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Abstract Background After the outbreak of COVID-19, a huge part of the health care services was dedicated to preventing and treating this disease. In case of COVID-19 infection, severe COVID-19 is reported more in pregnant individuals. Afterward, Vaccination against SARS-CoV-2 became a hot topic due to known effects in preventing severe COVID-19 during pregnancy. Vaccination of pregnant individuals started in August 2021 with the Sinopharm vaccine in Iran. The aim of current study was to determine the incidence of perinatal outcomes in women who were vaccinated during pregnancy. Method This retrospective cohort study included 129,488 singleton births from March 21, 2021, until March 21, 2022, in Tehran, Iran. The data was obtained from the Iranian Maternal and Neonatal (IMaN) Network and the Maternal Vaccination Registry. Adverse perinatal outcomes investigated in this study include preterm birth, extremely preterm birth, low birth weight, very low birth weight, intrauterine growth restriction, stillbirth, neonatal intensive care unit admission, congenital anomaly, neonatal death and low 5-minute Apgar score. The risk of all perinatal outcomes was evaluated using multiple logistic regression. The analysis was done using STATA version 14. Results Of all 129,488 singleton births included in this study, 17,485 (13.5%) were vaccinated against SARS-CoV-2 (all with Sinopharm (BBIBP-CorV)). The exposure to the Sinopharm vaccine during pregnancy caused a significant decrease in the incidence of preterm birth (P =0.006, OR=0.91 [95% CI, 0.85 to 0.97]), extremely preterm birth (P =

Background The neonatal mortality rate is a main indicator of the health and development of a country. Having insight into the cause of neonatal deaths may be the first step to reducing it. This paper depicts the cause of newborn deaths in Iran.Methods This cross-sectional study was performed on data from the national Iranian Maternal And Neonatal network to investigate all neonatal deaths in the country during the year 2019. The cause of death data were reported according to categories of birth weight, gestational age (GA), death time and place.Results The main causes of the 9959 neonatal deaths during the study period were respiratory distress syndrome (RDS) (37%), malformation (21%), prematurity of

Abstract Background Neonatal mortality accounts for more than 47% of deaths among children under five globally but proper care at and around the time of birth could prevent about two-thirds of these deaths. The Every Newborn Action Plan (ENAP) offers a plan and vision to improve and achieve equitable and high-quality care for mothers and newborns. We applied the bottleneck analysis tool offered by ENAP to identify obstacles and bottlenecks hindering the scale-up of newborn care across seven health system building blocks. Methods We applied the every newborn bottleneck analysis tool to identify obstacles hindering the scale-up of newborn care across seven health system building blocks. We used qualitative methods to collect data from five medical universities and their corresponding hospitals in three provinces. We also interviewed other national experts, key informants, and stakeholders in neonatal care. In addition, we reviewed and qualitatively analyzed the performance report of neonatal care and services from 16 medical universities around the country. Results We identified many challenges and bottlenecks in the scale-up of newborn care in Iran. The major obstacles included but were not limited to the lack of a single leading and governing entity for newborn care, insufficient financial resources for neonatal care services, insufficient number of skilled health professionals, and inadequate patient transfer. Conclusions To address identified bottlenecks in neonatal health care in Iran, some of our recommendations were as follows: establishing a single national authorizing and leading entity, allocating specific budget to newborn care, matching high-quality neonatal health care providers to the needs of all urban and rural areas, maintaining clear policies on the distribution of NICUs to minimize the need for patient transfer, and using the available and reliable private sector NICU ambulances for safe patient transfer.

Background: Risk scoring systems evaluate neonatal outcomes using perinatal and neonatal status. The present study aimed to predict the mortality risk of preterm or low birth weight infants using the Clinical Risk Index for Babies (CRIB-II) and Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE-II) scoring systems.Methods: This prospective cohort study investigated the preterm neonates admitted to the Neonatal Intensive Care Unit (NICU) of Vali-e-Asr Hospital, Tehran, Iran, with the birth weight of ˂1500g or a gestational age˂32weeks using the CRIB-II and SNAPPE-II scoring systems within the first 12 h after birth. The area under the curve, sensitivity, specificity, positive and negative predictive values of the scoring systems, as well as the association between neonate factors and neonatal death were calculated in this study.Results: Out of 344 neonates under study, 253casessurvived after24hof birth and 91 newborns died. The total CRIB-II scores in survived and deceased infants were 6.12 and 10.28, respectively. The area under the receiver operating characteristic (ROC) curve with a cut-off point of 8.5 was obtained at 0.838. Moreover, the sensitivity, specificity, positive predictive value, and negative predictive value were estimated at 74.4%, 78.65%, 55.37%, and 89.68%, respectively, for the CRIB-II system. Total scores of SNAPPE-II in survived and deceased infants were 16.9 and 51.6, respectively. The area under the ROC curve with a cut-off point of 27.5 was determined at 0.887. Sensitivity (84.44%) and specificity (79.05%) were calculated for the SNAPPE-II. Furthermore, positive and negative predictive values were 58.91% and 93.46%, respectively.Conclusion: This study demonstrated that the CRIB-II and SNAPPE-II scoring systems can be useful mortality predictors for at-risk neonates.

Background: Cleft lip and cleft palate are the most common maxillofacial congenital defects leading to facial deformity and complications in nutrition, respiration, and social interaction. The current study aims to report early findings of the pilot registry for congenital cleft lip and cleft palate in Iran and discuss limitations and further goals to collect and implicate information of cleft newborn patients. Materials and Methods: A 3-year hospital-based multicenter prospective cohort study of the congenital cleft lip and cleft palate registry was performed in various hospitals in Iran from 2018 to 2020. Newborns with oral clefts were included, and the type of cleft, location, geographical place, and gender of each patient were recorded. The descriptive statistics were reported as means and percentages analyzed with fisher exact test using SPSS software ver. 22 (IBM, Chicago, US). The P-value

Background: The first duty of any government is to ensure the health of its children and neonates. Today's countries are classified as declining mortality in this group. To increase neonatal survival rate, classified causes of newborn mortality are the core strategy and policies. This study was aimed to determine the classification of causes of neonatal death in Iran. Methods: Neonatal mortality refers to deaths of young children. It is measured by the neonatal mortality rate (NMR), which is the number of deaths of neonates per 1000 live births. This study was used data from 11693 neonatal deaths (from 22 weeks gestational age to neonatal death less than 30 days), in Iran's hospitals in 2012 that registered in the perinatal mortality surveillance system (hospital-based system). Demographic characteristics and other factors associated with neonatal death were investigated. To aid in cause of death analysis, burden of disease analysis, and comparative risk assessment we classified the causes of death according to international statistical classification of diseases version 10 (ICD 10), divided into three cause mortality strata. Results: Results showed the most common cause of neonatal mortality was "certain conditions originating in the perinatal period" (77.92%) with the highest incidence of "disorders related to length of gestation and fetal growth" (37.7%) in this group. Also it shows that 20.82% of deaths caused by "congenital malformations, deformations and chromosomal abnormalities" and 1.26% cases had occurred as a result of "accidents and injuries". The greatest cause of death in the neonates with weight over one thousand grams was "certain conditions originating in the perinatal period" (71.29%), with the highest percentage in the disorders related to "length of gestation and fetal growth" (29.65%). Conclusion: According to this study the "certain conditions originating in the perinatal period" special "disorders related to length of gestation and fetal growth" was the main cause of neonatal mortality. Also "congenital malformations, deformations and chromosomal abnormalities" was the second cause of neonatal mortality.

Background: Neonatal mortality is the major proportion of children mortality under five years and it is considered as the main health indicator in the first year of life. This paper has aimed to review the neonatal mortality in the numbers recorded at the Iranian Perinatal Mortality Surveillance System (IPMSS) by Iran Ministry of Health and Medical Education. Methods: A descriptive study was done in 2014. For assessment of sampling quality and quantity, 24 hospitals randomly were selected. Recorded information, related to perinatal mortality (deaths from 22 completed weeks of gestation until 30 completed days after birth inclusive of stillbirths and neonatal mortality) from selected hospitals, was compared with recorded data in IPMSS. Results: Results showed that, out of 1,725 perinatal deaths occurred in hospitals, 1,480 (85.80%) deaths were recorded in IPMSS. Of 1,041 neonatal deaths that occurred in hospitals (in hospital wards and delivery rooms), 875 (84.05%) were in IPMSS. It shows that a correction coefficient for hospital neonatal mortality was 1.1904. Based on analyzing process, correction coefficients for stillbirth reported by hospitals, stillbirth for all over the country and perinatal death were 1.130, 1.1775 and 1.2443, respectively. Considering these correction coefficients – that enabled to calculate 15,130 neonatal deaths – and 1,421,689 live births (according to Statistics Center) in 2012, neonatal mortality rate was 10.64 in 1,000 live births. Conclusion: Our data showed some problems in the registration system. Although implementation and supervision of such Surveillance System are not easy, they are essential and provide valuable data in perinatal audit and neonatal health care practices.

Objective: Despite the declining trend of maternal mortality (MMR) in Iran between 1990 and 2013, direct causes are still the major reasons for maternal death. One of these direct causes is complications of cesarean section (CS). Since the rate of CS in Iran is quite high (47.9%) and the trend continues to rise, there is an alarming threat of the possibility of increasing MMR in the country as a result of cesarean section complications, especially in repeated cases. In this study, we attempted to determine the indications of CS in reported maternal mortality, with special attention to risk factors predisposing to CS and/or to maternal mortality. Materials and methods: A retrospective study was implemented for the period between March 2009 and March 2012. All nationally reported data regarding maternal death during pregnancy, labor and 42 days after parturition during these 3 years was collected and input to software specially designed for this project. Subsequently, cases of maternal death related to pregnancy termination by cesarean section were selected for analysis. Results: There were 393 cases of maternal death with cesarean section as the termination method. Indications of CS were mostly emergency and repeat and the leading causes of death were postpartum hemorrhage and hypertensive disorders. Most of these deaths occurred in academic hospitals and the most common type of delay was brought about by hospital management, specifically personnel issues. Conclusion: Based on this study, acknowledging CS as a serious health threat endangering every achievement in the maternal health program is the most important policy and efforts should be focused on provision of guidelines for realistic CS indications, standardized CS procedures, and post CS care as well as propagation of training courses in risk management and high risk case-finding protocols.

Objective: To identify the effects of community-based interventions on the Neonatal Health Index in one district of Tehran-Iran. Materials and methods: A community and healthcare center-based study was carried out from January 2011 through September 2014. The population of the study included newborns from mothers residing in the 4th district of Tehran, Iran. Demographic data of mothers and infants were recorded in questionnaires before and after intervention. Interventions were implemented in hospitals, participants' homes, and health centers. The primary outcomes were comparison of mean birth weight, weight gain during the first 3-7 days, first week visit rate, hospitalization rate between the before and after intervention groups. Results: The populations in the before and after intervention groups were 274 and 250, respectively. A significant difference was seen between the gestational ages (P value = 0.007) of the two groups. Mean birth height in the first group was 50.35 ± 3.48 and in the second group was 55 ± 5.32 cm (P value = 0.04). Neonatal complications in the second group were 6.9% lower than in the first group (P value = 0.048). In the first group 41 neonates (15%) were hospitalized in the NICU while in the second group 12 cases (4.8%) were hospitalized (P value = 0.018). Seven cases (2.6%) in the first group and one case (0.4%) in the second group were resuscitated (P value = 0.0001). Conclusion: The results of implementing community-based newborn care strategies witnessed at the first week postnatal visit included improvements inneonatal gestational growth, management of neonates with potentially serious illnesses, diagnosis of warning signs and neonatal care practices.

Intervention in early childhood development as one of the social determinants of health, is important for reducing social gap and inequity. In spite of increasingly developing intensive neonatal care wards and decreasing neonatal mortality rate, there is no follow up program in Iran. This study was carreid out to design high risk infants follow up care program with the practical aim of creating an model action for whole country, in 2012.This qualitative study has been done by the Neonatal Department of the Deputy of Public Health in cooperation with Pediatrics Health Research Center of Tabriz University of Medical Sciences, Iran. After study of international documents, consensus agreement about adapted program for Iran has been accomplished by focus group discussion and attended Delphi agreement technique. After compiling primary draft included evidence based guidelines and executive plan, 14 sessions including expert panels were hold to finalize the program.After finalizing the program, high risk infants follow up care service package has been designed in 3 chapters: Evidence based clinical guidelines; eighteen main clinical guidelines and thirteen subsidiaries clinical guidelines, executive plan; 6 general, 6 following up and 5 backup processes. Education program including general and especial courses for care givers and follow up team, and family education processes.We designed and finalized high risk infants follow up care service package. It seems to open a way to extend it to whole country.

Background: The first duty of any government is to ensure the health of its children and neonates. Today's countries are classified as declining mortality in this group. To increase neonatal survival rate, classified causes of newborn mortality are the Core Strategy and Policies. This study was aimed to determine the classification of causes of neonatal death in Iran. Methods: Neonatal mortality refers to deaths of young children, typically those less than 28 days of age. It is measured by the neonatal mortality rate (NMR), which is the number of deaths of neonates per 1000 live births.This study was used data from 11693 neonatal deaths (from 22 weeks gestational age to neonatal death less than 30 days), in IRAN's hospitals in 2012 that registered in the Perinatal Mortality Surveillance System (hospital-based system). Demographic characteristics and other factors associated with neonatal death were investigated. To aid in cause of death analyses, burden of disease analyses, and comparative risk assessment we classified the causes of death according to International statistical classification of diseases version 10 (ICD 10), divided into three cause mortality strata. Results: The most common cause of neonatal mortality was "certain conditions originating in the perinatal period" (77.92%) with the highest incidence of "disorders related to length of gestation and fetal growth" (37.7%) in this group. Also 2419 (20/82%) of deaths caused by "Congenital malformations, deformations and chromosomal abnormalities" and 147 (1/26%) cases had occurred as a result of "accidents and injuries". The greatest cause of death in the neonates with weight over one thousand grams was "certain conditions originating in the perinatal period" (71/29%), with the highest percentage in the disorders related to "length of gestation and fetal growth" (29/65%). Conclusion: Policies and interventions should be in line with the priority given to the most common causes of death in prenatal care, prevention and treatment of complications of pregnancy and delivery.