فهرست مطالب مریم بهمدی

The time of umbilical cord clamping is an important strategy for better prognosis of preterm and full-term infants, and all health care providers should be informed about the components and importance of this approach. The present study was performed with aim to investigate the time and duration of umbilical cord clamping in the delivery or operating room of Khorasan Razavi Hospitals.

This descriptive study was conducted on 1237 babies born in the delivery or operating room of Khorasan Razavi public Hospitals between 2020 and 2022 with available sampling. In each hospital, a researcher assistant midwife who was not involved in the delivery process recorded the time of umbilical cord clamping after birth, and in the next step, she recorded the possible cause of early umbilical cord clamping by asking the obstetrician. Data were analyzed by SPSS software (version 26) and descriptive statistics tests. P<0.05 was considered statistically significant.

In this study, 165 neonates (13.4%) were premature and 1072 neonates (86.6%) were born full term. In addition, 915 neonates (73.96%) were born naturally and other 322 neonates (26.04%) by cesarean section. The mean duration of the umbilical cord clamping of the newborns was 35.25 ± 27.29 second, which was reported as 21.29 ± 14.95 second in cesarean section and 40.22 ± 28.92 second in natural delivery. In 719 neonates (58.1%), the umbilical cord is closed before 30 seconds and in 322 neonates (26%) before 15 seconds. Among the causes of early umbilical cord clamping, hasting by obstetrician (30%), caesarean section (3.7%), doctor's routine (2.1%) and mother's non-cooperation (1.5%) were the most common causes.

Umbilical cord clamping is done quickly or very quickly in the delivery room of Khorasan Razavi public hospitals, and in caesarean section, this urgency is very noticeable, and the most common cause of hasting is obstetrician. Therefore, correcting the thinking of the obstetrician in order to improve the time of umbilical cord clamping seems necessary. Delaying umbilical cord clamping plays an important role in the transition from fetal to newborn blood circulation and improves the health of newborns.

Failure to follow the standard guidelines in the selection and monitoring of infants before and during home phototherapy can result in unfavorable outcomes. The present study was conducted to determine the performance and complications of failure to follow the standard guidelines in infants undergoing home phototherapy in Mashhad, Iran.

In this cross-sectional study, a total of 202 infants who were referred to neurology clinic or hospitalized at the emergency or neonatal wards due to acute or chronic outcomes of home phototherapy were included in 2020-2021. Gestational age, gender, birth weight, age at jaundice onset, age and duration of phototherapy, weight on admission, etiology of jaundice, referrer, phototherapy service providing center, type of breastfeeding, hyperthermia incidence, serum or skin bilirubin levels at the beginning and end of phototherapy, hematocrit, direct and indirect Coombs test, reticulocyte count, TSH, T4, G6PD, maternal age and blood type, parity, type of delivery, and pregnancy and delivery problems were recorded.

The mean age of infants was 7.7±7.6 days, birth weight 2746±707 gr, admission weight 2601±771, bilirubin before home phototherapy 15.58±3.7 mg/dl, bilirubin on admission 17.5±5.8 mg/dl, and home phototherapy duration was 2.5±0.7 days. The frequency of causes of jaundice was as follows: ABO incompatibility (n=30), Rh incompatibility (n=22), urinary tract infections (n=13), fever and dehydration (n=19), hypothyroidism (n=7), biliary atresia (n=5), galactosemia (n=2), and etc. Thirty infants had pathologic weight loss, six had kernicterus, and three needed exchange transfusion.

According to the findings of the present study, it seems that the non-compliance with the guidelines and standards for the selection of babies eligible for home phototherapy along with the lack of monitoring of the health status and serum bilirubin of these infants lead to serious consequences (dehydration and pathological weight loss, need for exchange transfusion and kernicterus) in them. It is necessary to closely review and monitor the process of diagnosis and referral of babies with jaundice who need phototherapy and treatment to phototherapy centers at home or hospital.