ABSTRACT
Objectives@#Access to maternal and neonatal care services (MNCS) is an important goal of health policy in developing countries. In this study, we proposed a 3-level hierarchical location-allocation model to maximize the coverage of MNCS providers in Iran. @*Methods@#First, the necessary criteria for designing an MNCS network were explored. Birth data, including gestational age and birth weight, were collected from the data bank of the Iranian Maternal and Neonatal Network national registry based on 3 service levels (I, II, and III). Vehicular travel times between the points of demand and MNCS providers were considered. Alternative MNCS were mapped in some cities to reduce access difficulties. @*Results@#It was found that 130, 121, and 86 MNCS providers were needed to respond to level I, II, and III demands, respectively, in 373 cities. Service level III was not available in 39 cities within the determined travel time, which led to an increased average travel time of 173 minutes to the nearest MNCS provider. @*Conclusions@#This study revealed inequalities in the distribution of MNCS providers. Management of the distribution of MNCS providers can be used to enhance spatial access to health services and reduce the risk of neonatal mortality and morbidity. This method may provide a sustainable healthcare solution at the policy and decision-making level for regional, or even universal, healthcare networks.
ABSTRACT
Several complications during childhood is associated with nutritional status of infants at birth. Therefore, nutritional status of newborns must be evaluated properly after birth. Assessment of the nutritional status of neonates based on anthropometric and physical indices is simple and inexpensive without the need for advanced medical equipment. However, no previous studies have focused on the assessment methods of the nutritional status of infants via anthropometric and physical indices. This study aimed to review some of the key methods used to determine the nutritional status of neonates using anthropometric and physical indices. To date, most studies have focused on the diagnosis of fetal malnutrition [FM] and growth monitoring. In order to diagnose FM, researchers have used growth charts and Ponderal index [PI] based on anthropometric indices, as well as Clinical Assessment of Nutritional [CAN] Score based on physical features. Moreover, in order to assess the growth status of infants, growth charts were used. According to the findings of this study, standard intrauterine growth curves and the PI are common measurement tools in the diagnosis of FM. Furthermore, CAN score is widely used in the evaluation of the nutritional status of neonates. Given the differences in the physical features of term and preterm infants, this index should be adjusted for preterm neonates. Longitudinal growth charts are one of the most prominent methods used for monitoring of the growth patterns of infants
ABSTRACT
The stress resulting from premature delivery and the related neonatal care induces psychological and physical pressure on the mothers, and adversely affects their feeling of comfort. It seems that spiritual care as a sort of communication with a higher power [God] can bring peace to the stressed mothers, and prevent anxiety. Therefore, this study was designed to evaluate the effects of spiritual self-care training on feeling of comfort in mothers of preterm infants, hospitalized in the neonatal intensive care unit [NICU]. In this randomized clinical trial, 60 mothers of preterm infants hospitalized in NICU of Omolbanin and Ghaem hospitals, Mashhad, Iran in 2013, were selected, using convenience sampling, and were randomly assigned to intervention and control groups. In order to familiarize the mothers with their infants' condition, the mothers in both intervention and control groups were informed and trained for 15 minutes every day, over a 14-day period. The intervention group, in addition to infant-related information, received spiritual self-care training for 45 minutes in 6 sessions, every other day. Before and after each session of self-care training, the mothers filled a self-structured questionnaire related to feeling of comfort resulting from spiritual care. Data were analyzed using SPSS version 16, by repeated measures analysis of variance [ANOVA], t-test, and Chi-square tests. According to the results, the total mean of maternal feeling of comfort was 50.0 +/- 4.3 and 55.6 +/- 3.3 before and after the intervention, respectively. The results of t-test indicate that comfort significantly increased after the intervention [P=0.000]. Based on the results of this study, spiritual self-care training increases the feeling of comfort in mothers with premature infants, hospitalized in NICU
ABSTRACT
Surfactant administration via thin endotracheal catheter [Tec] seems to be less invasive than InSurE method. We analyzed data obtained from multicenter hospitals. This multi center randomized clinical trial study was conducted concomitant within NICU of three university hospitals of Tabriz, Isfahan and Mashhad for a period of 20 months on neonates with gestational age of 27-32 weeks. All infants received nCPAP before administration of surfactant. If we required fio2> 30%to maintain spo2 >85% then surfactant was administered. A 5f vascular catheter was placed through 1 to 2 cm below the vocal cords and surfactant was administrated slowly. Mean gestational age in TEC was 29.6 weeks and in InSurE was the same. Mean weight in TEC was 1339 grams and in InSurE was 1304 gram. Surfactant was administered to 66preterm via TEC method and to 70 infant via InSurE. Mortality in TEC group was significantly lower than InSurE. P<0.01RR=0.56, CI, 95[0.42-0.76]. NEC reduced in TEC. CPAP duration decreased in two centers, p<.05 but increased in another center. Fio2 decreased rapidly and HCO3 increased 2 hours after surfactant P<0.03 in TEC. The average mean of Oxygen supplementation, BPD, Mechanical ventilation between two groups was not statistically significant. TEC method was effective in treating RDS. Mortality was significantly decreased in TEC group. As TEC procedure is a new method of surfactant administration and there are few studies about it, so it is too early to be certain about all aspects of this procedure