Iranian Journal of Neonatology
Volume:7 Issue: 4, Autumn 2016

There is an assumption that fetus with restricted growth with an inappropriate intrauterine environment lies under stress. Although small-for-gestational-age (SGA) infants have higher mortality, difference in the outcome of SGA and appropriate-for-gestational-age (AGA) infants regarding respiratory morbidity is controversial. It seems that respiratory morbidities in SGA neonates is different from neonates with AGA. In this study, we intend to compare the mortality and respiratory morbidity rates between the preterm small for gestational age (SGA) and appropriate for age (AGA) neonates of less than 34 weeks of gestation.
This analytical cross-sectional study was conducted on 498 preterm neonates with gestational age of According to the results of the study, the two groups were significantly different in terms of their birth weight (P As the findings of the current study demonstrated, the mortality rate was similar in the SGA and AGA groups; however, the respiratory morbidities such as RDS and BPD were more prevalent in the AGA neonates.

Rooming-in, motivated by World Health Organization (WHO) strategies and baby-friendly hospital policies, is a practice followed in many maternity hospitals of Iran. Mother-infant dyad may easily be damaged by the separation caused by medical and surgical problems, which result in hospital stay. Regarding this, the aim of this study was to investigate the effects of the rooming-in practice in icteric newborns admitted to Mofid Children's Hospital of Tehran, Iran.
This study was conducted on 220 neonates admitted to Mofid Children's Hospital with the complaint of jaundice. Out of the 220 newborns, 124 cases were assigned into the intervention group (the rooming-in care) and 96 neonates were categorized into the control group (the routine-care). The two groups were compared in terms of the length of hospital stay, maternal satisfaction, nursing care time, and hospital stay complications. The data were collected by some trained mid-wives using a validated questionnaire. Data analysis was performed using paired sample t-test through SPSS version 16.
According to the results of the study, about 55% of the neonates were male. The neonatal mean ages of the intervention and control groups were 6.6 ±3.7 and 7 ± 3.8 days, respectively. Maternal satisfaction with neonatal care and maternal comfort during hospital stay were significantly higher in the intervention group (P=0.027). Furthermore, the two groups had no significant difference regarding the complications of hospital stay (P=0.655).
As the findings of the present study demonstrated, in spite of the similarities of the health issues, nursery essentials, and hospital stay complications between the two groups, the rooming-in was more favorable according to the mothers’ viewpoints.

Introduction and Annually one million newborns die due to the umbilical cord infection. Thus, in this study, we aimed toevaluate the effect of topical aloe vera gel on umbilical cord complications.
This randomized clinical trial was performed in maternity ward of Ghaem Hospital, Mashhad, Iran The samples were selected through convenience sampling and were randomly divided into three groups of aloe vera, control, and placebo. For data analysis, One-way ANOVA test was conducted.
Comparison of cord condition between the groups showed significant differences between the three groups. In the placebo group, the number of infants with redness around the cord was significantly higher compared to the control (P=0.002) and aloe vera (P=0.002) groups. In addition, cord swelling was significantly more frequent in the placebo group than the control (P=0.002) and aloe vera (P=0.002) groups. The incidence of cord infection was significantly higher in the placebo group than the control (P=0.000) and aloe vera (P=0.000) groups. The occurrence of infection in the umbilical cord of the newborns in the placebo group was significantly more compared to the control (P=0.000) and aloe vera (P=0.000) groups.
Topical aloe vera gel accelerated cord separation and reduced the rates of complications and infections.

Neonatal mortality, prematurity, and congenital disorders, known as crisis, are unexpected stressful events causing extreme maternal stress. According to the literature, about 28-70% of the mothers have a high degree of psychological stress. Among different treatments, praying as a complementary religious approach is the most common source that people use in difficult conditions. Regarding this, the aim of the present study was to determine the effect of praying on anxiety and stress in mothers with premature neonates admitted to the Neonatal Intensive Care Unit (NICU).
This clinical trial was conducted on 60 mothers with premature neonates. The participants were randomly divided into the intervention and control groups. In the intervention group, praying was performed one day after the presence of the mother in the NICU for 7 days. The tools employed in this study included the demographic characteristics and subject selection forms, depression, anxiety, and stress scale, as well as Symptom Checklist-90-R and prayer questionnaires. The validity and reliability of these tools were approved using content validity and internal consistency, respectively. Data analysis was performed by independent and paired t-tests as well as ANOVA through SPSS version 11.5.
The two groups were matched in terms of all maternal demographic and neonatal characteristics, except neonatal birth weight (P=0.045). As the results demonstrated, there was a statistically significant difference between the intervention and control groups in terms of their anxiety scores (P=0.02); however, the difference was not significant after one month following the intervention (P=0.076). Nevertheless, no statistically significant difference was observed between the stress scores of the two groups.
As the findings of the current study revealed, praying can be effective in reducing the maternal anxiety.

This study aimed to determine neonatal nurses’ perceptions of knowledge and practice in pain management in NICUs & neonatal units.
A cross-sectional descriptive study design was used. A total of 120 neonatal nurses who working in NICUs & neonatal units in Ardebil province, Iran were selected using the convenience sampling technique. A questionnaire of Nurses’ Perceptions of Neonatal Pain (Cong, 2013), including 36 questions with Likert scale and 2 open ended questions, was used. Data collected were analyzed with descriptive statistics of frequencies and percentages.
Nurses had Appropriate knowledge of neonatal pain management , but less than 50% felt that they received adequate training and continuing education on pain. Participants reported that they don’t use of pain assessment tools (65%). Less than half felt that the pain tool used in their unit was an accurate measure (44.2%). Fewer than half reported that pain was well managed (28.3%) , that their pain protocols were research evidence based (34.2%) and more than half reported that parents should be involve with the care and comfort of their infant during painful procedures (71.6%). Barriers to effective pain management emerged as high workload, shortage of personnel, lack of knowledge, absence of pain protocols, lack of time, and lack of trust in the pain assessment tools.
proper pain management was significantly correlated with adequate training, use of proper and accurate pain tools, and clear and research-based protocols and parental involvement. It can be improved by developing guidelines and support of nurses, develop of clinically feasible pain tools, adequate training and proper supervision.

Infancy is one of the most critical stages of life, which requires parents to have adequate knowledge in order to provide careful nursing, attention and care for newborns. Given the importance of infant health, it is essential to teach proper child care techniques and principles to primigravida parents. This study aimed to evaluate the effect of education on the awareness of primigravida couples toward infant care.
This clinical trial was conducted on 50 couples in the healthcare centers affiliated to Mashhad University of Medical Sciences, Mashhad, Iran. Study tools were researcher-made questionnaires, and data analysis was performed in SPSS version 16 using analysis of variance (ANOVA).
In this study, poor awareness of infant care was observed in the couples before training, which improved to moderate awareness after the educational sessions. Moreover, mean score of parental awareness significantly increased in mothers (P=0.005) and fathers (P=0.05) after the training.
According to the results of this study, educational intervention could promote parental awareness in primigravida couples. Therefore, application of this method could help parents to provide nursing care for their newborns.

The newborn’s first bath, performed in Neonatal Intensive Care Units (NICU), is believed to be a stressful situation, especially for the premature infants. As a developmental care approach, swaddle bathing is a low-stress bathing method for vulnerable preterm neonates. Given the limited number of the studies examining this bathing method, the present study was conducted with the aim of comparing the effects of swaddle and conventional bathing methods on some behavioral responses in premature infants.
This study was a randomized clinical trial conducted on 50 premature neonates admitted to NICU. The neonates, who met the inclusion criteria, were randomly assigned into experimental and control groups. The infants in the experimental group received swaddle bathing and those in the control group were given conventional bathing. To record the behavioral responses, the infant's faces were filmed in close-up during the bathing. The data were analyzed, using Chi-squared test, independent samples t-test, and Mann-Whitney U test.
The results demonstrated that the occurrence rates of such behaviors as facial grimace (P According to the findings of this study, swaddle bathing can reduce the neonatal stress during bathing. Consequently, this kind of bathing can be used as an appropriate, low-stress, and pleasant method for the preterm neonates in NICU.

Perinatal asphyxia is a common cause of infant morbidity and mortality and long-term neurological disabilities. Due to the high costs of admission, a large proportion of births and neonatal deaths occur in non-hospital settings. This study aimed to evaluate the incidence rate of perinatal asphyxia before and after the implementation of the health improvement program.
This descriptive-analytical study was conducted on all the infants with moderate and severe asphyxia during April 2013-2015. Subjects were divided into two groups of A and B (born after and before the health improvement program, respectively). Maternal and neonatal data were recorded in checklists and compared between these groups. Data analysis was performed in SPSS version 17.
In total, 111 asphyxiated neonates were classified into two groups of A and B, and incidence rate of asphyxia was estimated at 0.54% and 1.05%, respectively. Severe asphyxia was observed in 35.7% and 28.9% of the infants in groups A and B, respectively. Moreover, mean duration of mechanical ventilation was 25 and 79 hours in groups A and B, respectively.
According to the results of this study, implementation of the health improvement program reduced the incidence of perinatal asphyxia. In addition, number of cesarean cases due to previous C-section was observed to decrease. Therefore, it could be concluded that high-quality resuscitation efforts and restricted rules in the health improvement program lower the risk of long-term complications in asphyxiated neonates. However, no significant difference was observed in the mortality rate of the asphyxiated newborns in this study.

Given the overriding importance of neonatal jaundice and scarcity of studies on the role of route of delivery on its occurrence, this study aimed to investigate the association between neonatal bilirubin level and the route of delivery (i.e., normal vaginal delivery [NVD] and cesarean section [CS]).
This prospective, cross-sectional study was conducted in 2012 in Imam Reza Hospital of Mashhad, Iran, 2012. In all term infants, who met the inclusion criteria, serum bilirubin level was measured by the bili-test device between the second and seventh days after birth. In cases with skin bilirubin level>5 mg/dl, serum bilirubin was also checked. The collected data were analyzed using SPSS, version 16.
A total of 182 neonates were enrolled in the study, 56% of whom were male. The mean bilirubin levels in the NVD and CS groups were 9.4±2.9 mg/dl and 9.8±3.4 mg/dl, respectively (P=0.53). Additionally, comparison of the mean bilirubin levels between the two groups based of demographic characteristics demonstrated no significant differences.
This study showed no significant correlation between neonatal jaundice in term infants and the route of delivery.

The new neonatal ventilation methods have been developed along with utilization of new technological tools.This device is synchronized with the patient’s respiratory efforts. The ideal synchronized breath needs to be synchronous with initiation, size, and termination of the breath without delay in detecting of initial resiratory effort by device .The synchrony of respiration contributes to effective ventilation, therefore increase tidal volume and decrease complications. Neurally Adjusted Ventilatory Assist (NAVA) has been emerged as an innovative technology which gives the patient full control of timing and performance of the respiratory cycle of ventilator breath without gross delay. The electrical activity of the diaphragm (Edi) signal is filtered, amplified, digitalized, and then transmitted to the ventilator unit where it serves as a novel trigger for the mechanical breath. The ventilator assists the spontaneous breath by delivering a proportional pressure on a breath -by- breath basis. Then the synchrony of mechanical respirations with patient respirations contributes to effective ventilation and increase tidal volume and decrease complications. In this way, weaning is easier and faster. We review the first neonate in Iran who received this method of respiratory assistance devices and has been weaned easily in neonatal intensive care unit (NICU) of the Children’s Medical Center.

Choriocarcinoma is a rare highly malignant trophoblastic neoplasm. It can be preceded by any form of gestation including a complete or a partial mole, miscarriage and normal pregnancy. Simultaneous intraplacental choriocarcinoma involving both mother and infant is extremely rare. Hepatomegaly, anemia, elevated ßHCG is the diagnostic triad.
Here we report a 6 weeks old Afghan girl infant with intraplacental choriocarcinoma presented by severe anemia and widespread multiple metastatic lesions in liver, lung and brain with an elevated level of ßHCG .
According to rarity of the disease, rapid progression and the high mortality rate with delay in diagnosis and intervation , choriocarcinoma should be one of the differential diagnosis in severe infantile and maternal anemia without any antecedent reason. According to highly vascular and friable nature of tumor, biopsy can be dangerous for diagnosis. As choriocarcinoma secrets ßHCG, measurement of serum ßHCG is the most common method used to diagnose choriocarcinoma