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Background & Aim: Peripherally intravenous catheters (PIVs) are an important part of therapy for hospitalized children. Although such catheters provide necessary vascular access, their use puts patients at risk for local and systemic infectious complications with serious morbidity. Migration of skin organisms at the insertion site into the coetaneous catheter tract with colonization of the catheter tip is the most common rout of infection for peripherally inserted catheters in adults but in children this is controversial. The objective of this study is to find any relationship between colonization and catheter-related consequences.

Methods & Materials: In a descriptive cross-sectional study, 108 catheters of children and neonates hospitalized in NICU and infectious ward of Markaz Tebby Kodakan were cultured at a 2-month period. For all cases, a questionnaire of demographic characteristics and information about catheterization including location, dwell time, drugs and total parental nutrition was filled. The condition of catheterization for all cases was the same. Presence of only one colony was considered as positive colonization. Finally the data were analyzed by SPSS software.

Results: Excluding one case because of positive blood culture, from 107 catheters, 36 were colonized (33.6% of cases). Coagulate negative staphylococcus was the most common pathogen seen in 50% of total positive cases. Although there was a clinically significance between the dwell time of catheter and colonization but there was not any statistical significant association between colonization and any other variables including sex, age, hospitalization time, ward, location of catheter, dwell time, infusion of parental nutrition, and the administered drug.

Conclusion: This study is consistent with guidelines of CDC about avoiding unnecessarily routine replacement of catheters in neonates and children. As the risk of infection did not increase in association with dwell time of peripheral venous catheters, it seems it is better to leave catheters in place until there is a sign of local infection or infiltration.

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Background & Aim: Pregnancy experience can be a kind of crisis in women&aposs lives. Different forms of anxiety can make problems in pregnant women. This study aimed to determine the effect of attachment education on anxiety and attachment behaviors of first-time mothers.

Methods & Materials: In this clinical trial, 84 primigravida women were selected from two hospitals in Shirazi using convenience sampling. The participants were randomly allocated to the test and control groups. Data were collected using a personal data form, the Anxiety Inventory Spielberger, and the maternal infant attachment tab view. The intervention group received four two-hour sessions during one month training course on attachment behavior. Maternal attachment behaviors were shaped Weekly on the forms. The control group received usual care of pregnancy. At the first day after the delivery, the researchers observed mothers attachment behavior during breastfeeding in all groups using Avant sheet without informing the mothers. Data were analyzed using statistical tests such as Chi-square, T-test, and paired t-test.

Results: The mean of the anxiety score was no significantly different before the intervention between the groups (P=0.59). The average anxiety scores was statistically significant after the intervention in the two groups (P=0.003). Also, average scores on the attachment of mothers with the breastfeeding infants was statistically different (P<0.001) in the intervention group.

Conclusion: Attachment behavior training reduces anxiety and increases maternal attachment.

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Background & Aim: Premature infants undergo painful and stressful procedures during care and treatment. Nurses can help to reduce short- and long-term effects of pain caused by diagnostic and therapeutic procedures using various methods including music therapy. The aim of this study was to assess the effect of music therapy on physiological pain responses of premature infants during and after blood sampling.

Methods & Materials: This was an experimental study with crossover design conducted on 20 premature infants hospitalized in the intensive care unit of a hospital affiliated to the Tehran University of Medical Sciences for a five months period in 2010-11. Infants were randomly allocated in two groups of experiment and/or control. Each infant was considered as its own control. We assessed the physiological pain responses caused by blood sampling such as heart rate and oxygen saturation level. Infants in the experiment group listened to the Transitions music five minutes before until 10 minutes after the blood sampling. The responses were recorded and reviewed ten minutes before until ten minutes after the blood sampling in both groups and physiological changes were detected. Data were analyzed using ANOVA and Chi-square tests in the SAS and SPSS.

Results: Results showed significant difference in heart rate between the experiment and control groups during needle exit (P=0.022). There was also significant difference in heart rate between experiment and control group in the first 5 minutes of blood sampling (P=0.005).

Conclusion: Results showed that music therapy could reduce some physiological responses of pain during and after blood sampling. Music therapy can be used as a beneficial intervention following painful procedures such as blood sampling in the NICU.

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  Background & Aim: An important goal of nursing care in the Neonatal Intensive Care Unit (NICU) is to provide holistic care as well as the best possible outcome. Understanding perceived needs of mothers is valuable to achieve these goals. This study aimed to compare perceptions of nurses and premature infants’ mothers about mothers’ needs in the NICUs.

  Methods & Materials : This was a cross-sectional study in which 63 nurses and 63 mothers with premature infants were selected from the NICUs of four educational hospitals affiliated to the Mashhad University of Medical Sciences through stratified sampling method in two months. Data were gathered using the NICU Family Needs Inventory of Ward and were analyzed using descriptive-analytical statistical methods in the SPSS v.16.

  Results: Among the subscales related to family needs, the following items were reported to be important by mothers: Proximity (95.3%), Assurance (94.1%), Information (91.1%), Support (79.7%) and Comfort (72.8%). On the other hand, nurses believed that the following items were the most important needs of the mothers: Assurance (80.3%), Proximity (75.2%), Information (70.8%), Comfort (66.3%) and Support (64.8%).

  Conclusion : According to study findings, nurses should periodically assess needs of the mothers in the NICUs to be aware of the actual needs instead of placing subjective assumptions on mothers needs. This can improve effective communication and interaction with mothers and enhance satisfaction of the mothers with care.

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  Background & Aim: Premature infants are the most admitted group to NICUs. Stabilization of cardio pulmonary parameters is a main goal in NICUs. Mechanical ventilation and endothracheal suctioning are the most common and effective procedures to stabilize cardio pulmonary parameters. The aim of present study was to compare the effects of two endothracheal suctioning methods (open and closed) on physiological stability in premature infants under mechanical ventilation .

  Methods & Materials: In this clinical trial, 90 preterm infants (GA: 27-34 weeks) hospitalized in the NICUs of Alzahra and Taleghani hospitals were selected and randomly assigned to two groups. In one group, infants were suctioned using open suctioning method and in the other group, infants were suctioned using closed suctioning method. The physiologic parameters (O2 sat, HR, mean BP variation) and stability (recovery time of HR, BP) were compared between the groups. Data were analyzed using descriptive and inferential statistical methods such as x², independent t-test and mixed model in the SPSS-21 . 

  Results: There was significant statistical difference between the two groups on mean BP (P=0.016). Recovery time of the BP and HR was shorter in the closed suctioning group. Physiologic stability was better in the closed suctioning group (P<0.05) .

  Conclusion: Variation of the mean BP and recovery time was more in the open suctioning group compared with the closed suctioning group. Considering better physiologic effects of closed suctioning, it is recommended to assess the combined effect of closed suctioning with weight on physiologic parameters of premature infants .

  

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  Background & Aim: Technology advancement has increased the survival rates of premature infants. Preterm newborns frequently experience oral feeding difficulties due to lack of coordination in sucking, swallowing and respiration. This may negatively affect attainment of independent oral feeding skill and leads to longer hospital stays. This study aimed to examine the effects of non-nutritive sucking vs. oral massage therapy on attainment of independent oral feeding and length of stay in the NICU .

  Methods & Materials: This clinical trial was conducted on 72 premature infants (28-32 week gestational age) hospitalized in the NICU of Alzahra Hospital in Tabriz in 2013. The eligible infants were randomly allocated to one of the three groups: oral massage, non-nutritive sucking, and control groups. Newborn infants in the oral massage group received pre- and intraoral massage therapy (before gavage) for at least 10 days. The newborn infants in the non-nutritive sucking group were encouraged to suck on a finger of mother or the researcher before gavage. The control group received usual care. The time to attain independent oral feeding and length of stay in the hospital were compared in the groups . 

  Results: Compared to the control group, the time to oral intake was significantly shorter in both experimental groups (P<0.001). There was no significant difference between the duration to achieve independent oral feeding status among the groups (P=0.915). Length of stay in the hospital did not significantly differ among the three study groups (P=0.342) .

  Conclusion: Findings indicated that both oral massage and non-nutritive sucking therapy groups could accelerate attainment of independent oral feeding in premature newborn infants .

  

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  Background & Aim: Several studies have indicated that hospitalizing infants causes disruption on mother-infant attachment. The aim of this study was to assess the effect of infant massage by mothers on maternal attachment behavior in infants hospitalized in the neonatal care units .

  Methods & Materials: In this clinical trial, 42 mothers and their neonates were recruited and randomly allocated to the intervention and control groups. Mothers in the intervention group received training by means of educational movies about practical exercises on how to massage the infants. The trained mothers used massage techniques on their infants for five days. The process lasted 15 minutes. The attachment of the mothers on their infants was assessed before and on the day 5 after the massage. Data were collected using the scale of mother-to-infant attachment. Data were analyzed using the Chi-squared test, Fisher’s exact test and the t-test in the SPSS-19 . 

  Results: There were no differences between the two groups in terms of demographic variables and the mean of maternal attachment at baseline (P>0.05). Five days after the massage, there were statistically significant differences between the two groups in the mean maternal attachment (P<0.001) .

  Conclusion: According to the role of massage in attachment behavior, this traditional care is recommended to be used in neonatal units .

  

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  Background & Aim: Midwives are responsible for providing health services to mothers and infants in crises. The aim of this study was to identify educational needs of midwifery students regarding mother and infant mortality prevention in crisis situations .

  Methods & Materials: In this cross-sectional study, all 235 final-year BSc. and MSc. midwifery students were selected from four medical universities located in Tehran. Informed consent forms were completed and signed by the students. The students completed a researcher-made two-section questionnaire including demographic items and educational needs items regarding mother and child preventive services in crises. Data were analyzed in the SPSS . 

  Results: Mean score of the m aternal and neonatal prevention service dimensions were 70±21.5 ( out of 105 ) and 46.7 ± 9 (out of a 65), respectively. Most of the students (86.8% ) declared that their academic education did not prepare them for their roles in crises. Only 10.6% of the students had some courses on crisis and 11.5% of them had the experience of dealing with crisis. The students in the BSc. degree had more educational needs in both dimensions compared to the students in the MSc. degree (P<0.046). There were significant relationships between the age of students (P<0.001), their clinical experience (P<0.001), previous educational courses (P<0.001) and experience in crisis (P<0.05) with the educational needs. There was no significant relationship between the educational needs and the students’ universities ( P>0.05 ) .

  Conclusion: Educational curriculums should be revised regarding actions to be done on prevention of mother and infant mortality in crises .

  

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Background & Aim: Preterm infants are at increased risk for readmission after discharge from the neonatal intensive care unit. Some factors and characteristics of preterm infants have an effect on their readmissions. This study aimed to determine neonatal factors related to preterm infants’ readmissions to the neonatal intensive care unit.

Methods & Materials: This correlational study was conducted on a sample of preterm infants admitted to the neonatal intensive care unit at three teaching hospitals of Shahid Beheshti University of Medical Sciences in 2013. Samples were studied using a questionnaire on possible factors and characteristics related to readmission including sex, gestational age, birth weight, multiple birth and length of stay in the neonatal intensive care unit after discharge. The infants were also followed for readmission thirty days after discharge. The data were initially analyzed by univariate analysis and then by the logistic regression model.

Results: The results of univariate analysis revealed that the infants readmitted at the time of follow up were significantly more premature and had lower birth weight and a longer initial hospital stay in the neonatal intensive care units (P<0.001). In the logistic regression model, only gestational age and birth weight had a significant statistical association with infants’ readmission (R: 0.805, P=0.001 and odds ratio: 0.998, P=0.001 respectively).

Conclusion: Infants’ gestational age and birth weight were associated with hospital readmission within thirty days after discharge, so that the infants with lower gestational age and birth weight were more likely to be hospitalized again after discharge.

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Background & Aim: Although mechanical ventilation is a life-saving intervention for many infants with respiratory distress syndrome, it carries potential complications. One of these complications is prolonged duration of mechanical ventilation. More than 15 days of mechanical ventilation is associated with increased risk of cerebral palsy and attention deficit hyperactivity disorder among extremely low birth weight infants. The current study aimed to determine the relationships between the length of mechanical ventilation and its related factors in neonates with respiratory distress syndrome.

Methods & Materials: In this analytical study, a convenience sample of 60 premature infants of 33 weeks’ gestation or less with respiratory distress syndrome was recruited from three hospitals (Mahdieh, Mofid, and Imam Hossein) affiliated to Shahid Beheshti University of Medical Sciences in 2014-2015. Then, factors related to the length of mechanical ventilation such as sex, type of birth, birth weight, gestational age, Apgar score at the first minute, Apgar score at the fifth minute were assessed. The data were analyzed using descriptive statistics, Pearson correlation, independent t-test, and multiple regression analysis on SPSS software v.20.

Results: The mean gestational age was 30.62±1.8 weeks and the mean weight of infants was 1510.33±390.940 grams. The mean length of mechanical ventilation was 3.58±2.97 days. There  were not any correlations between sex, type of birth and the length of mechanical ventilation (P>0.05). Gestational age and weight were significantly correlated to the length of mechanical ventilation (P<0.001). But in adjusted analysis using multiple regression, only gestational age remained a significant factor related to the length of mechanical ventilation (P<0.05).

Conclusion: The results of the current study revealed that among the studied factors, only gestational age was a factor affecting the length of mechanical ventilation.

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Background & Aim: Violence during pregnancy affects both mother and fetus. This study was performed to investigate the relationship between physical, sexual and psychological violence during pregnancy and low birth weight in the world as a meta-analysis.

Methods & Materials: This study is a meta-analysis that was performed on articles published in Persian and English languages from the beginning of 1995 to the end of 2015. Articles were extracted by searching in the databases of Scopus, Medline, EMBASE, Pubmed, Web of Science, Google scholar, Science Direct, Irandoc, Magiran, Medlib, and SID using key words of violence during pregnancy, low birth weight, physical, sexual and psychological violence and their compounds. The results of studies were combined using a random effects model in the meta-analysis. The heterogeneity of studies was evaluated using the I² index and meta-regression, and the data analysis was performed using STATA software v.11.2 and SPSS software v.16.

Results: Of 254 found articles, 16 relevant articles with the sample number of 117287 people were included in the study. The results of meta-analysis showed that physical OR:1.61 (CI95%:2.04–2.28), psychological OR:1.26 (CI95%:1.02–1.56) and sexual violence OR:1.26 (CI95%:1.02–1.56) during pregnancy, lead to an increase in the rate of low birth weight infants in the exposed mothers.

Conclusion: Physical, psychological and sexual violence during pregnancy lead to an increase in the rate of low birth weight infants in the exposed mothers. Therefore, maternal screening and counseling by trained general practitioners and professionals before and during pregnancy are recommended.

Background & Aim: Birth weight is one of the most important indicators for evaluating the community health status.Violence during pregnancy affects both mother and fetus and leads to irreversible consequences. This study was performed to investigate the relationship between physical, sexual and psychological violence during pregnancy and low birth weight in the world as a meta-analysis.

Methods & Materials: This study is a meta-analysis that was performed on articles published in Persian and English languages from the beginning of 1995 to the end of 2015. Articles were extracted by searching in the databases of Scopus, Medline, EMBASE, Pubmed, Web of Science, Google scholar, Science Direct, Irandoc, Magiran, Medlib, and SID using key words of violence during pregnancy, low birth weight, physical, sexual and psychological violence and their compounds. The results of studies were combined using a random effects model in the meta-analysis. The heterogeneity of studies was evaluated using the I² index and meta-regression, and the data analysis was performed using STATA software v.11.2 and SPSS software v.16.

Results: Of 254 found articles, 16 relevant articles with the sample number of 117287 people were included in the study. The results of meta-analysis showed that physical OR:1.61 (CI95%:2.04–2.28), psychological OR:1.26 (CI95%:1.02–1.56) and sexual violence OR:1.26 (CI95%:1.02–1.56) during pregnancy, lead to an increase in the rate of low birth weight infants in the exposed mothers.

Conclusion: Based on the results, physical, psychological and sexual violence during pregnancy lead to an increase in the rate of low birth weight infants in the exposed mothers. Therefore, the relevant authorities are recommended to identify at-risk mothers and control their exposure toviolenceby implementing educational and interventional programs, maternal screening and counseling by trained general practitioners and professionals before and during pregnancy.

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Background & Aim: Vaccination is the most common painful procedure in childhood. This study aimed to compare the effect of Hugo point massage with and without ice on the injection-related pain of pentavalent vaccine in infants.
Methods & Materials: This study is a blind randomized clinical trial (IRCT2016052127982N1) conducted on 90 healthy, two-month old infants with normal weight, referred to Gonabad Fayazbakhsh health center to inject pentavalent vaccine in 2016. Infants were randomly assigned into three groups including 1) massage on Hugo’s point with ice 2) massage on Hugo’s point without ice and 3) control group. Data collection tool includes demographic information form and infant’s pain measurement tool. Data were analyzed using Chi-square test, Kruskal–Wallis test, analysis of variance and post-hoc Tukey HSD through the SPSS software version 16.
Results: There was no significant difference in pain intensity before vaccination between three groups. After vaccination, mean pain score for the first group was 7.70±1.26, for the second group was 8.03±1.06 and for the third group was 9.23±0.89. Also, crying duration in the first group was 35.03±23.12, in the second group was 40.39±21.62 and in the third group was 61.28±24.00. Both variables in the intervention groups were significantly lower compared to the control group (P<0.001) but there was no significant difference between the two intervention groups (P=0.586 and P=0.654).
Conclusion: Hugo’s point massage with and without ice can reduce the injection-related pain of pentavalent vaccine in infants and be used as a simple non-pharmaceutical method available to control vaccination pain.
 

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Background & Aim: Each conceptual model in nursing seeks to explain the fundamental concepts of the discipline based on the culture and values of societies in order to be used more effectively, as a scientific and practical framework. The aim of this study was to design a conceptual model of care during infancy from Islam perspective.
Methods & Materials: The conceptual model used in this study was designed based on the model synthesis process developed by Walker and Avant (2011) in three steps in 2017: Concept development and specifying focal concept, statement synthesis and identifying connections between concepts, systematic organization of connections and building an integrated representation. Qur’an and its interpretation books and Shiite Hadith books were of the resources.
Results: As a result of developing the concept of “care during infancy in terms of Islam”, six concepts were synthesized. “Infant as a person with dignity and potential for excellence” was as the focal concept. Other concepts included “basic principles of nurturing”, “parents as the representatives of God in nurturing infants”, “mother as the symbol of creativity and divinity of God”, “healthy and competent child”, and “God as the merciful nurturer”. After defining connections between the concepts, the structure of conceptual model was presented.
Conclusion: Infant care is nurturing a human being who has dignity, rights and potential for excellence from the time of conception. From Islam perspective, God is the eternal nurturer who nurtures the infant with kindness and dignity, and mother is the manifestation of the creativity and divinity of God. The infant is entrusted to the parents by God, and parents are the agents of God who lay the groundwork for nurturing the infant. In order to have a healthy and competent child, observing the principles of nurturing is important. “Care during infancy from Islam perspective” model is a conceptual model that can be used for the development of applied theories, clinical practice, research, and education of nursing students and the community.
 

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Background & Aim: Childhood vaccination as the most common iatrogenic pain is the main source of pain, anxiety and stress in children and parents, which is often done without pain management. Therefore, given the importance of pain control in children, and the recognition and application of pain control methods by the health team members, this study was conducted to evaluate the effect of ShotBlocker on vaccination pain in 6-month-old infants.
Methods & Materials: In this clinical trial study, 80 infants referred to Mehrshahr health center in Birjand in 2018-2019, were selected using the convenience sampling method based on the study criteria, and then randomly assigned to the control or experimental groups. In the experimental group, 20 seconds before the injection until the end of the injection, pressure was applied to the injection site with a ShotBlocker. The control group only received routine care. The pain status in the two groups was measured using the Pain Behavioral Response Scale (FLACC) 15 seconds after injection, and also the duration of crying from the time of vaccine injection to the end of crying was compared between the two groups. Data was analyzed using descriptive and inferential statistics including Mann-Whitney, t-test, and analysis of covariance at the significance level of less than 0.05.
Results: The study results revealed the mean pain intensity (4.32±0.99), duration of crying (14.4±3.92), and the time of onset of crying (4.05±0.933) were lower in the experimental group than those of in the control group (P<0.001).
Conclusion: Considering that ShotBlocker is effective in reducing pain intensity, the duration of crying and delay in onset of crying, it is recommended to use this simple, safe, and low-cost device to manage pain during vaccine injection.
Clinical trial registry: IRCT20191128045534N1
 

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Background & Aim: Due to the importance of breastfeeding in the health of premature infants, the present study was conducted with the aim of determining the effect of telephone counseling on the continuity and breastfeeding status of mothers with late preterm infants.
Methods & Materials: In this randomized controlled trial, 65 eligible mothers from Ahvaz in 2019-2020 were selected using the convenience sampling method and divided into two intervention and control groups using block randomization (with block sizes of 4). The routine care was provided for the control group. The intervention group received a daily telephone support counseling for 14 days after discharge. Data were collected using a questionnaire on the continuity of breastfeeding and breastfeeding status at the pre-counseling phase and then monthly up to four months after discharge. Data were analyzed using chi-square test, independent t-tests and Kaplan Meyer survival analysis at a significance level of 0.05 through the SPSS software version 16.
Results: According to Kaplan Meyer survival analysis, the rate of exclusive breastfeeding interruption in the control group was higher than that of in the intervention group (5 vs. 8) but it was not statistically significant. Improvement of breastfeeding status one month after discharge was significantly different between the two groups (P=0.048).
Conclusion: The results showed that telephone support counseling was effective in improving breastfeeding status up to the first month after discharge. Continuous telephone support counseling can be a good approach to improving breastfeeding and its continuity in the first month after discharge.
Clinical trial registry: IRCT20150731023423N13

 

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Background & Aim: Infantile colic is a stressful tension for the baby and parents, whose cause and certain treatment are still unknown. Therefore, this study was conducted with the aim of comparing the effect of massage and probiotic consumption on infantile colic.
Methods & Materials: This clinical trial was conducted in Tehran’s Children Medical Center in 2020-2021, and 75 colicky infants were included in the study based on ROM IV criteria and assigned into two groups of massage and probiotics. A total of 64 infants (34 in the massage group) and 30 in the probiotics group) completed the study. The duration of the intervention was 14 days. The first group received abdominal massage with olive oil twice a day, and the second group received probiotic drops, five drops a day. The study tool was the Barr Child Daily Measurement Scale. The information related to colic measurement, including the average time of colic crying, sleep, and frequency of defecation was analyzed within and between groups on days 1, 7, and 14.
Results: Abdominal massage and probiotic consumption both reduced infantile colic (P<0.05), but the massage group had more reduction than the probiotics group (P<0.05).
Conclusion: Considering that the massage method was more effective in controlling colic, using massage is recommended for the care of infants with colic, which is a non-drug, safe and simple method and can be easily taught to parents by nurses.
Clinical trial registry: IRCT20200903048602N1

 

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Background & Aim: Mothers with premature babies are more likely to experience anxiety than mothers with full-term babies. The separation of the mother from the baby disrupts physical contact with the baby, which is the most important component affecting attachment. The aim of this study was to determine the effect of a group positive thinking program on anxiety and attachment in mothers with premature infants admitted to the neonatal intensive care unit.
Methods & Materials: This study is a randomized clinical trial conducted in Kermanshah in 2020. A total of 72 mothers with premature infants admitted to the neonatal intensive care unit of Imam Reza and Mohammad Kermanshahi hospitals were randomly assigned into two groups of control and intervention. The Spielberger State Trait Anxiety Inventory and Postpartum Attachment Scale were used to collect the data. The collected data were analyzed using the SPSS software version 16 using statistical tests (ANOVA and Chi-Square).
Results: There was no significant difference in the state anxiety levels before (p =0.791) and after the intervention (p =0.373) between the control and intervention groups. Likewise, no statistically significant difference was observed in the latent anxiety levels before (p =0.831) and after the intervention (p =0.093) between the two groups but comparing the amount of changes showed a significant difference (p =0.025). Regarding attachment, none of the attachment subscales had a statistically significant difference between the two groups before the intervention (p>0.05). After the intervention, a significant difference was observed in the scores of the subscales “lack of hostility" and "satisfaction with the interaction" (p<0.05).
Conclusion: According to the findings of the study, the group positive thinking training is recommended to the nurses and managers of neonatal intensive care units as a complementary program, along with the routine care for mothers of premature infants.
Clinical trial registry: IRCT20210108049965N1