psychological health criteria, and it is person''s judgment from satisfaction of quality of life. Pregnancy is an experience that changes physical, social and mental of women. But the attitude of women towards their pregnancy are important and for a woman who has healthy pregnancy according to psychological, it is a Manifestation of a sense of self-actualization and feminine identity. This study aimed to determine the related factors with happiness in pregnancy. To determine factors associated with happiness in Pregnancy In this study, 300 low risk pregnant women who have referred to health centers for prenatal care, were selected by multistage sampling and demographic questionnaire, history of midwifery, lifestyle, Oxford happiness questionnaire and the personality traits of NEO- FFI complete. Content validity of the questionnaire was performed and the reliability was measured with Cronbach''s alpha. Data were analyzed with spss software and Spearman and Pearson correlation coefficients, Kruskal-Wallis, Mann- Whitney tests and One- way ANOVA were used. The mean age of subjects 25.1 years, with a standard deviation of 4.9 at the age of 18 to 35 years. The frequency of low, medium and high level of happiness was 11.3%, 72.5%, and 16.2% respectively. Happiness are related to employment status (p0.002, chi-square= 12.9, df= 2), exercise (p=0.000 and Z=3.36), entertainment (p= 0.043, f= 3.3, df= 78), duration of Religious activity (p=0.001, F=1.8, df=2), Neuroticism (p=0.000 and r=0.294), Extroversion (p=0.000 and r=0.289) Regarding to importance positive emotions such as happiness in mental health, programs is recommended for promotion of related factors in pregnancy.

Herpes Simplex Virus type 2 (HSV-2) is a highly prevalent sexually transmitted infection (STI) The prevalence of HSV-2 infection is increasing in many populations and geographic areas. Herpes simplex virus type 2 (HSV-2) is the cause of most genital herpes and is almost always sexually transmitted. Most HSV-2 infections are consequently expected to occur after the onset of sexual activity. Genital herpes is a cause of morbidity and increases the risk of HIV acquisition, due to disruption of mucosal membranes. Data on prevalence of herpes simplex virus type 2 (HSV-2) infections are limited in Asia Our study focuses on seroepidemiology of HSV-2 infection among pregnant women in Urmia-West Azerbaijan to estimate the regional Seroprevalence of anti HSV-2 antibody in Urmia and to investigate the possible correlation of seropositivity with abortion history. This study was conducted on 86 randomly selected pregnant women. ELISA was performed to detect anti HSV-2 IgG antibody. Detailed history and questionnaire filled. Of the 86 cases screened for anti HSV-2 IgG antibodies, 5 (5.81%) tested positive. These results may have public health importance for our country as the high rate of HSV-2 infection and be useful for designing strategies for focusing prevention efforts for HSV-2 infection.

Meatal stenosis is a recognized complication of circumcision done during nappy aged boys as a late presentation. The objective of this study was to describe the incidence of documented meatal stenosis in boys circumcised in infantile period. Meatal stenosis was defined as change in appearance of the delicate lips of the urinary meatus, with loss of ellipticated shape to a circular shape because of scar and visually apparent narrowing. The study included 356 consecutive samples of boys aged 6 months to 6 years (mean 2.5 y.o), circumcised in first 2 months of life, who visited in my private office referred for reasons urinary or non urinary complaints. The diagnosis was made in 32 of 365. Four of 32 stenotic cases were asymptomatic, common symptoms in other 28 boys were decreased urine caliber (11), crying before or during voiding (8), dysuria (5), penile deviation (3), bloody spotting (3). None cases had urinary tract infection, urinary tract sonography was within normal limit in all cases. Meatal stenosis is a complication of circumcision done during nappy aged boys as a late presentation. A careful meatal examination is indicated in any boys with history of circumcision during nappy age. We recommend to use lubricant or anti inflammatory ointments for prevention of meatal fibrosis and stenosis.

First minutes of a baby''s life are very important stage of life is filled with danger, this study aimed to assess the infant''s primary care standards do graduate midwifes. Present research is a cross-sectional study. Statistical society of this research is a group of recent graduated midwifes including 50 persons, have graduated in the recent three years and are providing midwifery services in the hospitals of Mashhad. Also a group including persons from heads of the health centers was selected, all these heads at least had 6 months job experience. Applied tool in this study for assessment of the graduated midwifes was self-assessment questionnaire of midwife. This questionnaire was prepared by international confederation of midwifery and it is approved by standards of World Health Organization (WHO). Another questionnaire is “assessment of midwifes by heads” which is extracted from the other questionnaire. Then collected data were statistically analyzed. 71.4% of the graduated midwives assessed their standard skills enough for their job in to determine of Apgar and 85.7 in the newborn''s primary care standards do graduate midwifery, 83.3% of the authorities in the maternities assessed the graduates enough skillful to handle the situations. One hundred percent of primary care skills are needed to enhance baby''s standards with regard to the importance of planning and special attention.

Prevalence of stillbirth is available item for prenatal care. Its prevalence is different in other region of the worlds because of definition and data connection. Prevalence of stillbirth is less than 1% in developed countries and developing countries 3%. The regular attention to prenatal care is essential for reducing stillbirth prevalence. The aim of study was to determine prevalence and cause of stillbirth in three university hospital in Mashhad. in a respective study all document of stillbirth was recorded in three hospital affiliated to Mashhad university of medical science for one year. Recorded data including maternal age, weight, sex and appearance of fetus and cause of stillbirth. Data was analyses by spss software. During one year from 11000 deliveries in these three hospitals there were 260 stillbirths (23 in 1000 deliveries).the cause of stillbirth was isolated hypertension 19.6%, hypertension with other cause 10.4%, premature rupture of membrane 7.6%, preterm delivery 6%, diabetes 3.2, placenta abruption 2.8%, incompetence cervix 1.2%, maternal illness 7.2% and others respectively. Stillbirth was more in primipara and decreased with increasing parity. Stillbirth was more in less than 35 years old mothers (81% vs. 19%). Prevalence of stillbirth in this study was the same as south Asian countries. The most common cause was hypertension. Therefore as 40% of stillbirths are because of controllable cause of hypertension, prematurity and diabetes, pay attention to these three etiologies in prenatal care services can easily reduce stillbirth.

Congenital hypothyroidism is the most common endocrine disease and is a major cause of preventable mental retardation. In most cases, it seems quite natural born at birth with delayed diagnosis, complications will cause irreparable brain. Now almost all industrialized countries and many developing countries the newborn screening program to systematically do. Khorasan Province neonatal hypothyroidism screening using TSH measurements are taken from the heel onto filter paper from the year 2006. This study is a retrospective study of neonatal screening results are. In a thyroid screening program to inform all mothers through health centers in 3 to 5 days of birth, blood samples on filter paper obtained their heels and the TSH is measured in this study, the results of the 2011 cases were analyzed. Newborn screening of 24,703 cases in 2011, 52% of the infants was girls and 48% boys. Samples in 3 to 5 days, and 30% of the time for various reasons, was later scheduled the 96.9% of normal results (i.e. TSH less than 5), and 3% were suspected (i.e., 5 to 20) and 0.01% positive (i.e. more than 20) have been reported. In positive tests for suspected cases of 4% and a total of 1.3 in a thousand babies have been born with hypothyroidism that the statistics of the prevalence of hypothyroidism (1 in 5000 births) is more. congenital hypothyroidism incidence in the study population in the province 1.3 that the results obtained in births is lower than the national rate (1.7 in a thousand births) is.

Many documents demonstrates relationship between high Body Mass Index and women anxiety and depression, but among our research now, there aren''t t any evidence about postpartum, so this study describes relationship between women Body Mass Index (BMI) before pregnancy and their postpartum anxiety level. In this study, 54 primiparous women were selected randomly and their BMI before pregnancy was calculated. in postpartum also, the anxiety scale was measured by spielberger questionnaire and entering data in spss softwere, was analyzed by Kruskal Wallis Test. The mean anxiety level of underweight (BMI< 18.6), normal (18.6 25) groups was orderly as follow: 41.5, 41.52 and 44.18. it seems more the average of BMI before pregnancy, more postpartum women anxiety level but it isn t significant Statistically (P = 0.208).

Conclusions

This study demonstrates that high grade of BMI before pregnancy may result in increasing postpartum women anxiety level, bad mood and delays maternal – neonate communication and correct breastfeeding.

Keywords: Maternal anxiety, Body mass index, Pregnancy, Postpartum

Improvements in newborn intensive care led to decreased mortality, but increased the morbidity rates of preterm infants. This study have designed to evaluate the short- term outcome in premature infants admitted to NICU at Amirkola Children Hospital(ACH), northern Iran from Mar20,2010- Mar21,2011 All the premature infants admitted to NICU and newborn services from Mar20, 2010- Mar21, 2011 entered to the study. Data like Death, NEC, IVH, and ROP were gathered. Gestational of age determined based on New Ballard Score.IVH and NEC diagnosed with brain ultrasonography and radiology. ROP diagnosed by indirect ophthalmoscopic exam made by a retinologist and if it was advanced then referred for therapy. Hearing test done with ABR technique and then if it was failed, referred to repeat ABR and any patients with hearing loss referred for rehabilitation with hearing aid. We followed up patients for hearing loss and blindness until the 2-2.5 years of age. In 159 premature neonates who admitted in this period 63.5% were boy and 36.5% was girl. Seventy nine percent delivered by C/S and 21% through NVD. The most frequent GA group was 34-37 week (56%).The mean CRIB score of the babies was 5.6±2.4. The mortality premature neonates were %9.7. The rate of IVH, NEC and threshold ROP were 9.5%, 3.1%, and 10.3% respectively. We have 1 neonate with blindness and 3 neonates with hearing loss. The finding of this study reveals an improvement in the short-term outcome in premature infants'' admitted to NICU at ACH, although there is some distance between the present condition and the real favorable outcome.

The most common clinical complication of pregnancy is preeclampsia, that beside bleeding and infection, it is one of the three main causes of pregnants maternal death around the world. Several studies suggest that some maternal factors such as prim gravids,elderly pregnancy, some occupations, previous high blood pressure, kidneys diseases, diabetes and some medical other diseases, urinary tract infections, infertility treatment, twin pregnancy can predisposing preeclampsia. A descriptive study was performed in Ghaem and Imam Reza hospitals in 2011.The population is mothers with gestational age more than 20 weeks. The Information of 225 maternal preeclampsia who were randomly selected, were collected with researcher made questionnaire. Data were analyzed by descriptive statistics, tables and spss software. Statistical results demonstrated that 77 (34.2%) were prim-gravid and others were multi- gravid.55 had a history of abortion (24.4%),3 person had a history of hydatidiform mole (1.3%).53 women(23.6%) aged over 35 years.11mother (4.9%) were employed and the other were housewive.5person (2.2%)had a history of kidney stones,6 person(2.7%) with a history of asthma, 38 (16.9%) with diabetes, 108 person (48%) had urinary tract infection,11(4.9%) had pregnancies after infertility treatment.8 Mother (3.6%)had twin pregnancies and the rest were had single baby. One of the most important roles of midwifes as a health care provider is early detection of high risk pregnancies and refers them to specialized centers to receive medical care. Because high-risks pregnancies are identified in prenatal care, complete full history and use of maternal demographic factors can be used to identify those who are in danger.

Neonatal mortality rate is an important index of development in different communities and respiratory distress syndrome is one of the important causes. This study aimed to determine the status and effective demographic factors of neonatal mortality due to respiratory distress syndrome in Rural Area of Ahvaz city Iran. It was a case control study of all neonatal death which had recorded health center rural area in Ahwaz city, Iran (54people) during 2010-2011 as case group. The control group (54 neonates alive) was selected as same birth date, age and residence for each case. Data was collected by a self-administrate questionnaire and interview with their mother to find the cause of death. All data has entered in spss software and analyzed by using chi-square, T-test. The results showed that neonatal mortality was for male 52.4% and female 47.6%. The most important causes of death were retard fetal growth (44.4%), respiratory distress syndrome (27.7%) and cardiovascular anomalies (16.6%). The findings reported significant correlation between neonatal mortality with, birth intervals and birth weight. Improve pregnancy care, prevention of preterm deliveries, interventional programs for high risk groups, preparing the medical team for premature births and NICU equipment may have a critical role in reducing of neonatal mortality.

Breast milk for infants, is the vital importance. So that is essential in the infant immune levels against the risk of acute respiratory infections, diarrhea, and supply minerals and vitamins, and also Emotional relationship between mother and child is stronger. And the infant will lead to the development of IQ. Considering that breast milk volume is directly related to the frequent and how to breastfeeding, knowledge in mothers in these cases is important in Desirable breastfeeding. The study was descriptive and analytical. Population of 109 mothers with children under two years of the city''s rural population in FARIMAN, Completing the questionnaires and interviews were survey and data collected was analyzed by spss software. Results indicate that 11.9 percent of mothers have adequate information about the benefits of breastfeeding, 23.8 percent in good level, 52.2 percent average and 11.9 percent is very poor. Knowledge in mothers Putting breast milk and hugging 90.7% is desirable,4.5% Unsuitable, 5.5% don, t have knowledge in this field. Awareness 92.6% of mothers about breast milk is desirable, while the 1.8 percent had incorrect information, and 5.5 percent had no knowledge. In case Appropriate number of breastfeeding at 87.1 percent knowledge desirable, 8.2 percent Unsuitable. And 4.5% Statement disavowed. Awareness of the symptoms adequacy of breast suckling, in the 54.1 percent correct, 1 percent wrong and 44.9 percent on this issue was not informed. The results of this study need to intervene to raise awareness mothers about Signs on Adequacy breastfeeding and to be felt need to provide resources and benefits media about breastfeeding.

meconium is the thick, Green - Black, with a bad odor material, that founded around the third month of pregnancy in the intestines of fetus. 8 to 15 percent of infants has the evidence of meconium stained fluid at birth. In this study the factors affecting maternal and neonatal meconium-stained amniotic fluid be examined. This study was done in the Vali-e- asr hospital in Birjand in 2011-2012. During this period, 48 delivery with meconium-stained amniotic fluid with 48 cases with clear amniotic fluid were compared. spss software and the t-test, Mann-Whitney and chi-square were used for data evaluation. The results showed that gestational age in meconium-stained amniotic fluid group was higher than the control group. If the distance of prior pregnancy to the current pregnancy was less, likelihood of meconium-stained amniotic fluid was higher, so the average distance in meconial group was 1.8 and in the control group was 2.8 years. Number of nulliparous women in the meconial group was more than control group. This was showed with the most number of history of abortions in the control group. Rate of cesarean delivery was higher in meconium- stained amniotic fluid group than the control group, which was mainly due to the prevention of Complications. Sex of infants in meconium- stained amniotic fluid group was more boy and in the control group was more girl. The results of this study showed that in gestational age above, the low distance of the previous pregnancy, nulliparous women and male sex of fetus, is more likely to have meconium-stained amniotic fluid.

The neonatal death rate indicates the improvement of community health. Knowing the maternal factors associated with neonatal death is very effective for proper planning to improve care systems during pregnancy, labor and birth. Therefore, the researchers decided to study the characters of mothers before and during pregnancy who had died neonate. This is a retrospective descriptive study and the research population included all infants who has been died in the NICU of Ghaem and Imam Reza hospitals for several reasons in 2011.Data were collected with researcher made questionnaire.160 neonates died but 40 cases of them omitted due to lack of required information in the questionnaire and also same information in twin`s mother. Data were analyzed by spss software From 120 cases,90 person(75%) live in town and the other live in rural area. maternal mean age was 27 years.8women(6.7%) had relation with their spouse.48mother(40%) were primi gravid and 52 multigravid.26 mother(21.7%) had history of abortion and 14(11.7)had death neonate.57(47.5%) had vaginal delivery and 63(52.5%) had cesarean delivery.during pregnancy 20(16.7%) were preeclamptic and 3(2.5%) diabetic and 7 pregnancy(5.8%) occur after infertility treatment.23(19.2%) were PROM and 4(3.3%)had history of drug abuse.97 pregnancy(80.8%) were singleton and the other were twin. Based on the results, several maternal factors such as maternal disease, pregnancies after infertility treatment, PROM, history of abortion, neonatal death, twin pregnancy, Relative marriage, using drug is associated with mortality. Therefore taking good history and Better care of mothers and prevention of maternal risk factors affecting neonatal mortality are necessary.

Infants have a high station in our society and to support an immune life for them in parents, governmental institutions and NGOs. Purpose of this essay is good using of ethic of doctor for getting to mentioned aim. A head text is written with descriptive and analytic method. one of the fundamental missions of penal right is supporting of value as life right that is situated in group of indigenous human rights. Infants need to increasing action of criminal justice system due to highly vulnerability, main role of medical systems in life continuation, modern complications of medical world and social life and anti_ human phenomenon smuggling of infants especially. In between, adherence of doctor of infants to medical ethic necessitates at least intervention of penal system. Doctor of infant is One of very impressing and low cast implements in prevention to victimization of infants that his capabilities has not received much attention to strategic plan of criminal politics republic Islamic of Iran. Complete recognition of doctor to life and growth of infant accomplished with his career and professional obligations follows maximum of his effort in eradication ahead risks life of infant and the best solutions for preservation of pleasant growth process in physical and mental aspects that is combined with medical oath. law and criminal supporting for infant have very importance in various aspects that nowadays, ignore partly. This shortage must eradicate with foreseen supported strategies and clear criterions in penal liability of infant doctor.

women''s employment is one of the fundamental problems in breastfeeding. Studies have shown that after delivery, amount of milk is equal in the mothers working and non-working. But after several months will be reduced markedly. In this study, with different departments was done coordination, and interviewed with the 351 mothers that had children under two years old. Then the results were extracted and analyzed about 77.6% children were feed with mother''s milk and 22.4% with formula The causes of use of formula in working mothers, respectively include: 42.16% back to work, 31.32% inadequate breast milk,, 6.02% mothers disease, 20.4% other. 87.7% of employed mothers were used from delivery leave for six months and 77.3% from mothers used passing hour for breastfeeding. 47.3% of mothers had facilities for milk pump and any mothers Kindergarten near their place of work. According to the results must: Increased delivery leave, create workplace facilities for women, Nursery established near the workplace, Diminish the responsibility of women during lactation, providing part time or flexible job and encourage mothers to try breastfeeding.

known benefits of breastfeeding have led the health policy based on promotion of breastfeeding. It seems that one of the appropriate ways to promote breastfeeding is to provide appropriate training to be effective. This study was conducted with the aim of comparing workshops and booklet on knowledge, beliefs and breastfeeding behaviors after delivery. This clinical trial was conducted on 90 pregnant women who were selected in quota sampling method from Gonabad health centers in 2011. Participants randomly allocated into three groups such as training workshop (30 people), booklet (30 people) and control (30 people).All the participants filled, demographic questionnaire, knowledge and health beliefs assessment form. In workshop group, a three-hour workshop on the breastfeeding was performed. In booklet group they received a booklet about breastfeeding and the control group did not receive any special training. During the first 24 hours after delivery all participants during breastfeeding the baby were observed and breastfeeding behavior check list was completed, they also completed knowledge and belief breastfeeding assessment form. Data analyses were analyzed by spss software, qui square test, Student t, and ANOVA and Schaffer tests. Average score of knowledge about breastfeeding after childbirth was higher in education workshop group than booklet (8.33±2.73 against 13.10±1.62) and Schaffer tests showed a significant difference in this case (P= 0.003). Average score of health beliefs about postpartum breast-feeding in the workshop training group was higher than the control group (43.9±6.01 against 50.8±3.68) and Schaffer tests showed a significant difference in this case (P=0.016). Mean score performance of breastfeeding in workshop group was higher than booklet groups (4.86±1.19 vs. 6.63±1.21) and Schaffer test showed a significant statistical difference in this case (p < 0.001). breastfeeding training through workshop method showed higher consciousness, health beliefs and proper behavior of breastfeeding right after childbirth than booklet. Then researchers suggest that breastfeeding training should be performed to mothers using workshops.

High risk is a pregnancy case which endangers the life of both mothers as well as fetus and The incidence between 10-30%being. Considering the importance of neonates health, it is decided in this research that, some of health indexes of born neonates from mothers whit high risk pregnancy to be studied. The findings of this plan can be used in programming procedure of pregnancy period observations, prevention of complication and birth health neonates. This is a descriptive analytical study carried out on 250 pregnant mothers with high risk pregnancies who referred to different hospitals related to the Shiraz University of Medical Sciences(from Mehr to Bahman2009) for various reasons, hospitalized, interviewed and their information were recorded. Collected data were analyzed using spss software and inferential statistics. the age of mothers with high risk pregnancy were between 14-48 years. 30 cases of complication (13 cases(43.33%)deliver complication,15 cases(50%) medical and 2 cases(6.6%) and surgical complication were diagnosed(respectively) were being diagnosed. Among mothers,124(62.4%) have preterm labor, 156(62.4%) delivered naturally and remaining 94(37.6%) delivered by cesarean. 76 neonate(29.81%)hospitalized at NICU. Reasons for hospitalization, immaturity, respiratory distress, and etc. Meanwhile, a significant relation was observed between hospitalization of neonate and existence of delivery complications (P<0.005).Five neonates (1.88%) due to abnormality, 18 neonates(7.2%) before birth and 9 neonates(3.6%)after birth were died. The incidence of high risk pregnancy in some cases is unpreventable. But, Pregnancy care trends can be summarized in, to have a healthy baby in the future or minimize complications for babies.

Neonates with lower hemoglobin and Hematocrit are more at risk of iron deficiency anemia. This rate is influenced by several factors. Children''s health can be improved by identifying these factors and taking appropriate actions. This study determined the relationship between type of delivery and umbilical cord blood hemoglobin and Hematocrit. This descriptive correlational study was performed on full-term neonates born in 22-Bahaman hospitals in Gonabad, Iran, during 2011. The sample size was determined based on previous studies and means comparison. Purposeful sampling was used to select 90 cases of normal delivery and 90 cases of caesarean section. Cord closure time was similar in both groups. Umbilical vein blood samples were sent to the specific laboratory for hemoglobin and Hematocrit to be measured. The data was analyzed by t-test, Fisher''s exact test, Pearson''s correlation and analysis of variance (ANOVA) at a significance level of 5% in spss software Our results showed that the mean of hemoglobin in normal delivery and caesarean section cases were 15.11 ± 1.38 and 13.88 ± 1.52, respectively. The difference between the two values was statistically significant (P < 0.001). There was a significant difference between the mean of Hematocrit in normal delivery (43.64 ± 4.58) and caesarean section (40.73 ± 4.53) groups (P < 0.001). The results showed a significant difference between hemoglobin and Hematocrit levels in both sexes, i.e. the levels were higher in boys (P = 0.01). Umbilical cord blood hemoglobin and Hematocrit in neonates of caesarean section were less than those with normal delivery. Therefore, the first group is more at risk of iron deficiency anemia. Development and promotion of safe vaginal delivery are recommended to avoid unnecessary complications of cesarean section. Moreover, iron deficiency anemia should be followed and treated in cesarean section cases.

wound complication is a main problem after cesarean section. Insufficient nutrition delay wound healing because decrease saved energy of body and provide conditions of infection. If nutrition be enough and suitable, body receive most of material and wound healing happen soon. There are a few papers about this problem and they have reported different results. So the aim of this paper was to detect: The effect of early post cesarean feeding on wound healing This study was a controlled trial. The research population was women delivered by cesarean section in OmolBanin hospital. The samples consist of 82 women randomly assigned in two groups of study and control. The study group started oral fluids 4 hours after surgery, followed by regular diet after return of bowel sounds. The control group started oral fluids 12 hours after surgery then oral solid food was allowed after defecation. The groups were compared about flatulence and pain 4, 12,24,36,48 hours after surgery. Also the groups were compared about wound healing after 10 days by Reeda scale. Data was analyzed using chi-square, Fisher exact test, Kruskal walis test, t test and Mann Whitney. The mean of Reeda score was 0.39 in the early feed group and 0.63 in the control group. There wasn’t a statistically significant difference between groups (p=0.257). Although the early feeding wasn’t effective on post cesarean wound healing, it did not increase infections and other wound complication.

First year of life especially is important in providing of a foundation for health and improvement of the life quality. In recent years Infants Mortality Rate has been decreased in our country but still is higher than the developed countries. In our study data was collected in a questionnaire for 2012 -2013 Admittion and Mortality infant in sayed Al Shohada hospital of farsan. This study was a case – method. There was 608 infants. 70% in infant ward and 30% in NICU ward. 100 percent of infant mortality was in neonatal period. The most important causes of death in neonatal were prematurity and low birth weight (77%). The most important causes of Admittion in NICU were icter (57%). In this study logistic regression analysis showed that few variables such as type of delivery, gestational age and weight of birth had the significant relationship with infant mortality. Prematurity and low birth weight was highly associated with mortality. Type of delivery, did not have the significant relationship with infant Admittion in NICU ward. Special care for premature and low birth weight infant and strengthening health care programs and emphasizing the need to identify high risk groups should be priorities.

Breast milk health is one of the most salient elements in feeding of premature infants. Generally in initial of breast feeding, different methods of disinfecting such as irrigation with usual detergents like water and soap are used to eliminate the probable bacteria. The necessity of the usage of such items has not been mentioned in some studies, and even at the time of comparison, different results have been obtained. Therefore we decided to study the importance of irrigation method in different ways of breast milk, whether manually or by pump, before and after irrigation, on mothers of low birth weight infants. This study is a kind of controlled and by chance trial which evaluates the results of samples collected from breasts of mothers of low birth weight infants. Sampling from breasts of these mothers was done on the basis of two ways: Manual with & without irrigation, pump expression with & without irrigation. Every sample was collected in a sterile container, and these containers were sent to microbial laboratory as soon as possible. Then in that place culture was done from every sample. If after 24 hours, there was no bacteria in plates, the plates were incubated again for another 24 hours. And after 48 hours if there was no growth of bacteria, negative result was recorded. After gathering the data, they were analyzed by statistical spss software. The results showed that the separated bacteria in samples collected manually, with & without irrigation, were consisted of: Staphylococcus-coagulase negative, Staphyloccus aureus, Enterococcus spp, Klebsiella pneumonia. In one sample of without irrigation and four samples of with irrigation, lack of growth of bacteria was observed. In pump expression samples, with & without irrigation, the separated bacteria were consisted of: Staphylococcus-coagulase negative, Staphyloccus aureus, Enterococcus spp, Klebsiella pneumonia, Enterobacter and Pseudomonas aeruginosa. Among the samples, in three samples of without irrigation and two samples of with irrigation, lack of growth of bacteria was observed. The results and surveys showed that bacteria load in pump samples were much more than manual samples. Perhaps one of the reasons for this is the creation of a biofilm which is resistant against irrigation in the pump. The pump device also may follow completely the infecting rule and their disinfections.

Preterm delivery is defined as delivery before 37 weeks of gestation, approximately two-thirds of infant deaths in the first year of life is involved and is still considered as one of the major health problems. Incidence of preterm delivery in different studies mentioned, this study determined the frequency of this type of delivery in women admitted to health centers of Mashhad University of Medical Sciences. This retrospective study on Iranian women referred to health centers of Mashhad University of Medical Sciences in the first six months of 2012 and Information from the health records of 40,293 mothers who had given birth were extracted and analyzed. According to the findings of this study, mothers who had given birth less than 37 weeks, a total of 1,555 people are attending mothers who had given birth less than 37 weeks is 3.9%. percentage of twin births was 1.2% and infants weighing less than 2,500 grams was equivalent to 5.6 percent high morbidity and mortality in preterm newborn infants is associated with causes and preventive measures for reducing LBW infants seems necessary.

Esophageal atresia is one of the most significant congenital diseases in pediatric surgery. Postoperative complications have become an important issue. Additionally, the little data are about life quality of baby''s that had been surgery. The aim of our study was to analyze and evaluating the long- term life quality of subjects. We performed an observational study of the clinical data of patients who were treated for esophageal atresia from 2009 to 2012.This data was extracted from the HIS system. The required data acquired by telephone interview. Statistical analyses were performed using spss software (Statistical Package for the Social Sciences). From 126 patients that had been surgery for esophageal atresia. The telephone interview was possible with 33 patient. Twenty tree patients (18.25%) were died. Furthermore, 63.6% of persons had weight below the 5th percentile for age. Respiratory complications there were in 12 patients (36.3%). Also 48.4% patients required endoscopy after operation. Cough during feeding reported in 54.4%patients. 24.2%of patients have combined cardiac anomalies. However, among these facts, 31 patients (94%) had normal development without vomiting and problem in the anastomosis place (esophageal). Although survival of patients with esophageal atresia has markedly improved due to advances in surgical techniques and neonatal intensive care, Post discharge morbidity and mortality in patients was relatively high. According to this study, most of patients had low weight and most of half of them had respiratory problems. In Summary, this founds suggest that patients with esophageal atresia required post surgical closed care and follow up.