comparison of CRIB, CRIB II, SNAP, SNAPII and SNAP-PE scores for prediction of mortality in critically ill neonates

Clinical Risk Index of Babies [CRIB], Score for Neonatal Acute Physiology [SNAP], an update of the Clinical Risk Index for Babies score [CRIB II] and Score for Neonatal Acute Physiology - Perinatal Extension [SNAP-PE] are scoring devices developed in neonatal intensive care units. This study reviewed these scoring systems in critically ill neonates to determine how well they could predict mortality. This prospective cohort study was conducted at the neonatal intensive care units of Mofid and Mahdieh hospitals between March 2006 and May 2009. We evaluated CRIB, CRIB II, SNAP, SNAPII and SNAP-PE score for each neonate and the final scores were then obtained. The predictive accuracy of these parameters were expressed as area under the receiver operative characteristic curve, sensitivity, specificity, positive predictive value and negative predictive value. Of 404 neonate evaluated 53% were male. Primary diagnoses were respiratory distress syndrome, gastrointestinal obstruction, sepsis, prematurity, and neuromuscular diseases. The authors detected mortality in 20.5% and found a significant difference in scoring systems between survived and death groups. The mean CRIB score in survived neonates was 2.57 +/- 3.66 and in death neonates 8.43 +/- 4.66 [p value<0.001]. We also found that the SNAP score had the highest area under the curve and the highest sensitivity, specificity, positive predictive value, negative predictive value and we had the lowest score for CRIB II. We concluded that the neonatal scoring systems could be a useful tool for prediction of mortality in NICUs and SNAP can predict the mortality better than the others

Comparison of oral ibuprofen and indomethacin therapy for patent ductus arteriosus in preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Intravenous indomethacin is the conventional treatment for patent ductus arteriosus (PDA) in preterm infants; however its use is associated with various side effects such as oliguria, gastrointestinal bleeding and reduction of cerebral perfusion. Intravenous ibuprofen has recently been used to treat PDA in preterm infants without reducing cerebral blood flow or affecting intestinal or renal hemodynamics. Intravenous forms of indomethacin and ibuprofen are not available in Iran. This study aimed to examine and compare the efficacy and safety of oral ibuprofen and oral indomethacin for the treatment of PDA in preterm infants.</p><p><b>METHODS</b>Thirty-six infants (gestational age less than 34 weeks) who had echocardiographically confirmed PDA were enrolled in this study. The patients were randomly administered with three oral doses of either indomethacin (0.2 mg/kg, at an interval of 24 hrs) or ibuprofen (a first dose of 10 mg/kg, followed at an interval of 24 hrs by two doses of 5 mg/kg each) (n=18 each group). The rate of ductal closure, side effects, complications, and the infants' clinical course were recorded.</p><p><b>RESULTS</b>The ductus was closed in all of 18 patients (100%) in the ibuprofen group and in 15 (83.3%) patients in the indomethacin group (P > 0.05). There were no significant differences in the levels of serum blood urea nitrogen and creatinine between the two groups before and after treatment. Necrotizing enterocolitis (NEC) occurred in 3 patients in the indomethacin group and none in the ibuprofen group (P < 0.05). The survival rate at 1 month after treatment was 94% (17/18) in both groups. One infant in the ibuprofen group died from sepsis and one in the indomethacin group died as a result of NEC.</p><p><b>CONCLUSIONS</b>Oral ibuprofen is as effective as oral indomethacin for the treatment of PDA in preterm infants. Oral ibuprofen therapy is associated with a lower incidence of NEC.</p>

Acquaintance with criminal law and duties of nursing

Health care securing as a main target of professional nursery can be obtained with new and up-to-date ethical and science method and proper communication with patients. Negligence can provide patient discontent and complaint. So legal information about that, will be nursing profession basis. Behavioral agents, expensive hospital care, nurses economic necessity, patients negative conception to medical personal and increase information of people be affected rising of complaints. Nurses will be responsible about their patients directly or indirectly. Nursery Community Organization activation is marked law train necessity in this society. Acquaintance with job description of different nursing groups based on health and care ministry act and its observance can be definitely not caused of bring proceedings or being exonerated of them from charge. Article 59, 60, 319 and of slamic penal code, in regard to security or responsibity of medical community in exchange for malpracticing, exactly has been stated. Malpractice divide to four types: a] carelessness b] improvidence c] in attention to directions. D] lack of skill. Malpractice is approved by existence of four situations, 1] damage 2] type of 3] divect relation between error and damage 4] disobeying on order. Acquaintance of nurses' community, with new medical science and intimate at duties and current law can be cause, operation without any default or malpractice