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.

Pre-Discharge Screening Trans-Cutaneous Bilirubinometry in Healthy Newborns in Mahdieh Hospital, Tehran

BACKGROUND

Incidence of jaundice is high in newborn infants. Since well appearing newborns are rapidly and routinely discharged from hospital, performing an inexpensive noninvasive pre-discharge screening test for evaluation of jaundice seems to be necessary.

OBJECTIVES

This study was conducted to compare the accuracy of cutaneous v/s serum bilirubin measurements in this regard.

PATIENTS AND METHODS

This was a prospective cross sectional study conducted in Mahdieh hospital, Tehran. 613 neonates weighing ≥ 1,800 g with gestational age of ≥ 35 weeks were enrolled. A pre discharge transcutaneous bilirubin test (TcB) was performed in all. Serum samples were taken from neonates with TcB ≥ 5 mg/dL in first and > 8 mg/dL in second 24 hours. Decision for treatment or recheck of bilirubin level after discharge was made based on serum bilirubin results.

RESULTS

Based on the study protocol, among 613 studied neonates, 491 (80%) revealed high TcB, of them 240 (49%) cases showed TBC ≥ 5 mg/dL in first and 251 (51 %) in second pre-discharge 24 hours. TcB ranged 3.3 - 17.1, mean TcB in first 24 hours was 6.9 ± 1 .7 (mode 6) and in second 24 hours 9.1 ± 2.1 (mode 10). Of 491 neonates with high TcB, capillary serum sample was taken as the second step and 398 neonates revealed high total serum bilirubin (TsB) with the same protocol for TcB. 108 (27.1%) neonates showed TsB ≥ 5 mg/dL in first and 290 (72.9%) in second 24 hours. According to the study results TcB has a 81% positive predictive value (PPV) in diagnosis of hyperbilirubinemia. Correlation coefficient of TcB and TsB in highest rate is equal to 72% (P value < 0.001).

CONCLUSIONS

TcB is an inexpensive, noninvasive and precise pre-discharge screening test for evaluation of hyperbilirubinemia, with a high PPV. It is highly recommended to be performed routinely due to high incidence of hyperbilirubinemia in neonates.