Mohammad Heidarzadeh

The Effect of Kangaroo Mother Care (KMC) on Breast Feeding at the Time of NICU Discharge

Background Exclusive breastfeeding is one of the most important essential components of Kangaroo Mother Care. Objective This study was performed to evaluate the effects of KMC on exclusive breastfeeding just at the time of discharge. Patients and Methods In this cross sectional study, 251 consecutive premature newborns admitted to neonatal intensive care unit (NICU) between May 2008 and May 2009 in Alzahra University Hospital in Tabriz were evaluated. All of candidate mothers were educated for KMC method by scheduled program. Standard questionnaire was prepared by focus group discussion, and mothers filled it prior to infant hospital discharge. Results In this study 157(62.5%) mothers performed kangaroo mother care (KMC group) versus 94 (37.5%) in conventional method care (CMC group). In KMC group exclusive breast feeding was 98 (62.5%) vs. 34 (37.5%), and P =.00 in CMC group, at the time of hospital discharge. Receiving KMC, and gestational age were the only effective factors predicting exclusive breastfeeding. Our result indicated that there was a 4.1 time increase in exclusive breastfeeding by KMC, and also weekly increase in gestational age increased it 1.2 times, but maternal age, birth weight, mode of delivery, and 5 minute Apgar score had no influence on it. Conclusions KMC is more effective, and increases exclusive breast feeding successfully. It can be a good substitution for CMC (conventional methods of care). It is a safe, effective, and feasible method of care for LBWI even in the NICU settings.

Comparison Outcome of Surfactant Administration Via Tracheal Catheterization During Spontaneous Breathing with Insure

Surfactant administration via thin endotracheal catheter (Tec) seems to be less invasive than InSurE method .We analyzed data obtained from multicenter hospitals. This multi center randomized clinical trial study was conducted concomitant within NICU of three university hospitals of Tabriz, Isfahan and Mashhad for a period of 20 months on neonates with gestational age of 27-32 weeks. All infants received nCPAP before administration of surfactant. If we required fio2>30%to maintain spo2 >85% then surfactant was administered. A 5f vascular catheter was placed through 1 to 2 cm below the vocal cords and surfactant was administrated slowly. Mean gestational age in TEC was 29.6 weeks and in InSurE was the same. Mean weight in TEC was 1339 grams and in InSurE was 1304 gram. Surfactant was administered to 66 preterm via TEC method and to 70 infant via InSurE. Mortality in TEC group was significantly lower than InSurE. P<0.01RR=0.56, CI, 95(0.420.76). NEC reduced in TEC. CPAP duration decreased in two centers, p<.05 but increased in another center. Fio2 decreased rapidly and HCO3 increased 2 hours after surfactant P<0.03 in TEC. The average mean of Oxygen supplementation, BPD, Mechanical ventilation between two groups was not statistically significant. TEC method was effective in treating RDS. Mortality was significantly decreased in TEC group. As TEC procedure is a new method of surfactant administration and there are few studies about it, so it is too early to be certain about all aspects of this procedure.

Early diagnosis and screening of congenital cardiac anomalies.

Considerable numbers of congenital cardiac anomalies are missed at the time of delivery. Study reports show that congenital cardiac anomalies are the second most common birth defect in many countries. Despite this fact, our previous study showed that the prevalence of congenital cardiac anomalies is the fifth most common one, indicating that many of these defects might not be properly diagnosed at the time of delivery and birth. The aim of this study was to estimate the missing frequency of congenital cardiac anomalies at the time of delivery and birth. The population of the study was 185,650 births in the Northwest region of Iran covered by the Tabriz Registry of Congenital Anomalies. A total of 451 children with congenital cardiac anomalies were studied in the region from 2000 to 2009. The expected prevalence of congenital cardiac anomalies at birth was estimated to be 24.2 per 10,000 births while a prevalence of 9.2 per 10,000 births was observed at the same time and place. This indicated that 59.1% of children with congenital cardiac anomalies were not identified at birth (p-value less than 0.05). This proportion increased by 13% over the study period from 2000 to 2009 (p-value greater than 0.1). Our findings indicated that a remarkable frequency of congenital cardiac anomalies was not diagnosed at birth because there was no paediatric cardiologist available at the time of birth in the gynaecology and obstetrics wards.

Innovation of High-risk Infants Follow-up Surveillance System in Iran

Background: Early childhood development is one of the most social determinants of health that must be notified in order to reducing social gap and inequity. In spite of increasingly developing intensive neonatal care wards and decreasing neonatal mortality rate, there is no follow-up surveillance system to identify high-risk infants (HRI) and their health problems for timely intervention after discharge. This study was carried out to design and pilot high-risk infant follow-ups (HRIFs) surveillance system, in Alzahra Hospital, a tertiary level center of Tabriz University of Medical Sciences (TUOMS), in 2012–2013. Methods: In this qualitative research after studying international documents, consensus about criteria of HRIs accomplished by focus group discussion. Then, Delphi agreement technique was used to finalizing assessment timetable. In the second phase, we piloted the designed surveillance system in Alzahra Hospital, a tertiary level center of TUOMS. Pilot study was implemented by follow-up team organized in designed model at the first phase of the study. Then, the findings of the pilot study were being assessed by an expert panel. If the members agreed on made decisions, they were being placed on the agenda of the national committee of development care of newborns for final approval. Results: High-risk infants follow-up surveillance system was designed in following steps: Defining of evidence-based criteria of HRIs, organizing the follow-up team, regulating the organs and neurodevelopment assessment timetable, publishing a health certificate notebook for HRIs, and designing Access database software for data collection, report and evaluation. Conclusions: We designed and piloted HRIFs surveillance system, so this system was institutionalized in Alzahra Hospital, finally. It can be prepared to apply in the whole country, after detecting the quantitative outcomes and developing the program in East Azarbijan.

Design and Evaluation of Electronic Briefs of Neonatal Intensive Care Unit in Taleghani Hospital, Tabriz, Iran

More than 9 million neonatal deaths are reported through out the world each year happening in the early weeks of life most of which relate to developing countries. Thus it is very important to present a better way to keep the infants healthy which could be possible by accessing accurate information at any time required during hospitalization of infants. Therefore the required data should be collected, stored and analyzed before which is best possible by using computer. The main objective of this research is enabling researchers and clinicians quick access to the data of the babies admitted in NICU. This study involves the stage of developing a system design and its implementation following the evaluation of the electronic records which is done in a query form. By defining the neccessar terminology and designing a data model, the database and user interface are developed by using a programing language and data base tools. Finaly, the system has been evaluated by user satisfaction showing to be about 85% As a result we suggest the hospitals take serious in buying the suitable technology for the NICU ward along with teaching the staffs how to work with it.

Parental needs in infant's end-of-life and bereavement in NICU: A qualitative study.

Background and Aims: Newborn death is an unexpected outcome for parents. Parents face with several needs in infant end-of-life. The health care team is responsible for meet these needs. This qualitative study aim was to explore of parental needs in infant end-of-life and bereavement. Materials and Methods: For this qualitative study, 24 single semi-structure interviews were done. A qualitative content analysis method was used. Sampling conducted on purposeful with maximum variation in five Neonatal Intensive Care Unit (NICU) environments in Isfahan city. Inclusion criteria for nurses and doctors were having at least one experience of caring for an infant and their family at end-of-life. Inclusion criteria for parents and their families were having at least one infant at end-of-life or had lost their infant for 6 months before in NICU. Results: Data analysis uncovered two main themes. Familys support needs with two subthemes (familys support needs before infants death and familys support needs after infants death) and familys preparatory needs upon infants death with two subthemes (management of the bad news of infants death by treatment team and management of the bad news of infants death by family). Discussion: Mourning mothers need for her husbands presence by her side, getting hospitalized in a separate room, and management of infants death news by father and family were among items rarely pointed out in other studies. Exploration of these needs cab be helpful for the health care team for providing care.

High Risk Infants Follow-Up: A Case Study in Iran

Background. A follow-up program for high risk infants was initiated in Alzahra Maternity Hospital in Tabriz city, Iran, in 2013. The aim of this paper is to give a brief report of the program. Material and Methods. Two groups of high risk neonates were studied. The first group comprising 509 infants received services in Alzahra Maternity Hospital implemented by the follow-up program. This included a full package for family to look after high risk infant and periodic clinical evaluation at two and four weeks after birth and then two, three, four, five, and six months later again. The second group including 131 infants in Taleqani Maternity Hospital received routine services after birth with no specific follow-up care. Results. Some anthropometric indices showed a significant improvement in the intervention hospital compared to control group. These included the following: head circumference at first and second months; weight in the first, fourth, fifth, and sixth months; and height in sixth month only. Clinical evaluation of infants showed an improvement for some of the medical conditions. Conclusion. Follow-up care program for a minimum of six months after discharge from maternity hospitals may help to avoid adverse and life threatening consequences in high risk infants.

Perception and expectation of Iran neonatal transport expert regard to developing neonatal transport system in Iran: A qualitative research

Introduction: This study was aimed to reach experts expectations of neonatal transport system for developing neonatal transport system in Iran. Materials and Methods: This is a qualitative study conducted by using focus group discussion (FGD) to present experts perspectives and expectancy about neonatal transport system. Participants was selected from all experts and specialist about neonatal transport in Iran countryside. Finally 48 experts, participate in this study. To data collection 4 FGD were conducted, data were analyzed by content analyses. All subthemes were categorized in main themes according to conceptual relationship as an expert panels opinions. In order to comply with the ethical issues involved in the study was voluntary, also permission for the recording session were taken and confidentiality was also ensured. Result: According to FGD results, 11 themes and 90 subthemes were founded related to neonatal transport system, the main identified themes included: Aims, necessity and models of neonatal transport system, organizing the transport system, management and quality of instruments in the transport system, Neonatal transport system staff, Human resource management and issue related to human resources, conditions and requirements of neonatal transport system, facilitating factors in neonatal transport system, information management and communication system and weakness of neonatal transport system. Conclusion: Neonatal transport systems in different countries must adapted according to situation and component of each country have different strength and weakness and in implementing a system must attend to geographical conditions, financial ability and access to professionals, health system structure, facilities related to neonatal health care, antenatal services in regain, health care related, health care program about neonates and pregnant women and epidemiological status and mortality and morbidity in deferent locals and regains in countryside.

Neonatal mortality rate in Iran: the Iranian Perinatal Mortality Surveillance System

Background: Neonatal mortality is the major proportion of children mortality under five years and it is considered as the main health indicator in the first year of life. This paper has aimed to review the neonatal mortality in the numbers recorded at the Iranian Perinatal Mortality Surveillance System (IPMSS) by Iran Ministry of Health and Medical Education. Methods: A descriptive study was done in 2014. For assessment of sampling quality and quantity, 24 hospitals randomly were selected. Recorded information, related to perinatal mortality (deaths from 22 completed weeks of gestation until 30 completed days after birth inclusive of stillbirths and neonatal mortality) from selected hospitals, was compared with recorded data in IPMSS. Results: Results showed that, out of 1,725 perinatal deaths occurred in hospitals, 1,480 (85.80%) deaths were recorded in IPMSS. Of 1,041 neonatal deaths that occurred in hospitals (in hospital wards and delivery rooms), 875 (84.05%) were in IPMSS. It shows that a correction coefficient for hospital neonatal mortality was 1.1904. Based on analyzing process, correction coefficients for stillbirth reported by hospitals, stillbirth for all over the country and perinatal death were 1.130, 1.1775 and 1.2443, respectively. Considering these correction coefficients – that enabled to calculate 15,130 neonatal deaths – and 1,421,689 live births (according to Statistics Center) in 2012, neonatal mortality rate was 10.64 in 1,000 live births. Conclusion: Our data showed some problems in the registration system. Although implementation and supervision of such Surveillance System are not easy, they are essential and provide valuable data in perinatal audit and neonatal health care practices.

Clinical Outcomes of High‑Risk Infant Follow‑Up Program in a Tertiary Care Centre

Background: High-risk infant follow-up (HRIF) program is necessary for early detection, timely intervention, and promotion of health outcomes in vulnerable infants, ethically. The present study was carried out to assess the clinical outcomes of the HRIF Program in Alzahra hospital as a tertiary care centre, in Iran. Materials and Methods: In this cohort study, 5840 neonates were born at Alzahra hospital, from June 1, 2011 to 30th February 2012. Among those who were admitted to neonatal intensive care unit (NICU), 253 infants were recruited by census according to HRIs criteria. After doing necessary measurements and family education, information was recorded in HRI health certificate and then entered in the access database for analysis. Results: From 253 eligible HRIs registered, 241 (95%) infants attended the follow-up clinic after discharge. A total of180 cases were recalled for further visits, 110 of which attended the clinic. Anthropometric indices had an increasing trend in the first 6 months of life. There was no significant relation between ages and stages questionnaire (ASQ) results and infant birth weight, height, and head circumference. The ratios of intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP) were 8.7% and 3.1%, respectively. The incidence of congenital hypothyroidism was 2:341 in HRIs. Conclusions: Although some outcomes, such as ROP, improved in our study compared to similar studies, the findings indicate an impairment of the current follow-up processes and highlight the necessity to modify the current HRIF program. Ethically, we insist on integrating HRIF program in child health services to promote early childhood development.