جستجوی مقالات مرتبط با کلیدواژه « preterm infants » در نشریات گروه « پزشکی »

Premature infants (born before 37 weeks of gestational age) frequently experience feeding difficulties due to underdeveloped oral motor skills and poor chewing, swallowing, and breathing coordination. In order to improve oral feeding efficiency in these infants, Oral-Motor Stimulation (OMS) has been used in various studies. This systematic review study will aim to assess the effectiveness of OMS for oral feeding in preterm infants.

The authors will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. They will conduct a search in electronic databases, including PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials in The Cochrane Library (CENTRAL), Medline via PubMed, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for nursing and related healthcare texts without language restrictions from the first month of 1991 to the fifth month of 2024 to achieve the study objectives. All Randomized Controlled Clinical Trials (RCT) examining the effect of OMS on oral feeding in preterm infants will be included in this study.

The primary outcome of this systematic review will be oral feeding, and the secondary outcomes will include duration of hospitalization, weight gain, and feeding efficiency. Two independent reviewers will select and extract data for the study. The Cochrane Risk of Bias Tool (RoB2) will be used to evaluate potential biases in the study. Publication bias will be evaluated using funnel plots, Begg’s, and Egger’s tests. The degree of heterogeneity among the studies will be assessed using the I2 statistic and the χ2 test. Analyses of subgroups will also be carried out. All meta-analyses will be conducted using Stata V.14.

This systematic review protocol for preterm infants will aim to promote evidence-based decision-making and support the development of clinical practice guidelines in preterm feeding.

The fetus receives various vestibular stimuli as a result of its mother’s walking and other activities, while premature infants are deprived of these typical stimuli due to hospitalization in a neonatal intensive care unit (NICU).

A single blinded randomized controlled clinical trial was designed to evaluate the effect of rhythmic maternal movements (RMM) on motor performance of infants born preterm with gestational age under 34 weeks. The aim of this plan is to stimulate the vestibular system in infants after preterm birth in hopes of improving motor performance. Seventy preterm infants will be randomized to experimental and control groups. The infants in the experimental group will be given RMM to improve motor development, heart rate and sao2. A neonatal occupational therapist trains mothers to do the RMM with a doll and explains the protocol. RMM is performed twice a day for a week. The Test of Infant Motor Performance (TIMP) is carried out at baseline and after a week of intervention by a blinded assessor.

This paper designed to study the effects of rhythmic maternal movements on motor performance, heart rate and sao2 of preterm infants hospitalized in a Neonatal Intensive Care Unit.

Preterm neonates are at high risk for a wide range of diseases and serious complications, namely intracranial hemorrhage (ICH). This cross-sectional study included 120 infants (60 preterm infants with intracranial hemorrhage and 60 healthy preterm infants) under 37 weeks old. In the first 3-4 days after birth, color Doppler of the neonatal middle cerebral artery was performed. Then, serial Doppler ultrasound was performed weekly (first four weeks after delivery) for one month and was compared between the two groups. In this study, among the Doppler parameters in the first week after birth, none of the parameters AT, S/D, PI, RI, and PSV were statistically significant between the two groups of preterm infants with ICH and normal preterm infants (P>0.05). None of the Doppler parameters AT, S/D, PI, RI, and PSV were statistically significant between the two groups of preterm infants with intracranial hemorrhage and normal preterm infants.

 Hypothyroidism is one of the most common causes of preventable intellectual disability and is common in preterm infants. Some studies have reported that developmental delay is still high in these patients despite appropriate treatment.

 This study aimed to investigate the short-term neurodevelopmental outcome of preterm infants with thyroid dysfunction.

 This cohort study included 50 preterm infants with thyroid dysfunction requiring levothyroxine treatment (case group) and 50 age- and sex-matched healthy preterm infants with normal thyroid tests (control group). The patients were followed, and Ages and Stages Questionnaires (ASQ) (including five domains) were filled out at 6 and 12 months to evaluate the short-term neurodevelopmental outcome.

 There was no statistically significant difference in gestational age, sex, and birth weight between the two groups (P-values = 0.648, 0.756, and 0.866, respectively). A total number of 4 (8%) and 7 (14%) of the case group and 1 (2.85%) and 2 (5.71%) of the control group had a possible neurodevelopmental delay based on the low score in at least one domain of ASQ at 6 and 12 months of age (P-values = 0.321 and 0.222, respectively). Treated hypothyroidism was not significantly associated with higher impaired neurodevelopmental outcomes (P-value = 0.236, Odd Ratio: 2.686, 95%CI: 0.523 - 13.787).

 In this study, the risk of neurodevelopmental impairment in preterm infants with hypothyroidism was similar to that of healthy preterm infants. Thus, these findings may confirm the adequacy of levothyroxine replacement therapy in preventing neurodevelopmental delay.

 The placenta, as a link between mother and fetus, is closely related to the development of the fetal nervous system. Histological chorioamnionitis (HCA) is common placental inflammation and an important factor in triggering premature delivery. Anabolic steroid (AS) is an important medication to promote fetal lung maturity. Therefore, this study investigated the relationship between HCA, AS, and brain injury in premature infants.

 This research aimed to explore the correlation of pathological changes in the placental HCA and the prenatal use of AS with brain injury in preterm infants.

 In total, 339 premature infants with a gestational age of under 34 weeks were taken as research subjects, and the placenta was examined by pathology after delivery. The samples were divided into HCA+ AS+, HCA+ AS-, HCA- AS+, and HCA- AS- groups based on the pathological results of the placenta and the prenatal use of steroid hormones. The occurrence of brain injury in preterm infants and the level of inflammatory indicators 2 h after birth were compared between the groups.

 The incidence of brain injury in preterm infants in the HCA+ group was higher than in the HCA- group (χ2 = 5.713, P < 0.05), and the AS- group than in the AS+ group (χ2 = 4.368, P < 0.05); The incidence of brain injury in the HCA+ AS+, HCA+ AS- and HCA- AS-groups was significantly higher than in the HCA- AS+ group (χ2 = 6.105, P = 0.013; χ2 = 9.086, P = 0.003; χ2 = 4.848, P = 0.047, respectively). The incidence of brain injury in preterm infants was the highest in the group (30%). When the procalcitonin level 2 h after birth was 0.213 ng/mL, sensitivity to predict the occurrence of brain injury in preterm infants was 70.7%, and specificity was 80.2%.

 Brain damage in premature infants is related to HCA in the mother and insufficient AS treatment before delivery. Brain damage is more likely to occur when both factors exist.

 Infants’ admission to neonatal intensive care units (NICUs) leads to the psychological vulnerability of their mothers. Providing education and implementing supportive interventions can improve the quality of parental care of premature infants and empower parents. The presence and participation of parents in the care of preterm infants may improve parents’ resilience.

 This study aimed to examine the effect of a virtual educational and supportive intervention on the mothers’ resilience with preterm infants admitted to NICUs in 2020.

 This quasi-experimental study was conducted on 100 mothers with preterm infants admitted to Afzalipour Hospital in Kerman in 2020. The participants were selected by purposive and convenience sampling and were divided into intervention and control groups using a random number table. The educational and supportive training intervention program was implemented for 2 weeks in the intervention group. However, the control group only received routine care. The data were collected using a demographic information questionnaire and the Connor-Davidson Resilience Scale (CD-RISC). The collected data were analyzed using SPSS version 22 at a significance level of 0.05.

 Resilience and all its dimensions showed significant improvements in the intervention group compared to their resilience before the intervention. The mean resilience scores in the intervention group were 57.62 ± 13.95 and 76.96 ± 08.07 before and after the intervention (P < 0.05). The mean resilience scores in the control group were 60.40 ± 14.41 and 62.70 ± 11.09 before and after the intervention (P > 0.05). Overall, the mean scores of resilience and its dimensions increased significantly in the intervention group than in the control group (P < 0.05).

 Implementing a virtual educational and supportive intervention improved the resilience of mothers with preterm infants. Overall, this program can be used by nursing managers and nurses to provide supportive care for parents of premature infants to improve the quality of care in these wards. Further research can be done to examine the attitudes and experiences of health care workers in this field.

Jaundice is a common neonatal disorder that occurs in most term and preterm infants. Chicory or dandelion flower has long been used in the treatment of jaundice. This study aimed to investigate the effect of common chicory essence and phototherapy on serum bilirubin levels in preterm infants admitted to the neonatal intensive care unit (NICU) of Valiasr Hospital in Birjand, Iran. This in vitro study was conducted on preterm infants with gestational age of less than 37 weeks and weight less than 2500 g. Bilirubin levels in blood samples from 21 infants were measured before and after the addition of chicory essence or distilled water. Then, phototherapy was performed, and bilirubin levels were measured again. Data were analyzed using SPSS (version 21). The mean weight of infants was 1542.8 ± 453.5 g. In the chicory essence group, the mean total serum bilirubin was 5.29 ± 1.55 and 0.18 ± 0.07 mg/dL before and after the intervention, respectively (P < 0.001). The mean indirect serum bilirubin was 4.96 ± 1.59 and 0.18 ± 0.07 mg/dL before and after the intervention, respectively (P < 0.001). The mean changes in total bilirubin in the distilled water and chicory groups were 5.15 ± 1.70 and 5.43 ± 1.99 mg/dL, respectively (P = 0.62). The results showed that both distilled water and chicory essence decreased direct and total serum bilirubin concentrations. The indirect bilirubin changes were not significant, and there was no difference in the total bilirubin changes between the two groups. Totally, the chicory essence had no effect on reducing the serum bilirubin level in preterm infants.

Respiratory distress in neonates is the most common condition of preterm infants receiving treatment in the neonatal intensive care unit. As a clinical assessment of respiratory distress, the Downes score can predict the risk of respiratory failure. The present study aimed to determine the survival of respiratory failure in the first 72 h in preterm infants with respiratory distress based on the Downes score assessment. A prospective cohort survival analysis was performed at three hospitals in Indonesia (Al-Islam Hospital, Bandung, Al-Ihsan Hospital, Bandung, and Cibabat Hospital, Cimahi) from April to July 2021. Subjects were infants aged 28-36 weeks, with respiratory distress based on the Downes score within the first 2, 6, 12, 24, 48, and 72 h after delivery. The analyzed variables included birth weight ([BW], <1500 vs. 1500-2500 g), gestational age ([GA], 28-32 vs. 32-37 weeks), and 5-min APGAR score (<7 vs. >7). Bivariate and multivariate analyses were conducted with Cox regression proportional hazard and the Kaplan-Meier estimate of survival rate was also performed. In addition, the adjusted hazard ratio (aHR) was calculated, and a P-value of less than 0.05 was considered statistically significant. Of the 89 subjects who met the criteria, 20 (22.47%) experienced respiratory failure. The multivariate analysis including BW (aHR: 1.846, 95%CI: 0.570-5.979, P> 0.05), GA (aHR: 2.273, 95 %CI: 0.697-7.416, P>0.05), and the 5-min APGAR score (aHR: 2.049, 95%CI: 0.811-5.179, P>0.05) estimated the survival rate for respiratory failure at the age of 72 h at 74.7% (standard error: 0.05%). A GA of <32 weeks, a BW of <1500 g, and the condition of asphyxia simultaneously increased the aHR of respiratory failure, with an estimated survival rate of 74.7%.

There is insufficient evidence supporting the superiority of the Nasal Intermittent Positive-Pressure Ventilation (NIPPV) over the Nasal Continuous Positive Airway Pressure (NCPAP) in initial respiratory support of preterm neonates suffering from the Respiratory Distress Syndrome (RDS). The present study intended to compare the effectiveness of these two approaches in preterm neonates with RDS who receive the Less Invasive Surfactant Administration (LISA).

The present clinical trial included 95 preterm neonates at the Fatemieh Hospital, Hamadan, Iran, from October 2019 to September 2020, with RDS, admitted to the Neonatal Intensive Care Unit. Sampling was performed using the convenience method. The participants were randomly assigned into two groups that received the NIPPV (n=48) or NCPAP (n=47) as the respiratory support method. Moreover, the neonates received LISA if needed. The groups were compared in the outcomes, such as the need for intubation within 72 hours after birth.

The groups were similar in clinical characteristics at birth. According to our findings, the NIPPV group had a significantly lower rate of need for intubation and invasive mechanical ventilation within 72 hours after birth  compared to the control group (8.3% vs. 27.7%, P=0.014); however, the groups were not significantly different regarding the need for the second dose of surfactant (66% vs. 56.2%, P=0.332), the mean respiratory support duration (6.89±3.20 vs. 6.70±3.71 days, P=0.295), the mean hospital stay (19.52±12.364 vs. 17.40±9.57 days, P=0.591), development of bronchopulmonary dysplasia (4.2% vs. 8.5%, P=0.435), and mortality (6.25% vs. 12.8%, P=0.317).

Compared to NCPAP, the NIPPV could significantly reduce the need for invasive mechanical ventilation within 72 hours after birth in neonates undergoing LISA

The interaction between premature infants and the ectopic environment requires special care due to developmental defects in various systems of their body. In this regard, the results of various studies have introduced the stimulation of premature infants with the smell of breast milk as an effective way to improve the physiological responses caused by prematurity and reduce the problems associated with prematurity. The aim of this study was to systematically review the intervention studies of aromatherapy with breast milk on improving behavioral and physiological responses and reducing prematurity problems in premature infants. A comprehensive search of related scientific studies, published until February 2020, was conducted in scientific databases of PubMed, ISI, Web of Science, Cochrane Library,  and  Scopus using the following keywords: Breast Milk, Maternal Milk odor, Mother's Milk, Mother's odor, Premature Birth, Olfactive stimulation, Pain, Aromatherapy, Apnea, Preterm infant, Preterm infant pain, Infant behavior, Infant physiological response. After applying the entry and exit criteria, 14 Articles were selected. The results revealed a decrease in transition feeding days in premature infants of the intervention group in exposure to an impregnated pad with breast milk as olfactory stimulation, when compared to the control group. Based on the results, longer sucking bouts, more bursts (>7 sucking movements) and more consumed milk were reported for the intervention group during each breastfeeding session, when compared to the control group. The frequency of sucking in response to fresh breast milk was also higher than frozen breast milk, but not statistically significant (p = 0.09). There was an elevation in the high-amplitude non-nutritive sucking frequency among the preterm infants within the last three days of 14-day study after presenting the odor of the maternal breast milk for a 60-second period. Beneficial effects occurred in the hospitalized infants due to the odor of mother; they included increasing mouth movements and pacifier acceptance, calming stressed or crying infants, and relieving their pain. The infant's ability to feed increases and the duration of the first lactation decreases due to the olfactory stimulation of the breast milk odor; and the number of sucks (260.4 [95% CI = 206-315]) and suck bursts (41.0 [95% CI = 36-46]) was unexpectedly observed in group 1 (breast milk odor), as compared to group 2 (144.8 [95% CI = 87-203] versus 27.4 [95% CI = 21-34]) This study showed that the use of aromatherapy with the mom’s milk is very effective in improving the behavioral and physiological response; and reduces the problems resulting from prematurity in premature babies. Therefore, the smell of breast milk can be used as a complementary method to accelerate the health promotion of premature infants.

The respiratory distress syndrome (RDS) is a common pulmonary disorder that usually occurs as a result of preterm labor and is associated with lack of surfactant. The aim of this study was to evaluate the pattern of surfactant prescription in Alzahra teaching hospital in Tabriz, Iran. 

This drug use evaluation (DUE) study was conducted in the neonatal intensive care unit (NICU) of Al-Zahra Hospital, Tabriz, Iran. The demographic and clinical data collection was performed using clinical records of patients. The pattern of surfactant replacement therapy was evaluated and compared with the European Consensus Guideline on the management of respiratory distress syndrome in 2016. 

A total of 252 premature infants who received surfactant between August 2017 and March 2018 were included. 80.8% of neonates were born by cesarean section. The most used surfactant was Curosurf®, which was used in 82.1% of cases. Only 34.9% of the infants received within 8 hours of birth. Moreover, 79% of infants received the standard dose of surfactant, while 9.5 % and 11.5% were given high and low doses of surfactant, respectively. 

The pattern of surfactant replacement therapy was not completely according to the guidelines, particularly regarding the time of administration.  Considering the importance of dose and timely administration of surfactant, providing strategies to decrease these errors are important.

Prematurity is one of the major health problems and common causes of neonatal mortality. One of the complications of premature infants is hyponatremia. The effect of hyponatremia on the prognosis of preterm infants has not been well studied. This study aimed to evaluate infants with late hyponatremia, its risk factors, and prognosis.

This descriptive analytical study reviewed preterm infants (<34 weeks) admitted to Al-Zahra or Children’s Hospital in Tabriz for one year (2019). Neonates diagnosed with hyponatremia after the second week were identified and evaluated for risk factors and short-term outcome.

A total of 186 neonates were studied. The mean gestational age of the neonates was 30 weeks (first and third quarters = 29-32 weeks). 101 (54.3%) infants were male. The route of delivery was the cesarean section in 60.7% of cases. Late hyponatremia was present in 50 (26.8 %) infants. Gestational age and birth weight were significantly lower in infants with hyponatremia than in the control group. Multivariate analysis showed that low birth weight, the use of prenatal steroids, and inappropriate weight for gestational age status independently predict the incidence of late hyponatremia. There was a significant relationship between the presence of prolonged late hyponatremia (over 7 days) and bronchopulmonary dysplasia and osteopenia of prematurity. However, no significant association was found between the presence of prolonged late hyponatremia in preterm infants with the length of hospital stay and in-hospital mortality.

Based on the findings of this study, low birth weight, prenatal steroid use, and lack of appropriate weight for gestational age were risk factors for late hyponatremia in preterm infants. Prolonged hyponatremia is associated with bronchopulmonary dysplasia and osteopenia of prematurity

Intraventricular hemorrhage (IVH) is a major cause of brain injury in preterm infants. Considering the high prevalence of IVH in preterm infants and the importance of determining the risk factors, this study was done to evaluate the prevalence of various grades of IVH and identify the different associated factors and short-term complications.

In this retrospective study, the medical records of 54 preterm infants (26-37 weeks gestational age) admitted to the neonatal intensive care unit (NICU) of Bahrami Hospital, Tehran, Iran (2015-2018) were examined. Cranial ultrasonography was performed in all patients, and IVH was classified into 4 grades. A checklist was prepared and filled them out, and then the data were analyzed using SPSS-21.

Out of all subjects, IVH was found in 11 infants (20.4%). The most frequent IVH grades were 1 and 2. The most common Apgar scores in the fifth minute was 6. The mean weight of infants and Apgar score in patients with IVH was significantly lower than that of those without IVH. In multivariate logistic regression analysis of factors affecting IVH, Apgar score was the only significant independent predictor of IVH, such that with each number increase in Apgar score, the risk of IVH decreased (up to 100%).

Based on the results of this study, birth weight, gestational age and fifth-minute Apgar score were associated with IVH. Prevention of preterm birth and other preventive measures can reduce the complications of this disease.

Bronchopulmonary dysplasia (BPD) remains a major problem in preterm infants that occurs in up to 50% of preterm infants. The inflammation plays an important role in its pathogenesis. This study was conducted to evaluate the efficacy intratracheal budesonide administration in combination with surfactant in the prevention of BPD in preterm infants.

In a randomized controlled clinical trial, 128 preterm infants with gestation age <30 weeks and birth weight <1250 g who had respiratory distress syndrome (RDS) and need surfactant replacement therapy were studied. They randomly allocated into two groups, surfactant group (n = 64) and surfactant + budesonide group (n = 64). Patients were followed till discharge for the primary outcome which was BPD.

The mean gestation age and birth weight of studied neonates were 28.3 ± 1.6 weeks and 1072 ± 180 g, respectively. BPD was occurred in 20 (31.3%) neonates in surfactant + budesonide group and 38 (59.4%) patients in surfactant group, P = 0.02. Respiratory support was needed in two groups similarly, but the mean duration of respiratory support was significantly longer in surfactant group in comparison with surfactant + budesonide group (mechanical ventilation 2.8 ± 0.6 vs. 0.8 ± 0.1 days, P = 0.006, nasal continuous positive airway pressure 5.2 ± 3.0 vs. 4.0 ± 3.5 days, P = 0.04 and high flow nasal cannula 7.7 ± 0.9 vs. 4.1 ± 0.5 days, P = 0.001).

Based on our findings, the use of budesonide in addition to surfactant for rescue therapy of RDS significantly decreases the incidence of BPD and duration of respiratory support. Future studies are recommended with a large number of patients before routine administration of surfactant and budesonide combination.

Oral ibuprofen has been known as a conventional treatment for closing patent ductus arteriosus(PDA) in preterm newborns. Since the use of it might lead to various side effects, other treatments needed to be evaluated. Therefore in a prospective study, we compared the efficacy and safety of intravenous acetaminophen versus oral ibuprofen for the closure of PDA.                                   

In this study which was done prospectively and under control, 50 preterm neonates with gestational ages and weights less than 37 weeks old and 2500 grams, respectively, who had PDA, large enough hemodynamically, were included in the study. The patients were divided into two groups: A(intravenous acetaminophen) & B(oral ibuprofen). The two groups were given at most two 3-day courses of the medication(the second course if necessary) and evaluated at the end of each course by echocardiography so as to determine the response to the treatment at each step. The rate of  ductal closure, the need for additional treatment, side effects, complications and the newborn’s clinical status were recorded. 

 Results:

The rate of ductal closure in the both groups after one course of treatment was similar and showed no meaningful significance statistically(P value=0.306). But that of the side effects was much higher in group B with a P value=0.021.

Intravenous Acetaminophen is not only as efficatious as oral Ibuprofen for the treatment