Summary The cord blood lipid profile may be associated with lifelong changes in the metabolic functions of the individual. The aim of the present study was for the first time in Iran to assess the cord blood lipid profile of neonates, as well as some of its environmental influencing factors. The subjects were 442 (218 boys and 224 girls) normal vaginal delivery newborns. Overall, 14.4% of neonates were preterm and the rest were full‐term. In total, 9.2% (n = 35) of the full‐term newborns were small‐for‐gestational‐age (SGA), of which 16 had a ponderal index (PI) below the 10th percentile (SGA I) and 19 had a PI above the 10th percentile (SGA II), 5.5% (n = 21) were large‐for‐gestational‐age (LGA), and the remainder were appropriate‐for‐gestational‐age (AGA).Before becoming pregnant, 6.9% of mothers were underweight, 49.3% had normal body mass index (BMI), 39.4% were overweight and 4.4% were obese. Total and high‐density lipoprotein cholesterol (HDL‐C) in girls were significantly higher than in boys (80.3 ± 33.3 and 31.1 ± 9.9 vs. 73.3 ± 23.1 and 28.8 ± 8.7 mg/dL, respectively, P < 0.05). The mean apolipoprotein A (apoA) of neonates with underweight mothers was significantly lower, and the mean apoB level of those with overweight mothers was significantly higher than other neonates. The mean low‐density lipoprotein cholesterol (LDL‐C), HDL‐C and apoA of the LGA newborns were significantly lower, and their apoB was significantly higher compared with AGA and SGA neonates. The SGA I neonates had significantly lower total cholesterol, LDL‐C, HDL‐C and apoA, as well as higher triglycerides, lipoprotein a and apoB than the SGA II group. The mean cord blood triglycerides of full‐term neonates was significantly higher than preterm neonates (69.4 ± 11.9 vs. 61.4 ± 12.7 mg/dL, respectively, P = 0.04). A preconception maternal BMI of ≥25 kg/m2 correlated significantly with the cord triglycerides (OR = 1.3, [95% CI 1.07, 1.5]) and with apoB (OR = 1.4, [95% CI 1.1, 1.5]). The BMI <18 of mothers before pregnancy correlated with low HDL‐C (OR = 1.3, [95% CI 1.04, 1.7]). Birthweight correlated with high cord triglyceride level (SGA: OR = 1.4, [95% CI 1.1, 1.7]; LGA: OR = 1.6, [95% CI 1.3, 1.7] compared with AGA). These associations remained significant even after adjusting for the preconception BMI of mothers. Our findings reflect the possible interaction of environmental factors and fetal growth and the in utero lipid metabolism. Long‐term longitudinal studies in different ethnicities would help to elucidate the relationship.

Breast milk odor has an analgesic effect in preterm newborns and can be used as a safe method for pain relief.

Background:To compare two methods of weaning premature infants from nasal continuous positive airway pressure (NCPAP).Methods:Between March and November 2012, 88 preterm infants who were stable on NCPAP of 5 cmH2O with FIO2 <30% for a minimum of 6 h were randomly allocated to one of two groups. The high flow nasal cannula (HFNC) group received HFNC with flow of 2 L/min and FIO2 = 0.3 and then stepwise reduction of FIO2 and then flow. The non-HFNC group was maintained on NCPAP of 5 cmH2O and gradual reduction of oxygen until they were on FIO2 = 0.21 for 6 h, and we had weaned them directly from NCPAP (with pressure of 5 cmH2O) to room air.Results:No significant differences were found between 2 study groups with regards to gestational age, birth weight, Apgar score at 1 and 5 min after birth, patent ductus arteriosus and use of xanthines. The mean duration of oxygen therapy after randomization was significantly lower in HFNC group compared to non-HFNC group (20.6 ± 16.8 h vs. 49.6 ± 25.3 h, P < 0.001). Also, the mean length of hospital stay was significantly lower in HFNC group compared to non-HFNC group (11.3 ± 7.8 days vs. 14.8 ± 8.6 days, P = 0.04). The rate of successful weaning was not statistically different between two groups.Conclusions:Weaning from NCPAP to HFNC could decrease the duration of oxygen therapy and length of hospitalization in preterm infants.

Objective:Endotracheal intubation is a common procedure in neonatal care. The objective of this study was to determine whether the premedication with remifentanil before intubation has analgesic effects in newborn infants.Methods:A total of 40 premature infants who needed endotracheal intubation for intubation-surfactant-extubation method were randomly assigned in two groups of an equal number at two university hospitals. The control group was given 10 μg/kg atropine IV infusions in 1 min and then 2 ml normal saline. In the case group, the atropine was given with the same method and then remifentanil was administered 2 μg/kg IV infusions in 2 min.Findings:For remifentanil and control groups, the mean birth weight were 1761 ± 64 and 1447 ± 63 grams (P = 0.29), and the mean gestational ages were 31.69 ± 3.5 and 30.56 ± 2.8 weeks (P = 0.28), respectively. Using premature infant pain profile score, infants who received remifentanil felt significantly less pain than the control group (15.1 ± 1.6 vs. 7.5 ± 1.4; P < 0.001). There were no significant differences in the duration of endotracheal intubation procedure (20.8 ± 6 vs. 22.8 ± 7.3 s; P = 0.33), the number of attempts for successful intubation and oxygen desaturation between groups.Conclusion:Premedication with remifentanil has good analgesic effects for endotracheal intubation in premature infants without significant derangements in mean blood pressure and oxygen saturation.

Objective:It is well known that a brief exposure to 100% oxygen for only a few minutes could be toxic for a preterm infant. The effectiveness of neonatal resuscitation was compared with low concentration oxygen (30%) and high concentration oxygen (HOG) (100%).Methods:Thirty-two preterm neonates were born in Isfahan Shahid Beheshti hospital with gestational age of 29-34 weeks who required resuscitation were randomized into two groups. The resuscitation was begun with 30% O2 in low concentration oxygen group (LOG). The infants were examined every 60-90 seconds and if their HR was less than 100, 10% was added to the previous FIO2(fraction of inspired oxygen) until the HR increased to 100 and SO2(saturation of oxygen) increased to 85%. In HOG resuscitation begun with 100% O2 and every 60-90 seconds, FIO2 was decreased 10 – 15% until the HR reached to 100 and SO2 reached to 85%.Findings:The FIO2 in LOG was increased stepwise to 45% and in HOG was reduced to 42.1% to reach stable oxygen saturation more than 85% at the fifth minute in both groups. At the first and third minutes after birth and there was no significant differences between groups in heart rate and after 1,2,4 and 5 minutes after the birth there was also no significant differences in SO2 between groups, regardless of the initial FIO2.Conclusion:We can safely initiate resuscitation of preterm infants with a low FIO2(approximately 30%) oxygen and then oxygen should be adjusted with the neonates needs.

Background:The mothers of premature infants are at risk of psychological stress because of separation from their infants. One of the methods influencing the maternal mental health in the postpartum period is kangaroo mother care (KMC). This study was conducted to evaluate the effect of KMC of low birth weight infants on their maternal mental health.Materials and Methods:The study was conducted in the Department of Pediatrics of Isfahan University of Medical Sciences, Isfahan, Iran. Premature infants were randomly allocated into two groups. The control group received standard caring in the incubator. In the experimental group, caring with three sessions of 60 min KMC daily for 1 week was practiced. Mental health scores of the mothers were evaluated by using the 28-item General Health Questionnaire. Statistical analysis was performed by the analysis of covariance using SPSS.Results:The scores of 50 infant-mother pairs were analyzed totally (25 in KMC group and 25 in standard care group). Results of covariance analysis showed the positive effects of KMC on the rate of maternal mental health scores. There were statistically significant differences between the mean scores of the experimental group and control subjects in the posttest period (P < 0.001).Conclusion:KMC for low birth weight infants is a safe way to improve maternal mental health. Therefore, it is suggested as a useful method that can be recommended for improving the mental health of mothers.

This study highlighted several issues regarding mothers' experiences of infants' discharge plan. Nurses should be aware of these themes to support the mothers during preparation of their infants for discharge from NICUs.

Cobedding is a comforting measure for twin premature infants during heel lancing, which can be performed without any significant adverse effects.