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Zakerihamidi M, Heidari E, Boskabadi H. Comparison of the Percentage of Umbilical Cord Nucleated Red Blood Cells in Preterm Neonates during Vaginal Delivery and Emergency Cesarean Section. Iran J Nurs Midwifery Res 2024; 29:73-77. [PMID: 38333336 PMCID: PMC10849285 DOI: 10.4103/ijnmr.ijnmr_122_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/13/2023] [Accepted: 08/28/2023] [Indexed: 02/10/2024]
Abstract
Background There are insufficient and contradictory reports regarding the effect of delivery method on the rate of umbilical cord Nucleated Red Blood Cell (NRBC). Therefore, the present study aimed to compare the percentages of umbilical cord NRBC in vaginal delivery and emergency cesarean section (C-section) in preterm neonates. Materials and Methods The present cross-sectional study was performed on mothers with vaginal delivery and C-section, from 2020 to 2021. The samples (n = 221) were preterm neonates selected using the convenience sampling method. The percentages of NRBC in neonates born by natural childbirth and by emergency C-section were measured and compared in this research. A researcher-made checklist, which included maternal and neonatal characteristics and laboratory evaluation, was used as a data collection tool. Results The statistical population of thisresearch included 93 (42.10%) and 128 (57.90%) neonates born by vaginal delivery and by C-section, respectively.The mean (SD) score of gestational ages at birth was 30.75 (2.81) weeks. The mean (SD) score of umbilical cord NRBC level were estimated at 8.01 (5.93) and 25.64 (22.61) for the neonates born by natural childbirth and by emergency C-section, respectively (t=-8.43, df = 150, p<0.001). Statistically significant differences were observed in the gestational age (t=-3.36, df = 218, p = 0.001), fifth-minute Apgar score (t=-2.32, df = 200, p = 0.021), umbilical cord NRBC (t=-8.43, df = 160, p<0.001), and short-term prognosis (p = 0.032) between the two groups. It was also revealed that the number of NRBCs in the dead neonates was about 1.5 times higher than that in the discharged neonates. Conclusions Based on the results of the present study, emergency C-section increased the mean of umbilical cord NRBC by three times, compared to that of normal delivery. Since an increase in the NRBC raises the risk of infant death, it is advisable to take steps to maintain the health of children by identifying high-risk neonates through umbilical cord NRBC measurement immediately after delivery and special care.
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Affiliation(s)
- Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
| | - Elahe Heidari
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Zakerihamidi M, Moradi A, Boskabadi H. Comparison of severity and prognosis of jaundice due to Rh incompatibility and G6PD deficiency. Transfus Apher Sci 2023; 62:103714. [PMID: 37164807 DOI: 10.1016/j.transci.2023.103714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Undiagnosed and untreated hyperbilirubinemia in infants may result in Kernicterus Spectrum Disorder and poor prognoses. Rhesus incompatibility and glucose-6-phosphate dehydrogenase (G6PD) deficiency are among the known causes of infantile jaundice. This study was designed to define the severity and prognosis in jaundiced infants with Rh incompatibility or G6PD deficiency. METHODS A total of 144 term, 2- 14 days old jaundiced infants (bilirubin > 20 mg/dl) with Rh incompatibility(85 infant) or G6PD deficiency(59 infant) were included in this cohort study with 24-month follow-up through available sampling at Ghaem hospital between 2015 and 2022. Denver II test was used at 6, 12, 18, and 24-month ages after discharge. Infants with Rh incompatibility or G6PD deficiency were assigned into two groups of favorable and poor prognosis. Following that, the bilirubin levels of these infants were compared at the time of admission. RESULTS The bilirubin level in G6PD deficient infants with poor prognoses (37.96 ± 9.25 mg/dl) and neonates with Rh incompatibility (36.23 ± 5.08 mg/dl) almost was the same (P = 0.232). 40 babies (47%) caused by Rh incompatibility and 33 (56%) babies caused by G6PD deficiency had a poor prognosis (P = 0.465). Average bilirubin in babies with RH incompatibility with favorable prognosis is 21.8 and poor prognosis is 36.2 mg/dl. In infants with G6PD deficiency, it was 24 mg/dl with favorable prognosis and 38 mg/dl with poor prognosis (P < 0.0001). The severity of hyperbilirubinemia had a significant role in the prognosis of infants in both groups (P < 0.0001). CONCLUSION The two-year prognoses of hyperbilirubinemia caused by G6PD deficiency are as poor as that of Rh incompatibility. The severity of hyperbilirubinemia had a significant role in the prognosis of infants in both groups.Exchange transfusion in cases with bilirubin < 25 mg/dl can improve the prognosis in both groups, especially in infants with Rh incompatibility.
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Affiliation(s)
- Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Islamic Azad University, Tonekabon Branch, Tonekabon, Iran
| | - Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Boskabadi
- Department of Pediatrics, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Boskabadi H, Abrishami M, Shoeibi N, Kakavandi M, Moradi M, Zakerihamidi M. Incidence of Retinopathy of Prematurity in Neonates with Neonatal Sepsis. Arch Iran Med 2023; 26:248-251. [PMID: 38301087 PMCID: PMC10685868 DOI: 10.34172/aim.2023.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 04/25/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND One of the most important complications of premature birth is retinopathy of prematurity (ROP). Sepsis may increase the incidence of this complication. The aim of this study is to compare the incidence of ROP in neonates with and without sepsis. METHODS In a retrospective case-control study, preterm infants admitted to the neonatal intensive care unit (NICU) of Ghaem hospital from 2014 to 2022 were examined. The case group consisted of 155 preterm infants with definite sepsis (positive blood culture and clinical signs of sepsis) and the control group included 145 preterm infants without sepsis whose maternal and neonatal characteristics were collected; they were examined by a retinologist and evaluated for ROP at 32 weeks or four weeks after birth. Finally, we used the chi-square and the t test to compare the two groups. RESULTS Out of 155 preterm infants with sepsis, 70% and out of 145 preterm infants without sepsis, 58% had ROP (P=0.023). Also, low birth weight, low initial Apgar score and low 5-minute Apgar score were significantly associated with ROP (P<0.05). CONCLUSION Based on the results of this study, sepsis is a serious risk factor for ROP. We can reduce its incidence and complication by preventing sepsis in premature infants.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Abrishami
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasser Shoeibi
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahsa Kakavandi
- Medical Student, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Moradi
- Medical Student, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
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Boskabadi H, Maamouri G, Ayati S, Boskabadi A, Bagheri F, Kalani F, Zakerihamidi M, Pourbadakhshan N, Moradi A. Comparing maternal and neonatal prooxidant-antioxidant balance during delivery. J Turk Ger Gynecol Assoc 2023. [PMID: 36991583 DOI: 10.4274/jtgga.galenos.2023.2022-9-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Introduction Oxidative stress (OS) is a disturbing factor in the balance between the production of free radicals and antioxidant defense, and in fact, the same victory of free radicals on the antioxidant defense of the body. Pregnancy and especially delivery are associated with increased OS. The relationship between maternal and infant prooxidant-antioxidant balance (PAB) is unclear. Therefore, the present study aimed to compare the PAB in the mother and baby. Material and Methods This cross-sectional study was conducted on 104 mothers and normal term infants during 2017-2020. Healthy mothers were checked for PAB before delivery and their umbilical cord after delivery. Data on the infant characteristics including age, gestational age, birth weight, Apgar score, and maternal history including the duration of mother's education, weight of the last month, and the gravidity were collected using a researcher-made questionnaire. Then, the cord and the PAB of the mothers before delivery were measured and compared by statistical methods. Results In this study, the mean PAB of the neonates and mothers was 30.76 and 214.87 HK, respectively. The results revealed a moderate association between the PAB neonate and maternal PAB before delivery but it was not significant. Conclusion Overall, the level of oxidants and antioxidants reduced during pregnancy and before delivery, and it was found that the relative incidence of neonatal PAB increases by increasing maternal PAB.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gholamali Maamouri
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sedigheh Ayati
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Bagheri
- Department of Pediatrics Nursing, School of Medical Sciences, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Farnaz Kalani
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
| | - Nafiseh Pourbadakhshan
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- Orthopedic Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
- Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Boskabadi H, Shoeibi N, Bagheri F, Pourbadakhshan N, Moradi A, Zakerihamidi M. Potential Role of Bilirubin in Preventing Retinopathy of Prematurity. Curr Pediatr Rev 2023; 19:197-202. [PMID: 35986544 DOI: 10.2174/1573396318666220819151154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND One of the most common problems in preterm neonates is retinopathy of prematurity (ROP). It has been shown antioxidants may be effective in preventing the development and progression of ROP. Considering the antioxidant properties of bilirubin, we decided to investigate the bilirubin level in neonates with ROP and compare it with healthy neonates. METHODS This case-control study was performed on VLBW neonates admitted to the NICU of Ghaem Hospital in Mashhad between 2014 and 2020 for a Jaundice evaluation. Complete neonate's characteristics, maternal history and laboratory results were collected in a questionnaire. Then the neonates were examined for ROP by a fellowship of the retina of an ophthalmologist at 32 weeks or four weeks after birth. The highest bilirubin levels during their hospitalization were also recorded. RESULTS Of 427 neonates examined, 121 (37.7%) had a normal eye examination, and 266 (62.3%) had ROP. The mean weight, gestational age and bilirubin were 1455.8 ± 431.4 grams, 31.6 ± 2.3 weeks and 8.8 ± 2.4 mg/dl, respectively. There was a significant difference between controls and neonates with ROP with regard to birth weight, duration of intermittent positive pressure ventilation (IPPV), duration of oxygen therapy, first and fifth minute Apgar scores, the maximum level of bilirubin and gestational age (P < 0.05). It was observed that the maximum level of bilirubin was lower in neonates with higher stages of ROP. CONCLUSION According to the results of this study, higher levels of bilirubin in neonates may be a protective factor against ROP. Moreover, increased levels of bilirubin are associated with reduced severity of ROP. Therefore, prophylaxis phototherapy in premature infants may need to be reconsidered.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naser Shoeibi
- Department of Ophthalmology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Bagheri
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad University, Mashhad Branch, Mashhad, Iran
| | - Nafiseh Pourbadakhshan
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- PhD (Tissue Engineering), Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
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Boskabadi H, Saravi A, Zakerihamidi M. Comparison of Retinopathy of Prematurity Incidence in Preterm Infants of Mothers with Preeclampsia and Infants of Healthy Mothers. J Obstet Gynaecol India 2022; 72:409-413. [PMID: 36458063 PMCID: PMC9568630 DOI: 10.1007/s13224-022-01660-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 03/29/2022] [Indexed: 10/18/2022] Open
Abstract
Introduction Preeclampsia is one of the four leading causes for pregnancy complications, maternal-fetal and neonatal mortality. This study was aimed at comparing the incidence of retinopathy of prematurity in neonates of mothers with preeclampsia and neonates of healthy mothers. Methods This cross-sectional study was performed among 213 mothers, including 49 healthy mothers and 164 mothers with preeclampsia whose neonates were admitted to the neonatal intensive care unit of Ghaem Hospital, Mashhad, Iran, during 2016-2021. The participants were chosen using the convenience sampling method. The data collection tool was a researcher-made checklist including items on laboratory evaluation, maternal and neonatal characteristics, and eye examination. The data were analyzed using t-test and Chi-square. Results In the two groups, gestational age (P = 0.112), first-minute Apgar score (P = 0.209), and fifth-minute Apgar score (P = 0.949) were not significantly different. There was a significant difference between the two groups in terms of maternal age (P = 0.0001), type of delivery (P = 0.0001), premature rupture of membranes (P = 0.003), and eye condition (P = 0.033). Conclusion The results of our study show that preeclampsia affects the prognosis of infants, and in neonates with preeclamptic mothers, the rate of premature rupture of the membranes, cesarean delivery, and retinopathy of prematurity were higher.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Saravi
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Islamic Azad University, Tonekabon, Iran
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Boskabadi H, Abrishami M, Shoeibi N, Sanei Z, Moradi A, Zakerihamidi M. Comparison of Vitamin D Levels in Premature Infants with and without Retinopathy of Prematurity. Arch Iran Med 2022; 25:209-213. [PMID: 35942992 DOI: 10.34172/aim.2022.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/28/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Retinopathy of prematurity (RoP) is a cause of newborn blindness. Several predisposing factors have been reported to contribute to the disease process. The current study aimed to compare serum vitamin D levels in infants with and without RoP. METHODS This case-control study was conducted on 154 very low birth weight (VLBW) infants admitted to Ghaem hospital, Mashhad, Iran, during 2016-2019. Retinal examination for RoP was done at the 32nd week of pregnancy and vitamin D level was determined using the infants' first-day serum samples. A researcher-made questionnaire including maternal, infant, laboratory, and retinal examination information was used as the data collection tool. RESULTS Out of 154 infants in the study, 56 (36.4%) were normal while 98 (63.6%) had RoP. Based on the severity of retinopathy, 43 infants (43.9%) were at stage I, 48 (49%) at stage II, and 7 (7.1%) at stage III. Significant differences in neonatal (P<0.001) and maternal (P=0.015) vitamin D levels, first and fifth minute Apgar scores (P=0.034 and P=0.001, respectively), and weight (P=0.014) were found between the infants with and without RoP. CONCLUSION The incidence of RoP was higher in infants with lower gestational age, lower birth weight, low first and fifth minutes Apgar scores, and male sex. Low serum levels of vitamin D in premature infants and their mothers were associated with incidence of RoP. The higher the stage of RoP, the greater was the severity of vitamin D deficiency. Thus, controlling the maternal vitamin D level during pregnancy, consumption of vitamin D supplements, and investigation of serum vitamin D levels in premature infants are recommended. Early correction of vitamin D deficiency may lead to reduction of RoP.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Majid Abrishami
- Eye Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Nasser Shoeibi
- Eye Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Zahra Sanei
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Ali Moradi
- Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Islamic Azad University, Tonekabon, Iran
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Boskabadi H, Khodashenas E, Bagheri F, Behgam N, Zakerihamidi M. Evaluation of hematologic factors and bilirubin following exchange transfusion in neonatal hyperbilirubinemia. Transfus Apher Sci 2022; 61:103451. [DOI: 10.1016/j.transci.2022.103451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022]
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Boskabadi H, Moradi A, Zakerihamidi M. Evaluation of Maternal and Infantile Levels of Vitamin D in Preterm Infants. Curr Pediatr Rev 2022; 18:47-52. [PMID: 34620066 DOI: 10.2174/1573396317666211006153153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 06/06/2021] [Accepted: 06/30/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Vitamin D deficiency is highly prevalent during pregnancy and in premature infants. This study was done to investigate the maternal and infantile levels of vitamin D in preterm infants. METHODS Using available sampling during 2018-2020, the maternal and umbilical cord serum levels of vitamin D were measured in 294 premature infants in Ghaem Hospital, Mashhad, Iran. A researcher- made questionnaire consisting of neonatal demographic and clinical characteristics was used as the data collection tool. Both maternal and placental vitamin D levels were categorized into four classes: severe deficiency (vitamin D<10 ng/ml), moderate deficiency (10.1≤vitamin D≤20 ng/ml), mild deficiency (20.1≤vitamin D≤30 ng/ml) and normal (vitamin D >30.1ng ml). RESULTS Vitamin D deficiency was seen in 89% of premature infants (46.6% severe, 30.6% moderate, and 11.9% mild). Serum levels of vitamin D were 18.28±13.94 ng/ml and 14.10±9.70 ng/ml in mothers and infants, respectively. The infants below and above 32 weeks exhibited vitamin D values of 10.97±6.31 ng/ml and 18.05±11.64 ng/ml, respectively. The difference in vitamin D levels between boys (12.59±8.40 ng/ml) and girls (16.05±11.45 ng/ml) was found to be significant (P=0.009). Moderate and severe vitamin D deficiency was more common at earlier pregnancy ages (P=0.001). CONCLUSION Vitamin D deficiency is more common and severe in preterm infants and their mothers. Controlling vitamin D levels during pregnancy, especially in women at risk of preterm labor and preterm infants, may help reduce prematurity problems.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
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Boskabadi H, Pourbadakhshan N, Pishghadam E, Zakerihamidi M. WITHDRAWN: Comparing Nucleated Red Blood Cells in Neonates with
and without Retinopathy. Curr Pediatr Rev 2021; 17:CPR-EPUB-117807. [PMID: 34503429 DOI: 10.2174/1573396317666210909155024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/06/2021] [Accepted: 06/08/2021] [Indexed: 11/22/2022]
Abstract
Since the authors are not responding to the editor’s requests to fulfill the editorial requirement, therefore, the article has been withdrawn by the publisher. Bentham Science apologizes to the readers of the journal for any inconvenience this may have caused. The Bentham Editorial Policy on Article Withdrawal can be found at https://benthamscience.com/editorial-policies-main.php. Bentham Science Disclaimer It is a condition of publication that manuscripts submitted to this journal have not been published and will not be simultaneously submitted or published elsewhere. Furthermore, any data, illustration, structure or table that has been published elsewhere must be reported, and copyright permission for reproduction must be obtained. Plagiarism is strictly forbidden, and by submitting the article for publication the authors agree that the publishers have the legal right to take appropriate action against the authors, if plagiarism or fabricated information is discovered. By submitting a manuscript the authors agree that the copyright of their article is transferred to the publishers if and when the article is accepted for publication.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University o Medical Sciences, Mashhad. Iran
| | - Nafiseh Pourbadakhshan
- Department of Pediatrics, Faculty of Medicine, Mashhad University o Medical Sciences, Mashhad. Iran
| | - Esmaeil Pishghadam
- Department of Ophthalmology, Faculty of Medicine, Mashhad University o Medical Sciences, Mashhad. Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, Faculty of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon. Iran
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Boskabadi H, Zakerihamidi M, Moradi A. Predictive value of biochemical and hematological markers in prognosis of asphyxic infants. Caspian J Intern Med 2021; 11:377-383. [PMID: 33680378 PMCID: PMC7911764 DOI: 10.22088/cjim.11.4.377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Asphyxia is one of the main causes of infant mortality and long-term neurologic complications. This cohort study was aimed to compare the diagnostic value of the hematologic and biochemical factors in the prediction of prognosis of asphyxia according to the high prevalence of asphyxia and its complications. Methods: In this cohort with a two-year follow-up study with availability sampling, 196 term asphyxic infants were involved from 2009 to 2018. A researcher-designed questionnaire was used as the data collection tool containing infantile and maternal particulars as well as the clinical and laboratory assessments. Serum levels of interleukin-1β(IL-1β), IL-6, pro-oxidant/antioxidant balance (PAB), heat shock protein (HSP) and nucleated red blood cells (NRBC) were checked in infants with perinatal asphyxia. Denver II developmental screening test (DDST-II) was performed at 6, 12, 18, and 24 month post-discharge follow-up visits. Data analysis for comparison of infants with normal and abnormal outcomes was performed using student t- test, chi-square, ROC curve, and regression models. Results: IL-6, IL-1β, PAB, and NRBC count are among the most important predictors of abnormal complications in asphyxic newborns. PAB>22 (HK) showed sensitivity and specificity of 88.6% and 71.6%, respectively in the prediction of complications of asphyxia. The sensitivity and specificity of an IL-6 higher than 28 (pg/mL) in the prediction of complications of asphyxia were found to be 96.1% and 78.6%, respectively. Elevated levels of IL-6 and IL-1β were associated with increased unfavorable outcomes. Conclusion: Combinations of: IL-1β+ IL-6 + NRBC; IL-6 + HIE grade + PAB; and IL-6+ HIE grade + NRBC had the highest predictive value (100%) for prognosis of asphyxic infants.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- Department of Midwifery, School of Medicine, Islamic Azad University, Tonekabon, Iran
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Boskabadi H, Maamouri G, Akhondian J, Ashrafzadeh F, Boskabadi A, Faramarzi R, Heidar E, Pourbadakhshan N, Shojaei SRH, Zakerihamidi M, Vatanchi AM, Sokhtanloo M, Razaghi N, Kalani F, Ataei H, Darabi A, Mousavi MS, Hakimiakhangan S, Bagheri F. Comparison of birth weights of neonates of mothers receiving vs. not receiving zinc supplement at pregnancy. BMC Pregnancy Childbirth 2021; 21:187. [PMID: 33676424 PMCID: PMC7936407 DOI: 10.1186/s12884-021-03598-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 01/27/2021] [Indexed: 01/11/2023] Open
Abstract
Background Zinc is an essential element for normal embryogenesis and embryonic and neonatal development. Therefore, we compared the birth weights of neonates born to mothers who consumed zinc supplement during pregnancy with that of neonates born to mothers who did not. Methods In a cross-sectional study, we divided 200 pregnant mothers into two groups: case group (mothers receiving zinc supplement during pregnancy) and control group (mothers not receiving zinc supplement during pregnancy) Then, the neonate’s cord zinc level and mother’s serum level were measured and neonate’s growth charts (weight, height and head circumference)were completed. Results In this study, both groups of mothers were observed to have zinc deficiency; 35% of the mothers who consumed zinc supplements and 81% of the mothers who did not consume zinc supplements (P < 0.001). Based on the results, maternal serum of zinc (P < 0.001), neonatal birth weight (P = 0.008), maternal age (P < 0.001) and parity (P < 0.01) in zinc-supplemented group were higher. Neonatal birth weight was associated moderately with mother’s zinc serum levels and poorly with neonatal serum zinc levels. Conclusion Zinc consumption during pregnancy increases serum zinc level of mother and neonatal weight. Neonatal weight has a higher correlation to maternal serum zinc level.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University o Medical Sciences, Mashhad, Iran
| | - Gholamali Maamouri
- Department of Pediatrics, Faculty of Medicine, Mashhad University o Medical Sciences, Mashhad, Iran
| | - Javad Akhondian
- Department of Pediatrics, Faculty of Medicine, Mashhad University o Medical Sciences, Mashhad, Iran
| | - Farah Ashrafzadeh
- Department of Pediatrics, Faculty of Medicine, Mashhad University o Medical Sciences, Mashhad, Iran
| | - Abbas Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University o Medical Sciences, Mashhad, Iran
| | - Raheleh Faramarzi
- Department of Pediatrics, Faculty of Medicine, Mashhad University o Medical Sciences, Mashhad, Iran
| | - Elahe Heidar
- Department of Pediatrics, Faculty of Medicine, Mashhad University o Medical Sciences, Mashhad, Iran
| | - Nafiseh Pourbadakhshan
- Department of Pediatrics, Faculty of Medicine, Mashhad University o Medical Sciences, Mashhad, Iran
| | - Seyed Reza Habibzadeh Shojaei
- Department of Orthopedic Surgeon, Faculty of Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran.
| | | | - Mohammad Sokhtanloo
- Department of Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naghmeh Razaghi
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farnaz Kalani
- Department of Pediatrics, Fellowship of neonatology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hosein Ataei
- Department of Pediatrics, Fellowship of neonatology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azadeh Darabi
- Department of Pediatrics, Fellowship of neonatology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojgan Sadat Mousavi
- Department of Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeideh Hakimiakhangan
- Neonatal Intensive Care, Faculty member of Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fathemeh Bagheri
- Neonatal Intensive Care, Faculty member of Azad University, Mashhad, Iran
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Boskabadi H, Maamouri G, Zakerihamidi M, Mohammadzadeh Vatanchi A, Sokhtanloo M, Mousavi MS, Ghahremani S, Bagheri F. Comparison of hyperbilirubinemia incidence between the newborns of zinc-taking and non-zinc-taking mothers during the third trimester of pregnancy. Caspian J Intern Med 2021; 12:521-525. [PMID: 34820057 PMCID: PMC8590408 DOI: 10.22088/cjim.12.4.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/17/2020] [Accepted: 09/02/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Identification and control of the risk factors for hyperbilirubinemia can reduce the incidence and complications of this condition. Serum zinc level in newborns is reported to be one of the factors affecting the severity and incidence of neonatal hyperbilirubinemia. Therefore, the present study was conducted to compare hyperbilirubinemia incidence in neonates of zinc-taking and non-zinc-taking mothers. METHODS In this observational study, we compared the incidence of hyperbilirubinemia during the first week of birth between newborns whose mothers had received zinc supplement during the third trimester of pregnancy (case group) with those whose mothers had not taken zinc supplement (control group). The checklist of newborns' conditions in both case and control groups was completed based on the obtained data regarding the infants, mothers, and laboratory findings. Data was analyzed using chi-squared test and t-test. RESULTS The mean serum levels of zinc were 79.76±15 mg/dl and 70.93±15.67mg/dl in mothers who had received zinc during the third trimester and those who had not taken zinc supplement, respectively. The mean serum level of zinc in newborns who underwent phototherapy was 41.68±9.21 mg/dl, while it was 68.53±20.85 mg/dl in neonates who did not receive phototherapy. In addition, 36% of the neonates whose mothers had not received zinc required phototherapy, while only 11% of newborns whose mothers had taken zinc supplement received phototherapy. CONCLUSION Zinc consumption during the third trimester of pregnancy increased the serum zinc level in both newborns and mothers and reduced the incidence and severity of idiopathic hyperbilirubinemia requiring treatment.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gholamali Maamouri
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, Faculty of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran ,Correspondence: Maryam Zakerihamidi, Department of Midwifery, Faculty of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran. E-mail: , Tel: 0098 1154271105, Fax: 0098 1152245014
| | | | - Mohammad Sokhtanloo
- Department of Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Marzieh Sadat Mousavi
- Department of Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Ghahremani
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Bagheri
- Department of Nursing, Faculty of Medical Sciences, Mashhad Branch, Islamic Azad University, Mashhad, Iran
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Boskabadi H, Zakerihamidi M. The prevalence of hyperglycemia in neonatal hypernatremic dehydration (NHD) and its correlation with prognosis in exclusively breastfed infants: A cohort study. Acta Pediatr Mex 2020. [DOI: 10.18233/apm41no6pp249-2561772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Boskabadi H, Rakhshanizadeh F, Moradi A, Zakerihamidi M. Risk Factors and Causes of Neonatal Hyperbilirubinemia: A Systematic Review Study. J Pediatr Rev 2020. [DOI: 10.32598/jpr.8.4.293.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Context: Jaundice is a common problem and the most common risk factor for hospitalization during the neonatal period. Objective: The prevention of neonatal hyperbilirubinemia would not be possible without identifying its predisposing risk factors. The present systematic review study aims to determine the risk factors of neonatal jaundice. Data Sources: Databases including Science Direct, Cochrane Library, Web of Science (ISI), PubMed, and Google Scholar were searched to identify all eligible papers concerning the risk factors of neonatal hyperbilirubinemia. Study Selection: This systematic review was performed to review the causes and risk factors of neonatal hyperbilirubinemia. Finally, 18 articles were defined as eligible for further review. Data Extraction: The keywords included neonates, jaundice, hyperbilirubinemia, and risk factors. The inclusion criteria were studies determining jaundice risk factors, while papers with only published abstracts were excluded. Results: A total of 18 eligible articles (3 retrospective, 4 prospective, 10 cross-sectional, and 1 historical cohort) out of 421 retrieved articles were included in this review. The etiologic causes for neonatal jaundice were ABO incompatibility (24.6%), infection (including UTI and sepsis) (13.7%), G6PD deficiency (9.4%), Rh incompatibility (7%), and cephalohematoma (2.9%), while, known predisposing factors for neonatal jaundice included unknown (33.2%), low birth weight (30.9%), hyperbilirubinemia in siblings (22.7%), prematurity (20.1%), and infant of diabetic mother (6.7%). Conclusion: According to our review with considering the studies, the etiologic causes for neonatal jaundice are ABO incompatibility, infection (including UTI and sepsis), G6PD deficiency, Rh incompatibility, and cephalohematoma. While, known predisposing factors for neonatal jaundice include low birth weight, hyperbilirubinemia in siblings, prematurity, and infant of diabetic mother.
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Boskabadi H, Maamouri G, Bagheri F, Zakerihamidi M. Comparison of the health status of exclusively breastfeeding infants and newborns receiving sugar water along with breast milk. Acta Pediatr Mex 2020. [DOI: 10.18233/apm41no5pp199-2071692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Boskabadi H, Maamouri G, Kalani-Moghaddam F, Ataee Nakhaei MH, Zakerihamidi M, Rakhshanizadeh F. Comparison of Umbilical Cord Serum Vitamin D Levels between Infants with Transient Tachypnea of the Newborn and those without Respiratory Distress. Arch Iran Med 2020; 23:530-535. [PMID: 32894964 DOI: 10.34172/aim.2020.55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 06/02/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Transient tachypnea of the newborn (TTN) is one of the most frequent causes of respiratory distress in neonates. A relationship has been shown between vitamin D deficiency and respiratory disorders in neonates. This research was carried out to evaluate the serum level of vitamin D in TTN newborns and their mothers compared to the control group. METHODS This case-control research was conducted during 2016-2019 in a general hospital affiliated with Mashhad University of Medical Sciences, Iran. Thirty-four infants with TTN and 82 neonates in the control group as well as their mothers were investigated. The levels of umbilical cord serum vitamin D in infants with TTN and also their mothers were compared to the control group. RESULTS The mean levels of serum vitamin D in infants with TTN and their mothers were 8.11 ± 4.32 and 12.6 ± 10.12 ng/mL, respectively (P<0.001), whereas they were 19.21 ± 12.71 and 25.96 ± 16.6 ng/mL in the newborns of the control group and their mothers, respectively (P<0.001). The mean differences (95% CI) of neonatal and maternal vitamin D level between the two groups were 11.10 (7.92-14.28) and 13.36 (7.90-18.08), respectively. In the TTN group, 100% of the infants had vitamin D levels less than 30 ng/mL (79.4% had severe, 17.6% had moderate and 2.9% showed mild deficiency). However, vitamin D levels lower than 30 ng/mL were observed in 76.4% of the neonates in the control group (28.8% had severe, 31.1% showed moderate and 16.3% had a mild deficiency) (P<0.001). CONCLUSION The serum vitamin D levels of infants with TTN and their mothers were significantly lower than the control group. Therefore, TTN in infants may be reduced through the treatment of vitamin D deficiency in mothers.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Neonatal Research Centre, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gholamali Maamouri
- Department of Pediatrics, Neonatal Research Centre, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farnaz Kalani-Moghaddam
- Department of pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Maryam Zakerihamidi
- Department of Midwifery, Faculty of Medicine, Islamic Azad University, Tonekabon Branch, Tonekabon, Iran
| | - Forough Rakhshanizadeh
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Boskabadi H, Heidari E, Zakerihamidi M. Etiology, clinical findings and laboratory parameters in neonates with acute bacterial meningitis. Iran J Microbiol 2020; 12:89-97. [PMID: 32494342 PMCID: PMC7244827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Neonatal meningitis is one of the most important and serious neonatal infections with a high mortality and morbidity rate. The present study aimed to investigate the causes, clinical signs, laboratory parameters and mortality rates in newborns with bacterial meningitis. MATERIALS AND METHODS This cross-sectional study was performed on 468 neonates aged 2-28 days admitted to NICU in Ghaem Hospital Mashhad, Iran by available sampling method during 2009-2018. Meningitis was confirmed according to positive results of CSF culture and clinical feature. By using researcher-made questionnaire, neonate's individual data including cardiopulmonary resuscitation, the Apgar score of the first and fifth minutes, gestational age, birth weight, clinical symptoms and laboratory data such as ESR, WBC and positive culture of CSF were studied. RESULTS Among 468 newborn suspected to infection, lumbar Puncture (LP) was performed for 233 cases (50%). Of 233 neonates, 148 neonates (63.5%) had negative results for CSF culture and 85 cases (36.5%) had positive CSF culture. 94% of cases with meningitis were born premature. Blood culture had positive results in 80% of infants with late-onset meningitis and negative in 20%. The most common clinical findings were respiratory symptoms (94%). Klebsiella pneumoniae and Entrobacter aerugenes were the most common microorganisms of meningitis. Gestational disorders were observed in 55.3% of newborns with meningitis. C-Reactive Protein (CRP) of neonates with meningitis was twice higher than normal cases, and leukocytes and proteins in the CSF in neonates with meningitis were higher than healthy ones. Finally, 36% of neonates with meningitis died in our study. For analyzing the relationships between variables, independent t-test was used after controlling the normality, and Chi-square was used for analyzing the relationship of variables with nominal scale. CONCLUSION The most common pathogens of meningitis were Klebsiella pneumoniae and Enterobacter aerogenes. Respiratory symptoms were the most common clinical signs, and laboratory symptoms included increased CRP, increased leukocytes and proteins in CSF.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elahe Heidari
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, Faculty of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
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Boskabadi H, Rakhshanizadeh F, Zakerihamidi M. Evaluation of Maternal Risk Factors in Neonatal Hyperbilirubinemia. Arch Iran Med 2020; 23:128-140. [PMID: 32061076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 09/18/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Diagnosis and timely treatment of neonatal jaundice and prevention of dangerous side effects of pathologic neonatal jaundice remain a serious debate. The first step in prevention of jaundice is the identification of predisposing factors. The present study aims to systematically review the maternal risk factors of neonatal hyperbilirubinemia. METHODS For this study, we searched databases including Science Direct, Cochrane Library, ISI, PubMed and Google Scholar from 1993 to 2017. The keywords searched based on MESH included hyperbilirubinemia, jaundice, infants, mothers and risk factors. The present systematic review was conducted on studies reporting maternal risk factors for neonatal jaundice. The inclusion criteria were: study on neonates; examination of maternal factors or both maternal and neonatal factors. Papers associated with the diagnosis and treatment of neonatal jaundice were excluded from the study, as well as those articles for which only abstracts were available. The limitations of this study include lack of access to all relevant articles, lack of qualified reports in some papers, and the limitation in number of articles related to maternal risk factors, and therefore inability to judge accurately about their effects on neonatal jaundice. RESULTS Of 500 searched articles, 17 articles (1 prospective article, 2 retrospective papers, 12 cross-sectional papers and 2 historical cohort articles) were finally investigated. Maternal risk factors included hypertension, diabetes, type of delivery, vaginal bleeding, premature rupture of membranes (PROM), maternal age, lack of initiation of feeding during the first hours of life, inappropriate breastfeeding techniques and presence of maternal breast problems. CONCLUSION The most common maternal risk factors for neonatal jaundice were prematurity, blood type incompatibilities, preeclampsia, hypertension, diabetes mellitus, vaginal bleeding, delivery problems (type of delivery, labor injuries, delivery at home, skin ecchymosis, and cephalohematoma), mothers and community cultural beliefs (use of traditional supplements), breast problems, and decrease in breastfeeding.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Forough Rakhshanizadeh
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medical Scienses, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
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Boskabadi H, Zakerihamidi M, Moradi A. Predictability of prognosis of infantile hypernatremic dehydration: a prospective cohort study. J Matern Fetal Neonatal Med 2020; 35:66-74. [PMID: 31937159 DOI: 10.1080/14767058.2020.1712698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Infantile hypernatremic dehydration (IHD) is a life-threatening disease with potential cerebral adverse effects.Purpose: This study was conducted to evaluate the prognosis of IHD.Methods/Search strategy: Using convenience sampling 183 term infants with IHD (Na+ > 150 mg/dl) were enrolled in a cohort study with 36 months follow-up during 2007-2017. A researcher-made questionnaire was used for data collection. Follow-up visits were performed using the Denver Developmental Screening II test after discharging from hospital. The t-test, chi-square test, regression models, and receiver-operating characteristic curve were performed for data analysis.Findings/results: 17.5% of neonates were diagnosed with abnormal outcomes. Postpartum breast growth, breastfeeding frequency and duration, convulsion, consciousness, urination frequency, urea, Cr, sodium and brain CT scan (p = .000) showed significant differences (p < .05) between the infants with normal and abnormal outcomes. Combination of the above variables had a high predictive power (98.6%) for determining the unfavorable prognosis in infants with IHD.Implications for practice: Sodium, urea and creatinine are high-sensitive/specific determinants of IHD prognosis. Combination of some risk factors is highly predictive for unfavorable prognosis of IHD.Implications for research: Combination of variables such as sodium, urea, creatinine, lethargy, state of fontanels, convulsion, loss of consciousness, state of the breast during postpartum, inverted nipple and brain CT scan has a high predictive power in the determination of unfavorable prognosis in IHD.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Islamic Azad University, Tonekabon Branch, Tonekabon, Iran
| | - Ali Moradi
- Orthopedic Research Centre, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Jomeh R, Boskabadi H, Maamouri G, Zakerihamidi M. Comparative study of the effect of the administration of surfactant through a thin endotracheal catheter into trachea during spontaneous breathing with intubation (intubation-surfactant-extubation method). J Clin Neonatol 2019. [DOI: 10.4103/jcn.jcn_32_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Boskabadi H, Zakerihamidi M. Evaluate the diagnosis of neonatal sepsis by measuring interleukins: A systematic review. Pediatr Neonatol 2018; 59:329-338. [PMID: 29239828 DOI: 10.1016/j.pedneo.2017.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 09/22/2017] [Accepted: 10/13/2017] [Indexed: 12/22/2022] Open
Abstract
Neonatal sepsis is a dangerous and common disease among infants which is associated with high morbidity and mortality. Interleukins may be helpful for diagnosis of neonatal sepsis. Therefore, this study is conducted to investigate the role of interleukins in the diagnosis of neonatal sepsis. In this study, databases including PubMed, Cochrane Library, ISI and Google Scholar were searched up to 2016. Keywords were: Sepsis, neonatal, interleukins, prediction and diagnosis. Study inclusion criteria were: Articles about the relationship between the diagnosis of neonatal sepsis and interleukins; studies on babies; English and Persian articles and enough information from test results. Articles that had focused on adult sepsis or had used other markers except ILs or just their abstracts were available were excluded from the study. Of 100 searched studies, eventually, 16 articles were considered including 12 prospective studies, 3 cross-sectional studies and 1 retrospective study. IL6 has been studied more than other interleukins (50% of articles). ILs 6, 8 and 10 are among the initial markers of neonatal sepsis diagnosis. IL6 above 68 pg/ml had 85% sensitivity and 80% specificity, IL8 above 269.51 pg/ml had 80% sensitivity and 50% specificity, IL10 above 27 pg/ml had 60% sensitivity and 87% specificity and combined interleukins above 186.83 pg/ml had 75.63% sensitivity and 71.49% specificity in sepsis diagnosis. Interleukins can be helpful in the diagnosis of neonatal sepsis based on the results of this study. IL6 had the most sensitivity and IL10 had the most specificity for diagnosis of sepsis.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran.
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Abstract
Introduction: Jaundice is the most common condition requiring medical attention in newborns. Phototherapy is the standard treatment for jaundice. However, in recent decades, phototherapy has been considered as an oxidative stress that can cause lipid peroxidation and damage to DNA. Accordingly, the present study was conducted to examine the possible effects of phototherapy on the Pro-oxidant/Antioxidant Balance (PAB) in jaundiced newborns.
Methods: The present clinical trial was conducted on 70 icteric term neonates admitted to Ghaem Hospital of Mashhad, Iran between February 2013 and February 2015. The study population consisted of all term neonates who were admitted to the hospital within 2 to 14 days after birth for unconjugated hyperbilirubinemia (bilirubin levels > 15 mg/dl) and were treated with phototherapy. Neonates’ and mothers’ characteristics, along with the cause of jaundice, were collected through a researcher-made questionnaire, and neonates’ bilirubin levels and PAB values were simultaneously checked before, during and after the phototherapy. Finally, bilirubin levels and PAB values were compared using statistical methods.
Results: According to the results, neonates’ underlying characteristics were not statistically different. The average and standard deviation of bilirubin levels and PAB values were, respectively, 18.90±2.97 and 16.29±9.83 (before phototherapy), 15.71±3.16 and 29.63±12.56 (during phototherapy), and 12.37 ±3.57 and 40.91 ±13.35 (after phototherapy).
Conclusion: The results of this study demonstrate that decreased levels of bilirubin after phototherapy cause a shift in the PAB value in favor of oxidants.
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Boskabadi H, Zakerihamidi M, Faramarzi R. The vitamin D level in umbilical cord blood in premature infants with or without intra-ventricular hemorrhage: A cross-sectional study. Int J Reprod Biomed 2018; 16:429-434. [PMID: 30234182 PMCID: PMC6129378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Intra-ventricular hemorrhage (IVH) is acute cerebral complications of premature infants which may lead to the long-term problems. OBJECTIVE According to the role of vitamin D in the stability of the blood vessels, the present study was carried out in order to compare the vitamin D level in the premature infants with or without IVH. MATERIALS AND METHODS This cross-sectional study was carried out on 180 premature infants in the Ghaem Hospital, Mashhad, Iran 97 infants without IVH (53.9%) and 83 with IVH (46.1%) through convenience sampling technique in 2015-2017. Serum vitamin D level of funiculus in the two groups was compared. A researcher made questionnaire was used which includes infants' personal and laboratory information; and their mother's information. RESULTS Seventy nine percent of infants suffered from vitamin D deficiency in which 33.9% had a severe deficiency (less than 10 ng/ml), 30% moderate deficiency (10.1-20 ng/ml), 15% slight deficiency (20.1-30 ng/ml) and 21.1% had normal vitamin D (>30.1 ng/ml). Vitamin D mean±SD of infants in the control group, 23.71±12.98 ng/ml and case group 15.92±10.27 ng/ml (p<0.001). In total 92.8% of infants with IVH had levels of vitamin D below30 ng/ml, while this rate was 67% in infants without IVH. CONCLUSION Vitamin D deficiency in the premature infants is very common. Also, the serum vitamin D level in infants with IVH was less than infants without IVH. Therefore, the recommendation of vitamin D may be effective in the prevention of neonatal IVH.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine Sciences, Mashhad University o Medical Sciences, Mashhad, Iran.
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medicine, Islamic Azad University, Tonekabon Branch, Tonekabon, Iran.
| | - Raheleh Faramarzi
- Department of Pediatrics, Faculty of Medicine Sciences, Mashhad University o Medical Sciences, Mashhad, Iran.
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Boskabadi H, Zakerihamidi M, Moradi A, Bakhshaee M. Risk Factors for Sensorineural Hearing Loss in Neonatal Hyperbilirubinemia. Iran J Otorhinolaryngol 2018; 30:195-202. [PMID: 30083525 PMCID: PMC6064763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hyperbilirubinemia is a common neonatal problem with toxic effects on the nervous system that can cause hearing impairment. This study was conducted to assess the risk factors for sensorineural hearing loss and other coexisting problems in icteric infants. MATERIALS AND METHODS In a case-control study, 200 term infants with bilirubin levels higher than 20 mg/dl admitted to the neonatal intensive care unit of Ghaem Hospital, Mashhad during 2007-2015 were investigated. Profiles of infants with hearing impairment (n=60) were compared with those of icteric newborns with normal hearing (140 newborns) as the control group. After confirming the clinical diagnosis of jaundice by laboratory findings, a validated questionnaire containing mother and infant profiles were used for data collection. The auditory brainstem response test was used for assessment of infant hearing status after discharge. RESULTS Sensorineural hearing loss among infants with severe hyperbilirubinemia was found to be 4.8%. Serum total bilirubin (P=0.001), creatinine levels (P=0.002), direct Coombs test results (P=0.001), etiology (P=0.000) and treatment for jaundice (P=0.000), eye movement disorders (P=0.001), opisthotonos (P=0.001), and microcephaly (P=0.001) were found to be significantly different between the two groups (P<0.005). The prognostic predictability of sensorineural hearing loss based on total bilirubin level was found to be 82%. CONCLUSION Hearing impairment occurs about 10-50 times more frequently in neonates with severe jaundice. Total bilirubin level has the highest predictability for infant hearing status. Blood group and Rhesus (Rh) incompatibilities between mother and child and G6PD deficiency are important known causes for hearing impairment due to jaundice.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medicine, Islamic Azad University, Tonekabon Branch, Tonekabon, Iran.,Corresponding Author: Department of Midwifery, School of Medicine, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran. E-mail:
| | - Ali Moradi
- Orthopedic Research Centre, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mehdi Bakhshaee
- Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Boskabadi H, Zakerihamidi M, Faramarzi R. The vitamin D level in umbilical cord blood in premature infants with or without intra-ventricular hemorrhage: A cross-sectional study. Int J Reprod Biomed 2018. [DOI: 10.29252/ijrm.16.7.429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Boskabadi H, Moradi A, Zakerihamidi M. Interleukins in diagnosis of perinatal asphyxia: A systematic review. Int J Reprod Biomed 2018; 17. [PMID: 31435616 PMCID: PMC6653496 DOI: 10.18502/ijrm.v17i5.4598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/25/2018] [Accepted: 09/12/2018] [Indexed: 11/24/2022] Open
Abstract
Background Biochemical markers including interleukins (ILs) has been proposed for early diagnosis of asphyxia. Objective This study has aimed to systematically review the significance of IL measurements in the diagnosis of perinatal asphyxia. Materials and Methods PubMed, Cochrane Library, Web of Science, Embase, and Scopus databases before 2017 were searched for the following keywords: asphyxia, neonatal, interleukin, and diagnosis. A total of 13 out of 300 searched papers were finally selected for evaluation. Interleukins under study were IL6 and interleukin 1 β (IL-1 β ). Interleukins had been measured in 10 studies by serum samples, 2 studies by samples of Cerebro Spinal Fluid (CSF), and 1 study by sample of umbilical cord blood. The inclusion criteria were: studies on neonates, with adequate information from the test results and studies using markers other than ILs to detect asphyxia; however, studies with only abstracts available were excluded. Results Research on the issue suggests that IL6 > 41 Pg/dl has the sensitivity of 84.88% and the specificity of 85.43%, whereas IL-1 β > 4.7 Pg/dl has the sensitivity of 78% and specificity of 83% in the diagnosis of neonatal asphyxia. Among diagnostic ILs for neonatal asphyxia, combination of IL6 and IL-1 β had the highest sensitivity, that is, 92.9%. Conclusion IL6 and IL-1 β of serum samples were used in the early diagnosis of perinatal asphyxia and are useful predictors for the outcomes of perinatal asphyxia and its intensity. In addition, simultaneous evaluation of IL-1 β and IL6 can improve the sensitivity of the early diagnosis of perinatal asphyxia.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, Faculty of Medical Sciences, Islamic Azad University, Tonekabon Branch, Tonekabon, Iran
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Boskabadi H, Zakerihamidi M. Evaluation of Maternal Risk Factors, Delivery, and Neonatal Outcomes of Premature Rupture of Membrane: A Systematic Review Study. J Pediatr Rev 2018. [DOI: 10.32598/jpr.7.2.77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Boskabadi H, Kalate Mollaei M, Zakerihamidi M, Ghayour Mobarhan M, Bagheri F. The effect of exchange transfusion on prooxidant-antioxidant balance in newborns Jaundice. Biomed Res Ther 2018. [DOI: 10.15419/bmrat.v5i3.425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction: Newborns have a limited amount of antioxidant protection. Exchange transfusion may affect Prooxidant-Antioxidant Balance (PAB). The present study is conducted to investigate the effect of the exchange transfusion on PAB in newborn jaundice.
Methods: The present study is based on a clinical trial which is conducted at Ghaem Hospital in Mashhad, Iran during 2015-2016 that involved sampling on 22 jaundiced newborns (high bilirubin of 17 mg/dL) over a course of 35 weeks. Data collection for the study questionnaire included maternal blood group, neonatal characteristics (age, sex, weight, gestational age, Apgar score, etc.), and laboratory assessment (bilirubin, hematocrit, direct and indirect Coombs testing, reticulocytes, Glucose-6-phosphate dehydrogenase (G6PD), thyroxine (T4), thyroid stimulating hormone (TSH), and PAB). The amount of PAB and serum total bilirubin (STB) of newborns before, after and 6 hours after the exchange transfusion were investigated. Data analysis was performed via statistical tests (paired t-test) using SPSS version 19.
Results: The average bilirubin before the exchange transfusion was 22.02±5.80 mg/dL, after the exchange transfusion was 11.56±3.95 mg/dL, and at 6 hours after the exchange transfusion was 14.99±4.20 mg/dL. The average PAB before the exchange transfusion was 19.06±11.91 HK units, after the exchange transfusion was 29.40±17.70 HK, and at 6 hours after the exchange transfusion was 40.82±18.79 HK.
Conclusion: The results of the study show that the Prooxidant-Antioxidant balance in the exchange transfusion changes in favor of prooxidants and also intensifies even up to 6 hours after the exchange transfusion.
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Latifnejad Roudsari R, Zakerihamidi M, Merghati Khoei E, Kazemnejad A. Development and Psychometric Properties of the Decision Making on the Type of Delivery Questionnaire in Iranian Women. Int J Community Based Nurs Midwifery 2017; 5:292-302. [PMID: 28670590 PMCID: PMC5478750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A tool which can help to decide on the determinants in selecting the delivery type is an effective step towards the goals of the World Health. This study aimed to develop and evaluate the psychometric properties of a scale based on Iranian culture to make decision on the type of delivery. METHODS This is a methodological study using a questionnaire proposed by Schneider. The following steps were used to design the project. In the first step, perceptions and experiences of 45 pregnant women, postpartum women, midwives, gynecologists and non-pregnant women were determined based on interviews and observations using focused ethnography. In the second stage, the terms in the questionnaire based on qualitative study was assessed. Then, in the third stage, psychometric testing of the decision making on the type of delivery scale (DMTDS) based on the cultural concepts of decision making towards the type of delivery and its influencing factors based on focused ethnography using face validity, content validity, construct validity, internal consistency and reliability was done on400 pregnant and postpartum women. RESULTS The initially developed scale consisted of 60 items on a 5-point Likert scale, which reduced to 43 items following measurement of the face and content validity. The results of the exploratory factor analysis elicited 36 items and a seven-factor structure including motivational beliefs on vaginal delivery, social beliefs towards childbirth, motivational beliefs on cesarean delivery, personal beliefs, sources of information, catastrophic thinking and child birth experiences. Cronbach's alpha coefficient (0.80) confirmed the high internal consistency of the scale. CONCLUSION The developed questionnaire appears to be a valid and reliable tool for health care providers to measure the women's decision making towards type of delivery. Therefore, this tool can be used in the Iranian community. The scale may help the midwives and obstetricians to be aware of the women's decision regarding their choice of delivery and as a result to plan appropriately in order to reduce unnecessary cesarean sections.
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Affiliation(s)
- Robab Latifnejad Roudsari
- Evidence-Based Care Research Centre, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medicine, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
| | - Effat Merghati Khoei
- Iranian National Center for Addiction Studies (INCAS), Institution of Risk Behavior Reduction, Tehran University of Medical Sciences; Tehran, Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, School of Medicine, Tarbiat Modares University, Tehran, Iran
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Boskabadi H, Maamouri G, Ghayour-Mobarhan M, Bagheri F, Zakerihamidi M, Mollaey MK, Abbasi E, Zareh A, Tamannanlo A. Comparison of the predictive value of prooxidant-antioxidant balance and heat shock proteins in the diagnosis of neonatal asphyxia. Biomed Res Ther 2017. [DOI: 10.15419/bmrat.v4i05.171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction: Asphyxia is one of the important cause of infants' mortality. Accurate and early diagnosis of asphyxia has an important role in performing appropriate protective treatment protocole; therefore, we compared the diagnostic value of two methods of Prooxidant-Antioxidant Balance (PAB) and Heat shock proteins 70 ( HSP70) among healthy term infants and Neonates with asphyxia.
Methods: In this prospective case-control study, we compared the diagnostic value of two methods of PAB and HSP70 in healthy term infants (N=38) and Neonates with asphyxia (N=30) in Mashhad Ghaem hospital from 2011 to 2015. The diagnostic value of HSP70 and PAB was compared with statistical tests of Chi-square, T-Test, Man-Whitney, Roc curve and regression models.
Results: The newborns in two groups were significantly different in terms of the first (P=0.000) and fifth minute Apgar score (P=0.000), HSP70 (P=0.000), PAB (P=0.000), PH (P=0.000), BE (P=0.000) and HCO3 (P=0.015). HSP>0.218 ng / dl has 60% sensitivity and 76% specificity for the diagnosis of asphyxia while PAB>11.3 HK has 84% sensitivity and 92% specificity for the diagnosis of asphyxia.
Conclusion: According to the results of this study, HSP70>0.22 ng/dl and PAB>11.3 HK Unite can be used as biochemical markers for the diagnosis of perinatal asphyxia (P=0.001). The sensitivity and specificity of PAB in the diagnosis of asphyxia is higher than HSP70 and Simultaneous measurement of these two markers can correctly diagnose 84% of asphyxia cases.
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Boskabadi H, Maamouri G, Tavakkol Afshari J, Zakerihamidi M, Kalateh Molaee M, Bagheri F, Parizadeh M, Ghayour-Mobarhan M, Moradi A, Ferns GAA. Combination of Serum Interleukin-1β and 6 Levels in the Diagnosis of Perinatal Asphyxia. Arch Iran Med 2017; 19:312-6. [PMID: 27179161 DOI: 0161905/aim.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Perinatal asphyxia is an important cause of death, as well as permanent neurological and developmental complications. Diagnosing in time would lead to better prognosis and applying the most proper treatment. We sought to define the predictive values of serum concentrations of interleukin-1β (IL-1β) and interleukin-6 (IL-6) in newborns with perinatal asphyxia to see if there is a relation between the short-term neurological deficit and serum IL-1β and IL-6 concentrations. METHODS This was a prospective (case-control) study conducted between March 2006 and April 2013, at the Neonatal Intensive Care Unit, Mashhad, Iran. Serum IL-1β and IL-6 levels were measured at birth in 38 consecutive uninfected neonates with perinatal asphyxia (blood pH < 7.2, low Apgar score, signs of fetal distress) and 47 randomly selected healthy newborns. The results were compared between the groups, using Chi-Square, t-tests, and Mann-Whitney tests, as well as receiver operator characteristics (ROC) curves and regression models. RESULTS Serum IL-1β and IL-6 concentrations in the infants who developed perinatal asphyxia were significantly higher compared to values in the normal infants [16.88 vs 3.34 pg/mL for IL-1β, (P = 0.006), and 88.15 vs 6.74 pg/ mL for IL-6, (P < 0.001) respectively]. The sensitivity and specificity for the diagnosis of perinatal asphyxia using serum IL-6 were 80.5% and 81.6% respectively. The sensitivity and specificity using serum IL-1β were 71% and 89.1%, respectively. CONCLUSION Evaluating serum IL-6 and 1β simultaneously, could improve the sensitivity and specificity of early diagnosis of the perinatal asphyxia. The most appropriate indicator of perinatal asphyxia is combined measurement of interleukin 1β and interleukin 6.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Gholamali Maamouri
- Department of Pediatrics, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Jalil Tavakkol Afshari
- Department of Immunology, Immunology Research Center, Avicenna Research Institute, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medicine, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran.
| | - Maryam Kalateh Molaee
- Neonatal Intensive Care Nursing, Faculty of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Bagheri
- Neonatal Intensive Care Nursing, Faculty of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mustafa Parizadeh
- Biochemistry and Nutrition Research Center and Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Majid Ghayour-Mobarhan
- Biochemistry and Nutrition Research Center and Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Ali Moradi
- Orthopedic Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A A Ferns
- Division of Medical Education, Brighton and Sussex Medical School, Mayfield House, Falmer, BN19PH, UK
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Hassan B, Zakerihamidi M. The correlation between frequency and duration of breastfeeding and the severity of neonatal hyperbilirubinemia. J Matern Fetal Neonatal Med 2017; 31:457-463. [DOI: 10.1080/14767058.2017.1287897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Boskabadi Hassan
- Department of Pediatrics, Faculty Member of School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medicine, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
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Boskabadi H, Zakerihamidi M, Sadeghian MH, Avan A, Ghayour-Mobarhan M, Ferns GA. Nucleated red blood cells count as a prognostic biomarker in predicting the complications of asphyxia in neonates. J Matern Fetal Neonatal Med 2016; 30:2551-2556. [PMID: 27809621 DOI: 10.1080/14767058.2016.1256988] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Nucleated-red-blood-cells (NRBC) count in umbilical cord of newborns is been suggested as a sign of birth asphyxia. The present study was conducted to explore the value of NRBC count in prognosis of asphyxiated neonates. METHODS Sixty-three neonates with asphyxia were followed up for two years. Maternal and neonatal information was recorded follow by clinical and laboratory evaluation. NRBC-level was determined per 100 white-blood-cells (WBC). After discharge, follow-up of asphyxiated infants was performed using Denver II test at 6, 12, 18 and 24 months. Neonates were divided into two groups, with favorable and unfavorable outcome based on developmental delay or death. RESULTS We observed that NRBC count with more than 11 per 100 WBC, had sensitivity of 85% and specificity of 90% in predicting complications of asphyxia, while in absolute NRBC count with more than 1554, the sensitivity and specificity were 85% and of 87%, respectively. Combination of NRBC + HIE (hypoxic ischemic encephalopathy) grade had a high-predictive power for determining the prognosis of asphyxia in neonates. CONCLUSION We demonstrate that NRBC/100 WBC and absolute NRCB count can be used as prognostic marker for neonatal asphyxia, which in combination with the severity of asphyxia could indicate high infant mortality, and complications of asphyxia. Further studies in a larger and multi center setting trail are warranted to investigate the value of NRBC and HIE in asphyxiate term infants.
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Affiliation(s)
- Hassan Boskabadi
- a Department of Pediatrics , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Maryam Zakerihamidi
- b Department of Midwifery , Faculty of Medicine, Islamic Azad University of Tonekabon , Tonekabon , Iran
| | - Mohammad Hadi Sadeghian
- c Hematology and blood banking Department, Ghaem hospital, Mashhad University of Medical Sciences , Mashhad , Iran
| | - Amir Avan
- d Department of Modern Sciences and Technologies , School of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran
| | - Majid Ghayour-Mobarhan
- d Department of Modern Sciences and Technologies , School of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran.,e Biochemistry of Nutrition Research Center, School of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran , and
| | - Gordon A Ferns
- f Division of Medical Education , Brighton and Sussex Medical School , Brighton , UK
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Boskabadi H, Zakerihamidi M, Heidarzadeh M, Avan A, Ghayour-Mobarhan M, Ferns GA. The value of serum pro-oxidant/antioxidant balance in the assessment of asphyxia in term neonates. J Matern Fetal Neonatal Med 2016; 30:1556-1561. [PMID: 27377567 DOI: 10.1080/14767058.2016.1209655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Asphyxia is a major cause of disabilities in term-born infants. Here we have explored the value in HIE (hypoxic-ischemic-encephalopathy) of using a combination of serum pro-oxidant/antioxidant balance (PAB) assay for predicting the prognosis of asphyxia. METHOD Ninety term neonates with asphyxia were enrolled and followed up for two years. Serum PAB, demographic/biochemical characteristics of mothers, and their neonates were determined. The Denver II test was used to assess outcomes. RESULTS Of the 90 asphyxiated neonates, 47 (52.2%) had a normal outcome and 43 babies (47.8%) had abnormal outcome. Serum PAB levels in neonates with normal and abnormal outcomes were 17.1 ± 9.23 and 48.27 ± 41.30 HK, respectively. A combination of HIE intensity and PAB, compared to other indicators, had a higher predictive-value (95.2%) for outcomes in asphyxiated babies. CONCLUSION We demonstrate that PAB in combination with HIE grade may have a better predictive value for the prognosis of asphyxiated babies and predicting future neurologic problems in asphyxiated term infants.
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Affiliation(s)
- Hassan Boskabadi
- a Department of Pediatrics , Neonatal Research Center, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS) , Mashhad , Iran
| | - Maryam Zakerihamidi
- b Reproductive Health, Department of Midwifery, School of Medicine, Tonekabon Branch, Islamic Azad University , Tonekabon , Iran
| | - Mohammad Heidarzadeh
- c Department of Pediatrics , Community Medicine and Public Health, Tabriz University of Medical Sciences , Tabriz , Iran
| | - Amir Avan
- d Department of Modern Sciences and Technologies , School of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran
| | - Majid Ghayour-Mobarhan
- e Biochemistry of Nutrition Research Center, School of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran , and
| | - Gordon A Ferns
- f Division of Medical Education , Brighton and Sussex Medical School , Brighton , UK
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Boskabadi H, Ashrafzadeh F, Doosti H, Zakerihamidi M. Assessment of Risk Factors and Prognosis in Asphyxiated Infants. Iran J Pediatr 2015; 25:e2006. [PMID: 26396695 PMCID: PMC4575793 DOI: 10.5812/ijp.2006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/03/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Asphyxia is considered an important cause of morbidity and mortality in neonates. This condition can affect many vital organs including the central nervous system and may eventually lead to death or developmental disorders. OBJECTIVES Considering the high prevalence of asphyxia and its adverse consequences, the present study was conducted to evaluate the risk factors for birth asphyxia and assess their correlation with prognosis in asphyxiated infants. PATIENTS AND METHODS This two-year follow-up cohort study was conducted on 260 infants (110 asphyxiated infants and 150 healthy neonates) at Mashhad Ghaem Hospital during 2007 - 2014. Data collection tools consisted of a researcher-designed questionnaire including maternal and neonatal information and clinical/laboratory test results. The subjects were followed-up, using Denver II test for 6, 12, 18, and 24 months (after discharge). For data analysis, t-test was performed, using SPSS version 16.5. P value ≤ 0.05 was considered statistically significant. RESULTS Of 260 neonates, 199 (76.5%) and 61 (23.5%) cases presented with normal neonatal outcomes and with abnormal neonatal outcomes (developmental delay), respectively. Variables such as the severity of asphyxia (P = 0.000), five-minute Apgar score (P = 0.015), need for ventilation (P = 0.000), and severity of acidosis at birth (P = 0.001) were the major prognostic factors in infants with asphyxia. Additionally, prognosis was significantly poorer in boys and infants with dystocia history (P = 0.000). CONCLUSIONS Prevalence of risk factors for developmental delay including the severity of asphyxia need for mechanical ventilation, and severity of acidosis at birth, dystocia, and Apgar score were lower in surviving infants; therefore, controlling these risk factors may reduce asphyxia-associated complications.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Farah Ashrafzadeh
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Hassan Doosti
- Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad,IR Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medicine, Tonekabon Branch, Islamic Azad University, Tonekabon, IR Iran
- Corresponding author: Maryam Zakerihamidi, Department of Midwifery, School of Medicine, Tonekabon Branch, Islamic Azad University, Tonekabon, IR Iran. E-mail:
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Latifnejad Roudsari R, Zakerihamidi M, Merghati Khoei E. Socio-Cultural Beliefs, Values and Traditions Regarding Women's Preferred Mode of Birth in the North of Iran. Int J Community Based Nurs Midwifery 2015; 3:165-76. [PMID: 26171405 PMCID: PMC4495324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 02/10/2015] [Accepted: 02/28/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pregnant women rely heavily on informal information while making a decision about the mode of delivery they would rather have, either as normal vaginal delivery (NVD) or cesarean section (CS). Through recognition of social attitudes towards different modes of delivery, societies can be directed towards a positive understanding of vaginal delivery, which can ultimately lead to maternal health promotion. Thus, this study aimed to explore the common beliefs, values and traditions surrounding women's preferred mode of birth in the North of Iran. METHODS Using a focused ethnographic approach, twelve pregnant women, 10 women with previous experience of childbirth, seven midwives, seven obstetricians, and nine non-pregnant women were included in this study through a purposeful sampling in health clinics of Tonekabon in the North of Iran. Semi-structured interviews and participant observations were used for data collection. Study rigor was confirmed through prolonged engagement, member check, expert debriefing, and thick description of the data. Data were analysed using Braun & Clarke thematic analysis (2006) and MAXqda software. RESULTS Through analysis, three major themes and 10 subthemes emerged. They included: 1) sociocultural childbirth beliefs with five subthemes: a) CS as protector of genital tract integrity, b) blind imitation in choosing mode of birth, c) NVD as a low cost type of delivery, d) CS as a prestigious mode of birth and, e) NVD as a symbol of woman's power and ability; 2) traditional health beliefs with two subthemes: a) NVD as a guarantee for woman's health, b) traditional childbirth facilitators; 3) religious beliefs and values with three subthemes: a) NVD as a symbol of God's power, b) call for help from the Mighty God, and c) NVD as a sacred phenomenon. CONCLUSION The results of this study indicated that cultural beliefs, values and traditions can significantly affect individuals' attitudes towards modes of delivery, their definitions of different modes, and the decisions they make in this regard. In order to develop a positive cultural and religious attitude towards vaginal delivery, women's awareness has to be raised through various ways and the existing misconceptions need to be corrected.
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Affiliation(s)
- Robab Latifnejad Roudsari
- Evidence-Based Care Research Centre, Department of Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran;
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medicine, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran;
| | - Effat Merghati Khoei
- Iranian National Center for Addiction Studies (INCAS), Institution of Risk Behavior Reduction, Tehran University of Medical Sciences, Tehran, Iran
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Zakerihamidi M, Latifnejad Roudsari R, Merghati Khoei E. Vaginal Delivery vs. Cesarean Section: A Focused Ethnographic Study of Women's Perceptions in The North of Iran. Int J Community Based Nurs Midwifery 2015; 3:39-50. [PMID: 25553333 PMCID: PMC4280556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 09/08/2014] [Accepted: 11/10/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cesarean section (C-section) in the North of Iran accounts for 70% of childbirths, which is higher than the national average of 55%. Understanding women's perceptions towards modes of delivery in different cultures can pave the way for promoting programs and policies in support of vaginal delivery. We aimed to investigate women's perceptions towards modes of delivery in the North of Iran. METHODS Using a focused ethnographic approach and purposive sampling, 12 pregnant women, 10 women with childbirth experience, nine non-pregnant women, seven midwives, and seven gynecologists were selected from hospitals, healthcare centers, and clinics of Tonekabon and Chaloos, Mazandaran, Iran, during 2012-2014. Data were collected through in-depth interviews and participant observation. Data analysis was performed using thematic analysis using MAXqda software. RESULTS Two major themes emerged from the data including: "vaginal delivery, a facilitator of women's physical and mental health promotion", and "C-section, a surgical intervention associated with decreased labor pain". Six sub-themes subsumed within these major themes were: vaginal delivery as a safe mode of delivery, fullfilment of maternal instinct, a natural process with a pleasant ending, and C-section as a procedure associated with future complications, a surgical intervention and sometimes a life saving procedure, and a painless mode of delivery. CONCLUSION In the North of Iran, women's justified cultural beliefs overshadow their micsconceptions, so it is hopped that through implementing appropriate training programs for raising awarness and correcting miscomceptions, vaginal delivery could be promoted even in regions with high rates of cesarean section.
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Affiliation(s)
- Maryam Zakerihamidi
- Department of Midwifery, School of Medicine, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
| | - Robab Latifnejad Roudsari
- Evidence-Based Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Effat Merghati Khoei
- Iranian National Center of Addiction Studies, Institution of Risk Behavior Reduction, Tehran University of Medical Sciences, Tehran, Iran
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Boskabadi H, Ramazanzadeh M, Zakerihamidi M, Rezagholizade Omran F. Risk factors of breast problems in mothers and its effects on newborns. Iran Red Crescent Med J 2014; 16:e8582. [PMID: 25068067 PMCID: PMC4103000 DOI: 10.5812/ircmj.8582] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 07/31/2013] [Accepted: 02/12/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND During lactation, especially the first few days after birth, some breast problems can cause pain and inadequate milk emptying. OBJECTIVES This study aimed to investigate the risk factors of breast problems and their effect on neonatal complications. PATIENTS AND METHODS This case-control study was conducted on 566 infants referred to Mashhad Ghaem Hospital clinic (from 2008 to 2012) in Iran. Researchers filled out the questionnaire with the relevant neonatal and maternal information. They also recorded the mothers' breasts problems after examination. Then the infants were divided into two groups: Infants whose mothers complained from breast problems (case group), and the infants whose mothers did not have any breast problems (control group). Finally, two groups were compared with respect to the maternal and neonatal risk factors. RESULTS THE TWO GROUPS WERE MATCHED ON THESE VARIABLES: parity (P = 0.861), maternal weight (P = 0.577), education level (P = 0.807), pregnancy complications (P = 0.383), gestational age (P = 0.161), Apgar score (P = 0.530), birth weight (P = 0.090), infant gender (P = 0.439), and infant age (P = 0.152). Case group vs. control group showed significant differences regarding prenatal care, mode of delivery, lactation status and the letdown reflex, serum sodium, frequency of urination and defecation, new weight and supplementation (P < 0.05). CONCLUSIONS According to our study, breast problems were fewer in mothers who had prenatal care, normal vaginal delivery, proper breastfeeding position, and let down reflex. Neonatal complications of breast problems include pathologic weight loss and decrease in the frequency of urination. Therefore, special attention to mother's breasts during pregnancy and in the early days of delivery, and their appropriate treatment may reduce breast problems and related neonatal complications.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | | | - Maryam Zakerihamidi
- Department of Midwifery, College of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding Author: Maryam Zakerihamidi, Department of Midwifery, College of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-9113934386, E-mail:
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Latifnejad-Roudsari R, Zakerihamidi M, Merghati-Khoei E, Kazemnejad A. Cultural perceptions and preferences of Iranian women regarding cesarean delivery. Iran J Nurs Midwifery Res 2014; 19:S28-36. [PMID: 25949249 PMCID: PMC4402990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 12/06/2014] [Indexed: 10/26/2022]
Abstract
BACKGROUND Data was reported in Iran in 2013 has shown that almost 42 percent of deliveries in public hospitals and 90 percent in private hospitals were carried out with cesarean section. This high rate of cesarean requires careful consideration. It seems that making decision for cesarean is done under the influence of cultural perceptions and beliefs. So, this study was conducted to explore pregnant women's preferences and perceptions regarding cesarean delivery. MATERIALS AND METHODS A focused ethnographic study was used. 12 pregnant women and 10 delivered women, seven midwives, seven gynecologist and nine non-pregnant women referred to the health clinics of Tonekabon, who selected purposively, were included in the study. To collect data semi-structured in-depth interviews and participant observation were used. Study rigor was confirmed through prolonged engagement, member check, expert debriefing, and thick description of the data. Data were analysed using thematic analysis and MAXQDA software. RESULTS Four themes emerged from the data including personal beliefs, fear of vaginal delivery, cultural norms and values and also social network. These concepts played main roles in how women develop meanings toward caesarean, which affected their perceptions and preferences in relation to caesarean delivery. CONCLUSION Most of pregnant women believed that fear of vaginal delivery is a major factor to choose caesarean delivery. Hence, midwives and physicians could help them through improving the quality of prenatal care and giving them positive perception towards vaginal delivery through presenting useful information about the nature of different modes of delivery, and their advantages and disadvantages, as well as the alternative ways to control labor pain.
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Affiliation(s)
- Robab Latifnejad-Roudsari
- Research Center for Patient Safety, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Effat Merghati-Khoei
- Iranian National Center of Addiction Studies, (INCAS), Institution of Risk Behaviour Reduction, Tehran University of Medical Sciences, Tehran, Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, School of Medicine, Tarbiat Modares University, Tehran, Iran
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Zakerihamidi M, Roudsari RL, Khoei EM, Kazemnejad A. Decision-making for vaginal delivery in the North of Iran: A focused ethnography. Iran J Nurs Midwifery Res 2014; 19:S37-44. [PMID: 25949250 PMCID: PMC4402986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 12/06/2014] [Indexed: 12/02/2022]
Abstract
BACKGROUND Many factors have been mentioned to influence decision-making for different kinds of delivery. Decision-making for vaginal delivery is under the influence of culture, perceptions, beliefs, values, attitudes, personalities, and knowledge. The current study aims at exploring the determinants of decision-making for vaginal delivery in the north of Iran from women's perspective. MATERIALS AND METHODS A focused ethnographic method with purposeful sampling method has been used. Semi-structured interviews and observation were conducted with 12 pregnant women and 10 delivered women, 7 midwives, 7 gynecologists, and 9 non-pregnant women in Tonekabon clinics. Interviews and observations were recorded and transcribed. The accuracy of the extracted codes and themes was confirmed by restoration of the arranged and coded texts to the participants (member check) and by an expert person from outside the study context. Data were analyzed using thematic analysis and MAXqda software. RESULTS Five themes were extracted from the data: Economic influencing factors, Cultural values and norms related to normal childbirth, Positive attitudes towards vaginal delivery, Role of important others, and Facilitators of natural birth. Several sub-themes and sub-sub themes also emerged from the data (e.g. safe delivery, forming maternal feelings, painful but tolerable, maternal role facilitator, inexpensive delivery, a process with good outcome and less complications, relief messenger). CONCLUSIONS Giving enough information about vaginal delivery for pregnant women and their family members, training pregnant women to increase tolerance during labor pain, and modifying expenses can increase economic affordability, positive cultural norms and attitudes about vaginal delivery, proper social support, use of normal delivery facilitators, and direct them toward vaginal delivery.
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Affiliation(s)
- Maryam Zakerihamidi
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robab Latifnejad Roudsari
- Evidence-based Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Effat Merghati Khoei
- Iranian National Center of Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
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