majid mohammadizadeh

Nasal Continuous Positive Airway Pressure (N-CPAP) is the standard method of respiratory support in neonatal intensive care units, and this method is used for almost all infants with respiratory distress syndrome (RDS) for respiratory support. The position of infants under N-CPAP (prone and supine) affects the amount of blood supply. This study aimed to compare the prone \\and supine positions, followed by the investigation of their effects on various respiratory parameters and prematurity complications in premature infants with RDS treated with N-CPAP. This randomized clinical trial was conducted on 127 premature infants under N-CPAP treatment in the neonatal intensive care units of Al-Zahra and Shahid Beheshti hospitals, Isfahan, Iran. Babies were placed in two groups of 68 and 59 cases with supine and prone positions, respectively. The duration of N-CPAP, the number of prescribed doses of surfactant, the need for mechanical ventilation, time to full feed, and positive end-expiratory pressure (PEEP) were investigated in this study. The obtained data were then analyzed using SPSS software (version 22). The mean±SD values of gestational age and birth weight of the neonates were 31.88±1.30 weeks and 1672.40±443.67 g, respectively. The frequency of using different modes of mechanical ventilation was significantly lower in the prone position group, compared to the supine position group ([17% vs. 32.4%], X2[3, N=127]=7.95, P<0.05). There was a significant correlation between position and using mechanical ventilation during the first 72 hours (P=0.04, Correlation Coefficient=0.182). Multivariate analysis indicated a significant correlation between position and mean time of PEEP (P<0.001, F=13.67), mean of surfactant use (P=0.013, F=6.38), and time to full feed (P=0.002, F=10.29). The results of this study showed that placing preterm infants with RDS who are treated with N-CPAP in the prone position reduces complications related to being preterm or using N-CPAP.

Neonatal sepsis is a leading cause of death in neonates worldwide. The investigation of biomarkers for the early diagnosis of neonatal sepsis is in progress with controversial outcomes. The current report aims to evaluate the values of salivary C‑reactive protein (CRP) and interleukin‑18 (IL‑18) for the diagnosis of neonatal sepsis.

In this cross‑sectional study, 89 neonates, including 49 neonatal septic case and 40 healthy group admitted at the neonatal intensive care unit, were evaluated. The salivary samples of IL‑18 and CRP were measured before the antibiotic therapy initiation, as soon as blood samplings. Sepsis diagnosis was confirmed by the positive blood culture. The diagnostic values of the biomarkers were determined using the receiver operating characteristic curve (ROC curve) analysis. Besides, the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) positive likelihood ratio (LR+), negative likelihood ratio (LR‑), and diagnostic accuracy were measured.

Salivary CRP level was remarkably higher in septic case than healthy group (5.2 ± 4.61 vs. 3.5 ± 1.7; P = 0.02), while salivary IL‑18 was not different between the groups (0.1 ± 0.29 vs. 0.04 ± 0.19; P = 0.25). The ROC curve for IL‑18 showed insignificant values (P = 0.37). The ROC curve of salivary CRP showed area under the curve of 0.63 (95% confidence interval: 0.51–0.74; P = 0.03) with the sensitivity, specificity, PPV, NPV, LR+, LR − and diagnostic accuracy of 44.9% (31.8–58.7), 80% (65.2–89.5), 73.3% (55.5–85.82), 54.2% (41.6–66.3), 60.6% (50.29–70.18), 2.24 (1.57–3.2), and 0.68 (0.63–0.75) at the cutoff of 4.55 ng/L, respectively.

Based on the findings of the current study, salivary CRP can be considered a biomarker for the early diagnosis of neonatal sepsis, while no statistical values for salivary IL‑18 were detected. Due to the significance of neonatal sepsis, further evaluations are strongly recommended.

This study aimed to determine the effects of various positions on the arterial oxygen saturation during enteral feeding of preterm infants admitted to Neonatal Intensive Care Units (NICUs). It is assumed that different body positions influence arterial oxygen saturation during enteral feeding. This crossover clinical trial included 88 infants. The inclusion criteria were gestation age of fewer than 32 weeks, a weight of 1001-1500 gr, age of fewer than one month, 5-minute Apgar score of at least 5, exclusive breast-feeding, absence of any underlying illness, no oxygen therapy, and a minimum feed volume of 10cc for two h. The subjects were selected from the infants admitted to NICUs at Alzahra, Shahid Beheshti, and Amin hospitals, Isfahan, Iran, using a convenience sampling method. Subsequently, they were randomly assigned to four groups of 22 cases per group. The four groups were A, B, C, and D who were initially positioned on the left side, supine, prone, and right side, respectively. The arterial oxygen saturation was recorded on a minute-by-minute basis 5 min before, during, and 5 min after enteral feeding. Data were analyzed in STATA software (version 14) using a one-way analysis of variance, (ANOVA), linear mixed model, and the Chi-square test. According to the results of the one-way ANOVA and Chi-square test, no significant difference was observed among the four groups regarding the demographic characteristics. Moreover, the linear mixed model revealed no significant difference among the four groups of intervention, the four periods of the study, and carryover effect in terms of the mean oxygen saturation before, during, and after enteral feeding. The results revealed that variations in infant positions during feeding had no effects on the arterial oxygen saturation. Therefore, neonatal nurses are advised to carry out enteral feeding without unnecessary changing of the infant position, which leads to lower manipulation, and improved sleep and awakening cycle of the infants.

Currently, the method of early nasal continuous positive airway pressure (nCPAP) and selective administration of surfactant via an endotracheal tube is widely used in the treatment of respiratory distress syndrome (RDS) in premature infants. To prevent complications related to endotracheal intubation and even a brief period of mechanical ventilation, in this study, we compared the effectiveness of surfactant administration via a thin intratracheal catheter versus the current method using an endotracheal tube.

Thirty eight preterm infants ≤34 weeks’ gestation with birth weight of 1000–1800 g who were putted on nCPAP for RDS within the first hour of life, were randomly assigned to receive surfactant either via endotracheal tube (ET group) or via thin intratracheal catheter (CATH group). The primary outcomes were the need for mechanical ventilation and duration of oxygen therapy. Data were analyzed by independent t-test, Mann–Whitney U-test, and Chi-square test, using SPSS v. 21.

There was no significant difference between groups regarding to need for mechanical ventilation during the first 72 h of birth (3 [15.8%] in ET group vs. 2 [10.5%] in CATH group; P = 0.99). Duration of oxygen therapy in CATH group was significantly lower than ET group (243.7 ± 74.3 h vs. 476.8 ± 106.8 h, respectively; P = 0.018). The incidence of adverse events during all times of surfactant administration was not statistically significant between groups (P = 0.14), but the number of infants who experienced adverse events during surfactant administration was significantly lower in CATH group than ET group (6 [31.6%] vs. 12 [63.2%], respectively; P = 0.049). All other outcomes, including duration of treatment with CPAP and mechanical ventilation, times of surfactant administration and the need for more than one dose of the drug, the rate of intraventricular hemorrhage, mortality and combined outcome of chronic lung disease or mortality were statistically similar between the groups

Surfactant administration via thin intratracheal catheter in preterm infants receiving nCPAP for treatment of RDS has similar efficacy, feasibility and safety to its administration via endotracheal tube.

Continuous distending pressure (CDP) is considered as standard care in neonates with decreased pulmonary compliance. Concerns regarding the implementation of non-invasive CDP in a respiratory cycle in order to establish an optimal level of functional residual capacity (FRC) abound in the related literature. Examples include how to manage gas leakage in the interface, no imposed increased work of breath (WOB) on patients and prevention of applying trans-pulmonary pressure levels leading to metabolic acidosis. Following the development of autoflow hardware, pressure control (PC) respiratory pattern was defined in the field of mechanical ventilation (MV) in order to compensate for gas leakage in interface or compensate for pressure drop and increased CDP pressure level in respiratory phases of inspiration and expiration.

The study aimed at decreasing WOB in neonates with RDS using pressure control-nCPAP.

This study was a retrospective clinical trial performed on 70 neonates weighing about 1000 grams with RDS. Participants were randomly assigned into two respiratory support groups based on the use of pressure limited nCPAP (PL-nCPAP) and pressure control nCPAP (PC-nCPAP). Each group consisted of 35 infants compared in terms of their demographic characteristics, duration of non-invasive respiratory support, rapid shallow breathing (RSB) index, ventilator’s WOB, need for MV, need for surfactant administration, chronic lung diseases, pneumothorax, intra-ventricular hemorrhage (IVH) and death.

No significant difference was observed between the mean time of non-invasive respiratory support and the need for MV, between the incidence of pneumothorax and IVH and also between the mortality rate and degree of involvement in chronic lung diseases in the two groups. The mean respiratory ventilation rate of ventilator’s WOB in PC-nCPAP group was significantly higher than that of PL-nCPAP group. The mean RSB index was also significantly higher in PL-nCPAP group than in PC-nCPAP group. Finally, the mean of surfactant administration in PL-nCPAP group was significantly higher than that in PC-nCPAP group.

In this study, ventilator’s WOB in PC-nCPAP group, which was significantly higher than that of PL-nCPAP group, can be explained by significantly higher RSB index in PL-nCPAP group and significantly lower mean surfactant prescription in PC-nCPAP group.

Gastrointestinal (GI) dysmotility is a common problem among preterm neonates with very-low-birth-weight and is manifested as feeding intolerance, and in this situation, total parenteral nutrition (TPN) is needed for several complications. Erythromycin is a prokinetic antibiotic that neonatologists widely prescribe for the treatment of GI dysmotility in high and low doses.

This study aimed to evaluate the effects of an intermediate dose of Erythromycin in the treatment of feeding intolerance in preterm neonates.

This study is a randomized clinical trial on preterm neonates admitted in two university-affiliated hospitals in Isfahan, Iran, during 2016 - 2017. Feeding is started for all neonates with 20 mL/kg/day doses and if they tolerate it, 20 mL/kg/day is added daily to receive toreach 150 mLcc/kg/day. The infants were divided into two groups, which received either Erythromycin (5 mg/kg/dose every 6 hours) or placebo for eight days. These outcomes were evaluated: time duration to reach 75, 110, and 150 mL/kg/day feeding volume, lavage count after the intervention, time duration of oxygen dependency and hospitalization, the incidence of necrotizing enterocolitis, intraventricular hemorrhage, patent ductus arteriosus, chronic lung disease, cholestatic icterus, sepsis, and hypertrophic pyloric stenosis.

Sixty-four neonates (female 38 (59.3%) and male 26 (40.6%)) with the mean gestational age 30.10 ± 2.49 weeks were evaluated. The mean time duration to reach 75, 110, and 150 mL/kg/day feeding volume was significantly lower in the Erythromycin group (4.19 vs. 6.84 days, P < 0.001, 6.35 vs. 9.08 days, P < 0.001 and 9 vs. 11.46 days, P < 0.001 in the Erythromycin vs. placebo groups, respectively). Also the number of lavages were significantly lower in the Erythromycin group (0.35 ± 0.56 vs. 3.03 ± 3.08 in the Eerythromycin and placebo groups; P < 0.001).

Intermediate dose of Erythromycin can reduce the time duration to reach full feeding volume and is safe for preterm neonates.

Endotracheal intubation is a common procedure in neonatal care. The objective of this study was to determine whether the premedication with remifentanil before intubation has analgesic effects in newborn infants.

A total of 40 premature infants who needed endotracheal intubation for intubation‑surfactant‑extubation method were randomly assigned in two groups of an equal number at two university hospitals. The control group was given 10 µg/kg atropine IV infusions in 1 min and then 2 ml normal saline. In the case group, the atropine was given with the same method and then remifentanil was administered 2 µg/kg IV infusions in 2 min.

For remifentanil and control groups, the mean birth weight were 1761 ± 64 and 1447 ± 63 grams (P = 0.29), and the mean gestational ages were 31.69 ± 3.5 and 30.56 ± 2.8 weeks (P = 0.28),respectively. Using premature infant pain profile score, infants who received remifentanil felt significantly less pain than the control group (15.1 ± 1.6 vs. 7.5 ± 1.4; P < 0.001). There were no significant differences in the duration of endotracheal intubation procedure (20.8 ± 6 vs. 22.8 ± 7.3 s; P = 0.33), the number of attempts for successful intubation and oxygen desaturation between groups.

Premedication with remifentanil has good analgesic effects for endotracheal intubation in premature infants without significant derangements in mean blood pressure and oxygen saturation.

Continuous positive airway pressure (CPAP) is used as respiratory support in preterm neonates; however, the best weaning method has not yet been determined. In this study, we compared sudden complete and gradual weaning from nasal CPAP (NCPAP) in preterm newborns.
This randomized controlled trial was conducted on 62 preterm neonates who were born with a gestational week of < 32 weeks and required NCPAP for at least 24 h. The neonates were stable on NCPAP at 0.21 FiO2 and 5 cm H2O positive end-expiratory pressure. They were randomized into two groups of gradual and sudden weaning using random numbers sheet. The primary outcome was successful weaning at the first attempt. The secondary outcomes included the number of NCPAP weaning attempts, the need for mechanical ventilation (nasal and endotracheal), duration of NCPAP, oxygenation, and length of hospital stay.
According to the results, 80.6% of the patients in the sudden weaning group and 74.2% of the patients in the gradual weaning group were weaned successfully in the first attempt. However, there was no statistically significant difference between the two groups in this regard (P=0.54). Duration of NCPAP was significantly lower in the sudden weaning group, compared to that in the gradual weaning group (P<0.001). Numbers of NCPAP weaning attempts, the need for mechanical ventilation, duration of oxygenation, and hospital stay in the two groups were not significantly different.
There was no difference between sudden complete and gradual weaning from NCPAP in terms of treatment success and complications. The selection of the appropriate technique may depend on available equipment and treatment costs.

Jaundice is one of the most common problems in the neonatal period. Phototherapy is one of the most commonly used treatments for jaundice that can be used as a simple, practical home-based treatment. Hospitalization during the first days of birth to conduct phototherapy may result in problems like nosocomial infections and mother separation from the baby. The aim of this study was to evaluate the efficacy of home phototherapy in the duration of treatment, mean bilirubin level, and complications. This clinical trial was performed on newborns with jaundice in Isfahan health centers. The sample was randomly divided into two groups: Phototherapy at home (32 patients) and phototherapy at the hospital (32 patients). A demographic questionnaire and a researcher-made checklist were used to collect data on variables such as the duration of treatment, the frequency of treatment failure, mean bilirubin, and phototherapy complications. The mean duration of phototherapy in both groups was two days, which showed no significant difference (P = 0.32). The most common complication in both groups was skin rashes and restlessness, which also showed no significant between two groups (P > 0.05). There was no significant difference in terms of treatment failure (P = 0.246). Statistical tests also revealed that bilirubin reduction was the same in both groups. Home phototherapy can be suggested as a safe treatment with no complication to the patients.

Considering all the latest achievements in neonatal respiratory care, bronchopulmonary dysplasia (BPD) is still among the most prevalent morbidity causes in premature infants. Involvement in this process results in longer period of hospitalization for the newborn and in the long run makes the living conditions more diffcult. Taking the multifactorial pathogenesis into account, approaches to tackle chronic lung disease (CLD) are mainly focused on interventions and prevention procedures. This study tries to investigate the potential capability of inhaled budesonide in the prevention of BPD in newborns with gestational age of This study was a randomized clinical trial done on seventy newborns with gestational ages of 23–28 weeks with RDS in Isfahan Shahid Beheshti Educational Hospital from June 2014 to April 2016. Patients were randomly assigned to two groups of intervention with budesonide and control. There were 35 newborns in each group. Upon recording demographic characteristics, the newborns in two groups were compared based on the length of noninvasive ventilation, the need for invasive mechanical ventilation, the number of surfactant administrations, pneumothorax, intraventricular hemorrhage, patent ductus arteriosus (PDA), CLD, and death.
The length of the need for nasal continuous positive airway pressure showed no statistically signifcant difference between the groups (P = 0.54). The number of newborns who needed invasive mechanical ventilation also revealed no meaningful difference (P = 0.14). Similarly,
the number of newborns who were characterized as affected by CLD also showed no signifcant difference between the groups (P = 0.053). Moreover, the number of newborns who experienced pneumothorax was not signifcantly different for the groups (P = 0.057). The number of newborns
who received three administrations of surfactant had also no statistically meaningful difference between the groups (P = 0.69). However, the number of newborns who received two doses of surfactant was statistically lower in budesonide intervention group than the control (P = 0.041).
The prevalence of intraventricular hemorrhage with degrees of I, II, and III also showed no statistically meaningful difference between the groups with P = 0.74, 0.32, and 0.49, respectively. The occurrence of PDA had no meaningful difference between the groups (P = 0.66). Relative death cases also revealed no signifcant difference between the groups (P = 0.53).
The current study revealed a decrease in CLD prevalence for newborns in interventional group; however, this decrease was not statistically meaningful. The newborns, in the intervention group, who had received two doses of surfactant (survanta) showed a signifcant decrease, which can be the basis for further research in this feld.

Premature birth may complicate the development and quality of the mother–infant attachment relationship. Music and kangaroo care are two common complementary cares performed in the neonatal intensive care unit (NICU). The present study investigated the effect of kangaroo care combined with music on the mother–premature neonate attachment.
In this clinical trial, 64 mothers with premature neonates were selected and assigned to the control and study groups through random allocation. In the control group, kangaroo care, and in the study group, kangaroo care combined with music was adopted. The level of mother–premature neonate attachment was measured and compared before and after the intervention in both the groups using Avant’s Maternal Attachment Assessment Scale.
There was a significant increase in the mean overall score of attachment in the kangaroo care combined with music group (70.72 (11.46)) after the intervention compared to the kangaroo care without music group (53.61 (9.76)).
The mean overall score of mother–neonate attachment in the kangaroo care combined with music group was higher than the kangaroo care group. This difference can be related to the effectiveness of music combined with kangaroo care.

Untreated procedural pain leads to long‑term and short‑term complications in neonates. Preventing pain in sick infants and neonates, whose conditions are getting worse, not only is a professional and legal duty but also a prevention measure to decrease future psychological and even neurological complications. Therefore, nurses should prevent newborns’ pain. The aim of this study was to compare the effects of massage and breastfeeding on the pain of the neonates.
This was a clinical trial conducted among 75 full‑term and near‑term infants who underwent venipuncture. The newborns were randomly allocated to the following groups (n = 25 for each): group 1, breastfeeding; group 2, massage; and group 3, control. In the first group, venipuncture was done 2 minutes after breastfeeding. In the second group, massage was done with effleurage technique for 3 minutes and venipuncture was done 2 minutes after massage. The Neonatal Infant Pain Scale (NIPS) was used for pain measurement in the first 30 seconds of venipuncture. Data were analyzed by t‑test and one‑way analysis of variance (ANOVA).
The lowest mean pain score recorded in the massage group (0.92) whereas it was 4.84 in the breastfeeding group and 6.16 in the control group. ANOVA test and post‑hoc statistics revealed that both interventions resulted in a significant reduction of the pain scores.
According to the findings of this study, the lowest pain score was in massage group, then in breastfeeding group and control group accordingly. Considering the fact that massage and breastfeeding are natural, useful, and cost free interventions and do not need any special facility, these methods are suggested in pain management and pain control during painful procedures administrated for infants.

Sleep is essential for organizing and maturation of the brain in premature infants; it also plays a role in maintaining the natural balance between different nervous centers. Given the role of nurses in neonatal sleep care, this study aimed at assessing the impact of a training program on the nurses’ knowledge and performance in a Neonatal Intensive Care Unit (NICU).
In this quasi‑experimental study which structured into three stages, 35 nurses working in an NICU in Isfahan, Iran, were included. The neonatal sleep training program was in the form of a lecture with questions and answers and then placing posters and booklets in the NICU. The data were collected by a questionnaire for nurses’ knowledge and performance assessment which its validity and reliability were determined through content validity and internal consistency, respectively. The nurses’ knowledge was assessed via 40 multiple‑choice questions before, immediately after, and 1 month after the training program, and their performance was evaluated before and 1 month after intervention using 15 multiple‑choice questions. The data were analyzed by descriptive and inferential statistics using the SPSS software version 16.
The results showed that the mean score of nurses’ knowledge after training has significantly increased as compared to before training (33.33 (4.4) vs. 19.33 (4.1)) (P The results indicated that this method of training program could lead to an increase in nurses’ knowledge, but it did not significantly improve their performance. It may be due to a low number of training sessions; therefore, it is recommended to implement long‑term training programs in this field.

In neonatal intensive care unit (NICU), neonatal sleep is disrupted due to different factors. Due to the critical role of sleep in premature infants’ brain development, this study aimed to investigate the effect of nesting and swaddling on the sleep duration of premature infants hospitalized in NICUs.
In a crossover clinical trial, 42 preterm infants who met the inclusion criteria were enrolled. They were randomly assigned to two groups of nest–swaddle and swaddle–nest. Sleep status was evaluated by observation and use of Prechtl’s criteria. Then, durations of total sleep time (TST) and quiet sleep time (QST) were recorded. Data were analyzed using repeated measure analysis of variance (ANOVA).
Mean values of TST and QST during nesting and also swaddling periods were significantly higher than in the control period in both groups (P Both swaddling and nesting could significantly increase the duration of TST and QST, compared to the control. There were no significant differences between the effects of these interventions on TST and QST. Therefore, using any of these methods is suggested to improve infants’ quality of sleep in NICU, with respect to the ward policies.

Premature neonates’ feeding is of great importance due to its effective role in their growth. These neonates should reach an independent oral nutrition stage before being discharged from the Neonatal Intensive care Unit. Therefore, the researcher decided to conduct a study on the effect of palady and cup feeding on premature neonates’ weight gain and their reaching full oral feeding time interval.
This is a clinical trial with a quantitative design conducted on 69 premature infants (gestational age between 29 and 32 weeks) who were assigned to cup (n = 34) and palady (n = 35) feeding groups through random allocation. The first feeding was administrated either by cup or palady method in each shift within seven sequential days (total of 21 cup and palady feedings). Then, the rest of feeding was administrated by gavage.
Mean hospitalization time (cup = 39.01 and palady = 30.4; P The neonates in palady group reached full oral feeding earlier than those of cup group. Subjects’ weight gain was also higher in palady group compared to the cup group. Premature neonates with over 30 weeks of gestational age and physiological stability can be fed by palady.

Kangaroo mother care (KMC) is the most implementation intervention in caring of the infants, as in this method, both the mothers and infants are cared. The World Health Organization recommends implementation of KMC for all infants. However, there are some barriers in the way of its application. The purpose of this study was evaluation of the practical application of KMC and nurses’ perspective about its implantation barriers in the neonatal intensive care units (NICUs) in Iran.
The descriptive study was conducted on 96 infants and 80 nurses working in the NICUs of two university hospitals in Isfahan, Iran. Data were collected by a two-section questionnaire and analyzed by t-test through SPSS 14.
Study findings indicated that mean weight and age of the infants with KMC were 1510 g and 32 weeks, respectively. KMC was implantation for 32 min in a day. From nurses’ perspective, mother-related barriers were the main barriers in the implantation of KMC as mothers were not present by their infants. Another barrier was the mothers’ fear of touching their infants. In the domain of organizational barriers, physician’s order was found to be the most important barrier in application of KMC.
Identifying barriers in implantation of KMC is essential to support the mothers. Regarding mother-related barriers, organizational barriers, and the need for a physician’s order for implementation of KMC, policy makers must provide facilities and equipment for applying KMC practice for mothers and improve the protocol of KMC in the NICU.

Gradually over time, the number of premature deliveries has increased. In these circumstances, many neonatal intensive care units (NICUs) show a tendency towards early discharge due to frequent requests for admission of new premature newborns. In a descriptive-analytical study, we retrospectively surveyed the premature infants’ files for gestational age (GA), birth weight (BW), and the duration of the first hospitalization during 2010-2011. Furthermore, the readmission rate during the first year of life and causes were identified. During the study period, 495 infants were enrolled. The ranges of gestational age and birth weight of infants who were admitted in neonatal intensive care unit were 24-36 weeks and 470-2500 g, respectively. 172 (34.74%) infants had a birth weight of less than 1500 g (very low birth weight or VLBW); and 144 of them (29.09%) were severely premature (gestational age of 24-31 weeks). The median (range) time of hospitalization in VLBW infants was 22 days (1-75). 67 (15.3%) infants were rehospitalized during the first year of life. Only 32 (6.4%) of all infants were readmitted during the first three months of life. Pneumonia (32.89%), icter (17.10%), treatment of retinopathy of prematurity (ROP) (10.52%) and sepsis (9.20%) were the four most common causes of rehospitalization during the first year of life. Due to the high rate of reception requests for premature newborns and the low possibility for readmission, this research suggested that premature neonates who could have controlled body temperature at room temperature, with no recent apnea or bradycardia and with weight increasing via feeding, could be discharged regardless of gestational age and body weight.

To compare two methods of weaning premature infants from nasal continuous positive airway pressure (NCPAP). Between March and November 2012, 88 preterm infants who were stable on NCPAP of 5 cmH2O with FIO2 <30% for a minimum of 6 h were randomly allocated to one of two groups. The high flow nasal cannula (HFNC) group received HFNC with flow of 2 L/min and FIO2 = 0.3 and then stepwise reduction of FIO2 and then flow. The non‑HFNC group was maintained on NCPAP of 5 cmH2O and gradual reduction of oxygen until they were on FIO2 = 0.21 for 6 h, and we had weaned them directly from NCPAP (with pressure of 5 cmH2O) to room air. No significant differences were found between 2 study groups with regards to gestational age, birth weight, Apgar score at 1 and 5 min after birth, patent ductus arteriosus and use of xanthines. The mean duration of oxygen therapy after randomization was significantly lower in HFNC group compared to non‑HFNC group (20.6 ± 16.8 h vs. 49.6 ± 25.3 h, P < 0.001). Also, the mean length of hospital stay was significantly lower in HFNC group compared to non‑HFNC group (11.3 ± 7.8 days vs. 14.8 ± 8.6 days, P = 0.04). The rate of successful weaning was not statistically different between two groups. Weaning from NCPAP to HFNC could decrease the duration of oxygen therapy and length of hospitalization in preterm infants.

Surfactant administration together with nasal Continuous Positive Airway Pressure (nCPAP) administration is considered to be the basis for Newborn’s Respiratory Distress Syndrome (RDS) management. This study evaluated the method of directing the surfactant to the lungs in newborns affiliated with RDS through i-gel (i-gel surfactant administration/i-gelSA) compared to the standard care INSURE method, in a clinical trial.

This randomized control trial (RCT) was done on newborns weighing ≥2000 g, with RDS, while being supported with Bubble-CPAP. Newborns, which required FiO2 ≥0.3 under Continuous Distending Pressure (CDP) ≥5 cm H2 O for more than 30 minutes to maintain SpO2 in the range of 89 - 95%, were given 100 mg/kg of Survanta. In the interventional group or the i-gelSA (i-gel Surfactant Administration) group, 35 newborns experienced surfactant administration with i-gel and 35 newborns in the control or INSURE group. The average a/APO2 before and after surfactant administration, repeated need for surfactant administration, average nCPAP duration, need for invasive mechanical ventilation, pneumothorax, and the average duration of hospitalization in the Neonatal Intensive Care Unit (NICU) were compared.

Although the average a/APO2 showed no significant difference before the procedure; in the i-gelSA group, this average was meaningfully higher after the administration of the surfactant (P = 0.001). The other factors showed no significant difference.

According to the results of this study, the surfactant administration using i-gel was more successful in oxygenation improvement than the INSURE method, and the i-gel method could even be promoted to the standard care position. However, more research is needed in this area.

The aim of this study was to assess the success rate of nasal intermittent positive pressure ventilation (NIPPV) for treatment of continuous positive airway pressure (CPAP) failure and prevention of conventional ventilation (CV) in pretermneonates. Since November 2012 to April 2013, a total number of 55 consecutive newborns with gestational ages of 26-35 weeks who had CPAP failure were randomly assigned to one of the two groups. The NIPPV group received NIPPV with the initial peak inspiratory pressure (PIP) of 16-20 cmH2O and frequency of 40-60 breaths/min. The CV group received PIP of 12-20 cmH2O and frequency of 40-60 breaths/min. About 74% of newborns who received NIPPV for management of CPAP failure responded to NIPPV and did not need intubation and mechanical ventilation. Newborns with lower postnatal age at entry to the study and lower 5 min Apgar scoremore likely had NIPPV failure. In addition, treatment failure was higher in newborns who needed more frequent doses of surfactant. Duration of oxygen therapy was 9.28 days in CV group and 7.77 days in NIPPV group (P = 0.050). Length of hospital stay in CV group and NIPPV groups were 48.7 and 41.7 days, respectively (P = 0.097). NIPPV could decrease the need for intubation and mechanical ventilation in preterm infants with CPAP failure.

Light-emitting diodes (LEDs) are light sources recently used for phototherapy in neonatal jaundice. We compared the efficacy and safety of LEDs with fluorescent phototherapy in the treatment of indirect hyperbilirubinemia.

This controlled trial was conducted on preterm infants hospitalized in neonatal intensive care unit of Shahid Beheshti Hospital in Isfahan (Iran) who needed conventional phototherapy for uncomplicated indirect hyperbilirubinemia. Neonates received phototherapy through devices with LEDs or special blue fluorescent tubes. Primary outcomes included the rate of fall of total serum bilirubin (TSB, mg/ dL/hour) and duration of phototherapy (hours). Secondary outcomes were treatment failure and side effects.

A total of 64 infants with gestational age of 33.5 ± 1.2 weeks, chronological age of 73.0 [SE = 7.3] hours, and weight of 1757.5 ± 147.6 gram were enrolled. The rates of fall of TSB were 0.20 [SE = 0.03] and 0.12 [SE = 0.01] mg/dL/hour in the LED and fluorescent groups, respectively (P = 0.472). Treatment duration was 37.5 ± 26.8 and 45.3 ± 32.1 hours in the LED and fluorescent groups, respectively (P = 0.292). There was no treatment failure in the two groups. Mild hyperthermia was occurred in 3.1% and 28.1% of infants in the LED and fluorescent groups, respectively (P = 0.006).

LED light source is as effective as fluorescent tubes for phototherapy of preterm infants with indirect hyperbilirubinemia. Considering less frequent side effects, less energy consumption, longer life span, and lower costs, LED phototherapy seems to be a better option than current conventional phototherapy

Mechanical ventilation is used for some infants in neonatal intensive care units (NICU) due to many physiological and clinical causes. Since these patients have endotracheal tubes, cleaning and keeping the airways open through suctioning should be done to increase oxygenation. This study aimed to evaluate effect of open and closed suctioning methods on respiratory parameters of infants undergoing mechanical ventilation. In this crossover clinical trial, 44 infants were selected among those undergone mechanical ventilation in NICU of Isfahan’s Al-Zahra Hospital using convenience sampling method. The subjects were randomly divided into two groups. In the first group, open suctioning was carried out and after three hours of cleaning, closed suctioning was done. In the second group, closed suctioning was firstly done and following three hours of cleaning, open suctioning was implemented. Respiratory rate (RR) and percentage of arterial blood oxygen saturation was measured before, during and after each type of suctioning. Data were analyzed using repeated measures ANOVA and independent student’s t-test. There was a significant difference between mean respiratory rate and arterial blood oxygen saturation in infants before, during and after the closed and open suctioning. The percentage of arterial blood oxygen saturation had a significant reduction in open method compared to closed method during suctioning and immediately after it. RR three minutes after suctioning showed a significant reduction in both steps in open method compared to closed method. Close method caused fewer changes in hemodynamic status of infants. Therefore, in order to prevent respiratory complications in infants, nurses are recommended to perform the endotracheal tube suctioning by closed method.

This study was performed to find out whether transcutaneous bilirubinometry could be a valid screening method for hyperbilirubinemia in preterm infants, especially for those who needed mechanical ventilation. We evaluated 63 preterm Iranian newborns who were managed in the neonatal intensive care unit of Shahidbeheshti University Hospital, Isfahan, Iran from April 2009 to April 2010.Transcutaneous bilirubin (TCB) measurements were obtained using BiliCheck™ shortly before or 10 minutes after taking blood for determination of the plasma bilirubin level in premature newborns, who did not receive phototherapy. We assessed the correlation between the transcutaneous bilirubin and plasmabilirubin level by linear regression analysis. We also analyzed the gestational age, birth weight, postnatal age, sex, and hematocrit, for determination of their effect on transcutaneous bilirubin accuracy. The overall bilirubin concentration ranged from 5.4 to 17 mg/dL and from 4.8 to 17.3 mg/dl for total serum bilirubin (TSB) and transcutaneous bilirubin, respectively. The mean values obtained by transcutaneous bilirubinometry were slightly higher than the total TSB values. The correlation coefficient between TSB and TCB was r=0.82, P<0.001, and this was not influenced by gestational age, postnatal age or hematocrit, which were previously considered to be important. The correlation coefficient between TSB and TCB in mechanically ventilated preterm infants was r=0.75, P<0.001. Plasma bilirubin level can be accurately measured by BiliCheck™ in premature newborns, even in newborns who need mechanical ventilation.

Preterm and low birth weight (LBW) infants are at greater risk of developing bilirubin-associated brain damage compared with term infants. Certainly, phototherapy, if used appropriately, is capable of controlling the bilirubin levels in LBW infants; but there is not a unique phototherapy treatment strategy in LBW infants. This study was designed to compare the prophylactic phototherapy and late treatment of jaundiced newborns weighing 1000-1500 grams. Sixty newborns with birth weight 1000-1500 g were studied. They were divided into two groups: the "Prophylactic" group, in which phototherapy started within six hours after birth and continued for at least 96 hours, and the "Treatment" group, which received phototherapy when indicated according to birth weight and suspended when bilirubin level fell below 50% of bilirubin level for blood exchange. Mean value of daily transcutaneous bilirubin (TCB), duration of phototherapy, the need for blood exchange, and the highest TCB value in both groups were analyzed. In the prophylactic group, the highest daily mean rate of TCB was 7.71±1.84 mg/dl, which happened on the third day. In the treatment group, it was 8.74±1.72 mg/dl on the fourth day after birth. The TCB values in prophylactic group were significantly less than those of the treatment group only on the fourth and fifth days after birth (P<0.001). Although the median duration of phototherapy in the treatment group was shorter than that of the prophylactic group (137.60±57.39 vs 168.71±88.01 hours, respectively), this difference was not statistically significant. Only one neonate needed blood exchange in the treatment group. The prophylactic phototherapy treatment for babies weighing 1000-1500 g significantly decreases bilirubin levels on the fourth and fifth days after birth but the clinical course of hyperbilirubinemia does not alter in LBW infant, as indicated by the non-significant change in the duration of phototherapy.

Various continuous positive airway pressure (CPAP) devices have been used in treatment of neonates with respiratory distress syndrome (RDS). This study was designed to compare the efficacy of bubble CPAP versus medijet CPAP, used along with surfactant, to treat RDS during the first hours of life. Eighty-eight neonates with gestational age between 29 to 336/7 weeks who had clinical manifestations of RDS and required FIO2 > 21% were randomly assigned to receive either bubble CPAP or medijet CPAP (44 in each group). During the first 30 to 60 minutes of life, if CPAP rises to 8 cm H2O and FIO2 requirement exceeds 40%, surfactant was administered via endotracheal tube. The procedure was repeated twice more at 12 hour intervals, if CPAP treatment had to be continued with FIO2 > 30%. Mechanical ventilation was considered in the presence of clinical or laboratory evidence of respiratory failure. Duration of CPAP treatment and oxygen therapy, need for second and third doses of surfactant and mechanical ventilation, and the occurrence of chronic lung disease (CLD) and pneumothorax were compared between groups. There was no significant difference in the duration of CPAP treatment and oxygen therapy between bubble CPAP and medijet CPAP groups (47 ± 25.7 vs. 46.7 ± 22.4 [P = 0.874] and 158.7 ± 191.9 vs. 144 ± 165.9 [P = 0.702], respectively). The need for second and third doses of surfactant and mechanical ventilation, and the occurrence of CLD and pneumothorax were not significantly different between groups (P was 1, 0.361, 1, 0.72 and 1, respectively). Considering the limited available data, it is highly recommended to evaluate the similar efficacy of bubble CPAP and medijet CPAP in treatment of RDS, along with the use of surfactant, in other large clinical trials.