hasan boskabadi

Despite the very important role of breastfeeding in preventing the mortality of premature infants, the decrease in the volume of breast milk in mothers with premature infants is common. Acupressure is a non-pharmacological solution to increase milk volume. The aim of the present study was to review the effect of acupressure on the milk volume of mothers with premature infants.

In this narrative review, in order to find related studies, databases of Google Scholar, PubMed, Science Direct, Proquest, Magiran, SID, Scopus, Researchgate, and Elsevier were searched using the keywords of acupressure, milk volume, premature infant, neonatal intensive care unit and their combination with AND and OR operators in Persian and English languages from 2010 to 2023.

In this review study, 6 articles were included. The results of the studies investigated in the present study showed that acupressure is effective in increasing the volume of breast milk. It should be noted that all the studies reviewed in this study indicated on the effect of acupressure on the volume of breast milk and differ only in the degree of effectiveness.

Maternal diseases during pregnancy have many effects on the fetus and infant, and on the other hand, respiratory and infectious problems are very common in premature neonates, so this study was performed with aim to compare these two common problems in mothers with normal and problematic pregnancies.

In this retrospective descriptive study, the premature neonates hospitalized in the NICU of Ghaem Hospital, Mashhad during 2014-2022 were examined, and the information related to the study, including maternal information (mother's age, type of delivery, maternal diseases  and pregnancy complications) and newborn information (respiratory problems, blood culture, complete blood cell count, C-reactive protein(CRP) and Erythrocyte Sedimentation Rate ( ESR)) were recorded. Then the neonates' characteristics in the two groups of healthy mothers and mothers with common pregnancy diseases were compared. Data were analyzed by SPSS (version 26) and Independent t-test and Chi-square test. P<0.05 was considered statistically significant.

From a total of 982 mothers and newborns, mean gestational age in the group of healthy and diseased mothers was 31.93 and 30.95 weeks, the incidence of respiratory distress syndrome was reported in 39 (32.5%) and 357 infants (56.9%), non-specific respiratory distress in 13 (7.8%) and 105 infants (12.9%), primary pulmonary hypertension in 0 and 22 infants (2.7%), sepsis in 37 (22.4%) and 219 infants (26.8%), and the incidence of meningitis in 2 (1.2% ) and 15 infants (1.8%), respectively (P<0.001)

Prematurity, its severity and related problems increase in infant of mothers with problems during pregnancy. Respiratory and infectious problem, respiratory support and necessary care also increase.

Neonatal sepsis is an important cause of death in neonatal intensive care units where rapid diagnosis and appropriate treatment can reduce neonatal complications. Our aim is to compare. High-sensitivity C-reactive Protein (hs-CRP) and CRP (C-reactive protein) in neonates with sepsis and non-infectious neonates.

Between December 2019 and May 2020, 173 neonates of Mashhad University of Medical Sciences, including 85 neonates with positive blood culture (case group) and 88 uninfected for the control group were included in this prospective cohort study. One ml of blood was taken from all infants for hs-CRP as well as CBC (Complete blood count) samples and culture of blood, spinal fluid and urine if needed. Latex kits were used for CRP and hs-CRP and MacConkey culture medium was used for microbial culture.

The mean of hs-CRP and CRP was significantly higher in the case group compared to the control group (P > 0.05). Comparison within the group, the mean CRP in the two groups prior to, during and after infection were significantly different (P < 0.05).

The results of this study showed that hs-CRP and CRP are helpful in diagnosing late neonatal sepsis, and hs-CRP is superior to CRP in terms of specificity and positive predictive value.

Neonatal sepsis is one of the most common causes of neonatal mortality. This study was performed with aim to evaluate the clinical symptoms, maternal and neonatal risk factors of definitive sepsis in neonates admitted to the neonatal intensive care unit.

This retrospective cohort study was conducted in 2011-2019 on 285 infants admitted to the NICU of Ghaem Hospital in Mashhad. Neonates with positive blood culture and at least one clinical symptom and laboratory result of sepsis were considered as definitive sepsis and entered the study. After confirming the diagnosis based on the blood culture and laboratory report, the researcher-made checklist containing maternal, neonatal, and laboratory characteristics of the neonates was completed. Data were analyzed by SPSS software (version 23) and independent t-test and Chi-square test. P<0.05 was considered statistically significant.

In this study, 35.44% of cases were diagnosed as early sepsis and 64.66% as late sepsis. The most common cause of fetal risk of early neonatal sepsis was preterm (86%) and the most common maternal risk factors for early neonatal sepsis were premature rupture of membrane (19.6%), preeclampsia (15.08%), hypertension (7.36%), chorioamnionitis (6.6%), and diabetes mellitus (4.56%). Duration of hospitalization, duration of mechanical ventilation, and duration of oxygen therapy were the risk factors for late sepsis. The most common clinical and laboratory symptoms were respiratory distress, hypotension, SPo2 loss, apnea, jaundice, abdominal distention, tachycardia seizures, high CRP (77%), thrombocytopenia (53%), leukocytosis (38%), coagulopathy (36%), and high ESR (22.3%).

The most common risk factor for early neonatal sepsis was prematurity before PROM. Therefore, controlling and eliminating the predisposing factors of PROM and prematurity may reduce the incidence of neonatal sepsis. The most common clinical symptom was respiratory distress and the most common laboratory symptom was positive CRP.

Neonates have limited reserves of energy. In esophageal atresia (EA) repair surgery, there were concerns about feeding initiation due to the location of the surgery.

To determine the effect of early enteral feeding on feeding tolerance and the duration of hospital stayin neonates with esophageal atresia.

In this randomized clinical trial, 48 neonates who underwent type-C esophageal atresia surgery at Dr. Sheikh (a subspecialty centers in eastern Iran), July 2015 - November 2017 were randomly divided into the intervention and control groups. In the intervention group, 48 hours after surgery, feeding was initiated once the absence of anastomotic leakage was confirmed by a chest X-ray. The control group received routine feeding from the fifth day after surgery. Feeding tolerance and length of hospital stay (LOS) were compared. Data were analyzed in SPSS-16 using Fisher's exact and Independent sample T tests.

The mean weight before intervention was 2550.1±523.4 grams in control and 2540.6±856.0 grams in intervention groups. Results revealed no significant differences between the intervention and control groups in the frequency of feeding volume tolerance (P=0.48). The mean duration of NGT feeding , time to achieve complete oral feeding and LOS were significantly lower in the intervention group (P<0.05).

Implications for Practice: 

In EA repair surgery early enteral feeding improved feeding tolerance and decreased LOS. So the approach to feeding after EA repair surgery is recommended to be reviewed, and considering patient’s condition, can be started earlier even from 48th hours after surgery.

Telenursing and Multimedia are the educational methods for mothers and it seeks to involve them into the process of caring the premature newborns. Being succeeded in breastfeeding represents the mother's ability to breastfeed the baby. This study aimed to investigate the effect of post-discharge education through Telenursing and Multimedia methods on the success in breastfeeding the newborns aged 35-37 weeks.

A six -month clinical trial was conducted on mothers and newborns in the rage of 35-37 weeks who were fed with breast milk and admitted to the Neonatal and obstetric intensive care unit of Emam Reza Hospital, Ghaem and Um-ol-Benin Hospital of Mashhad. The samples were randomly divided into two intervention groups (each group included 30 newborns). The effect of Telenursing and Multimedia methods on the success of lactation was compared in both groups. The data were analyzed using IBFAT and BEET tools, SPSS 19 and descriptive and inferential statistics (Chi-square and independent t-test)

The results suggested a significant difference between the means of breast feeding in both educational groups (p <0.05). There was no significant difference in terms of sucking in both educational groups (P>0.05). Breastfeeding status was significantly different (P<0.05). There was no significant difference between the means of weight before and after intervention (P >0.05). But telenursing and multimedia methods differed significantly before and after the intervention (P<0.05)

The findings represented that both educational methods had similar effects on the behavior of mother and baby in breastfeeding (based on BEET TOOL), effective nutrition of infant, frequency and the period of breastfeeding.

Pressures arising from premature infant care specially hospitalized infant can affect infant''s quality of life and health by causing long term destructive effects on family''s psychological and physical health.

To investigate the effect of family participation on mother''s general health and length of hospitalization of premature neonate.

In this clinical trial 60 primiparous women and their premature infants hospitalized in neonatal intensive care units، were randomly allocated to family participation and control groups. In the experimental group، empowering family in order to particiapte in the infant fundamental care was implemented in the «teaching» and «indepededant practice» phases. Control group received routin care. Mother''s general health was measured using Goldberg General Health questionnaire. Data were analyzed by independent t-test and Mann Whitney test using SPSS version 11/5 was done.

There was a significant difference between experimental group (21/18±8/95) and control group (35/38±12/99) in terms of Mother''s General Health (p<0/01). There was no significant difference in average length of stay between two groups.

Family participation in caring of premature infants may increase mothers'' general health and can be suggested as a practical method for increasing mother''s general health.