High Risk Infants Follow-Up: A Case Study in Iran

The Effect of Home Visit Program Based on the Continued Kangaroo Mother Care on Maternal Resiliency and Development of Premature Infant: A Randomized Clinical Trial

BACKGROUND

Premature birth is a crisis for mothers and affects resilience. Premature babies are at risk for developmental disorders. The Kangaroo Mother Care (KMC) can reduce maternal stress and improve the growth of the baby. This study aimed at assessing the effect of home visit based on the continued KMC on maternal resiliency and development of premature infant.

METHODS

This randomized controlled trial conducted on 50 pairs of mothers and premature babies with gestational age of 26-32 weeks who were admitted to Neonatal Intensive Care Unit of Om-al-Banin Hospital, Mashhad, Iran in 2019. The KMC is practiced routinely for all eligible newborns in this hospital. The experimental group continued the KMC one month after discharge at home and received two home visits. Resiliency of the mothers was assessed in admission, discharge, and one month after discharge with the Connor and Davison questionnaire and the development of the newborns was assessed in two months of adjusted age with Ages and Stages Questionnaire (ASQ). Data analysis was performed using SPSS software version 16 and t-test, Mann-Whitney, ANOVA, Friedman, Chi-square, Fishers exact. The significance level was set at P<0.05.

RESULTS

The resiliency score of the mothers one month after discharge was112.50±5.50 and 76.40±5.60 in the experimental and control groups, which was significantly different (P<0.001). The ASQ development score of the newborns in two months of adjusted age was also significantly higher in the experimental than the control group (280.40±15.60vs223.80±22.00) (P<0.001).

CONCLUSION

The results showed that the home visit program based on the continued KMC was effective in increasing maternal resilience and the development of premature infants. Trial Registration Number IRCT20181121041718N1.

Risk factors for hearing impairment in neonates in South Africa: scoping the context for newborn hearing screening planning

PURPOSE

The current study aimed to describe the medical case history factors in a group of neonates admitted to high care and Kangaroo Mother Care wards at two hospitals in Gauteng, South Africa and to explore the relationship between specific case history factors and audiological outcomes.

METHODS

This study was part of a bigger study titled "Early detection of hearing loss: exploring risk-based hearing screening within a developing country context" where all case history data were recorded from participant medical files at the time of an initial hearing screening, through the use of a case history form that was developed for this study. Results were analyzed using descriptive statistics. The relationship between case history factors and audiological outcomes was analyzed using Fisher's exact test.

RESULTS

Findings revealed that, of all the case history data, preterm birth (95.7%), exposure to ototoxic medication (87.7%), neonatal jaundice (NNJ) (80.6%), and birthweight below 1500 g (66.7%) were the most frequently occurring case history factors in this South African sample. No statistically significant association was found between these frequently occurring case history factors and the repeat hearing screening outcomes in this sample.

CONCLUSIONS

Risk factors for hearing impairment cannot be viewed in isolation but should be considered in relation to their interaction with multiple other risk factors. Contextually understanding the profile of high risk has implications for medical intervention, as well as for the field of Audiology where planning for early identification and intervention services for hearing impairment is vital. Such contextually relevant evidence allows for a snap shot of how this population presents, what their needs and requirements are, and their possible future requirements; hence, raising important planning implications for the department of health and for targeted newborn hearing screening as well as early childhood intervention within the South African context.

Risk factors of neonatal mortality in Iran: a systematic review

Background: Reducing neonatal mortality is an important measure to reduce the overall under-five-years' mortality. Identifying the risk factors is the first step in this regard. This study performed with the aim of determining the risk factors of the neonatal mortality in Iran. Methods: Databases of SID, MagIran, IranMedex, IronDoc and Google Scholar for the Persian resources and Scopus, Science Direct, PubMed, Ovid, EMBASE, ISI web of science and Cochrane for English resources were searched up to January 2017. The inclusion criteria were the studies analyzing at least one risk factor for neonatal mortality in Iran with a control group and multivariate regression analysis. Eight papers met the inclusion criteria. The risk factors were extracted and tabulated. Results: Of the 1713 records retrieved, 8 were eligible to include in the analysis. Preterm birth, low birth weight, smoking and addiction, and anomaly were the important risk factors of neonatal mortality in Iran. Moreover, an extended list of potential risk factors identified on most of which the evidence was controversial and insufficient. The factors categorized into modifiable and identifiable ones. Conclusion: On the modifiable risk factors, proper intervention, and on the non-modifiable ones, early detection and special care may be helpful in preventing the babies from death. Population-based studies with large sample size and multivariate analysis are needed to make clear the effect size of the identified risk factors.

Clinical Outcomes of High-Risk Infant Follow-Up Program in a Tertiary Care Centre

BACKGROUND

High-risk infant follow-up (HRIF) program is necessary for early detection, timely intervention, and promotion of health outcomes in vulnerable infants, ethically. The present study was carried out to assess the clinical outcomes of the HRIF Program in Alzahra hospital as a tertiary care centre, in Iran.

MATERIALS AND METHODS

In this cohort study, 5840 neonates were born at Alzahra hospital, from June 1, 2011 to 30th February 2012. Among those who were admitted to neonatal intensive care unit (NICU), 253 infants were recruited by census according to HRIs criteria. After doing necessary measurements and family education, information was recorded in HRI health certificate and then entered in the access database for analysis.

RESULTS

From 253 eligible HRIs registered, 241 (95%) infants attended the follow-up clinic after discharge. A total of180 cases were recalled for further visits, 110 of which attended the clinic. Anthropometric indices had an increasing trend in the first 6 months of life. There was no significant relation between ages and stages questionnaire (ASQ) results and infant birth weight, height, and head circumference. The ratios of intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP) were 8.7% and 3.1%, respectively. The incidence of congenital hypothyroidism was 2:341 in HRIs.

CONCLUSIONS

Although some outcomes, such as ROP, improved in our study compared to similar studies, the findings indicate an impairment of the current follow-up processes and highlight the necessity to modify the current HRIF program. Ethically, we insist on integrating HRIF program in child health services to promote early childhood development.

Assessing infant-oriented care with developmental support approach in Iranian NICUs

INTRODUCTION

Developmental care program is a comprehensive program to reduce secondary effects of NICU and special care on brain development in premature infants. This study aimed to assess neonatal care situation in Iranian NICUs based on developmental approach to design and provide clinical guidelines for daily care for the caregivers and the infant's family.

METHODS

This was a cross-sectional study conducted in NICU_S in Iran. A total of 23 NICUs of 9 Universities of Medical Sciences were investigated. The checklist contains 30 items in 6 domains. Data were analyzed using STATA software, version 13.

RESULTS

The total mean score obtained from all six domains was 31.29 of 100, and in all domains, the mean scores calculated were not above 50. In "supporting infant," "developmental caregiving activities," "supporting the infants' state organization," "providing neonatal pain management," "developmental care approaches in documentation," and "developmental care approaches in NICU staffing," the total mean scores were 34.76, 21.6, 20, 30.18, 31.30, and 50, respectively.

CONCLUSION

The low mean score of infant-centered developmental care implies health staff's focus on neonatal care with at least the quality of care and its impact on development in preterm infants, and inadequate attention to the infant as an active member in care.