Building a maternal and child cohort amidst Lebanon's socioeconomic collapse: preliminary results and navigating research challenges.

The impact of conflict and crisis on maternal and child health underscores the need for reliable research in vulnerable populations. Lebanon, amidst ongoing economic collapse, political instability, and healthcare system strain, offers a case study for exploring these impacts, particularly on preterm babies and their development. This study aims to assess the feasibility of establishing a prospective cohort of mothers and their full-term and preterm babies in Lebanon, examining the association between social determinants, preterm birth, and developmental outcomes amidst the nation's multifaceted crises. The planned cohort involves 50 full-term and 50 preterm mother-baby pairs recruited at birth and followed up to 9-12 months post-birth. Data collection spans social determinants, perceived stress, social support, quality of life, and developmental assessments. Challenges in recruitment, follow-up, and data collection in the context of Lebanon's socio-political and economic turmoil are evaluated, alongside ethical considerations for research in vulnerable populations. Preliminary findings highlight substantial recruitment and follow-up challenges, notably due to population mobility, economic instability, and healthcare access issues. Despite these obstacles, 113 mother-baby pairs have been recruited. Early analysis reveals significant stress and reduced quality of life among mothers, particularly those with preterm infants, against a backdrop of declining birth rates and healthcare worker exodus. Conducting research in crisis settings like Lebanon presents unique methodological and ethical challenges but remains crucial for understanding and improving health outcomes in vulnerable populations. The study underscores the importance of adaptable research designs and ethical diligence in crisis research, highlighting the need for interventions tailored to these contexts. Establishing a mother and child cohort in Lebanon's crisis-ridden setting is faced with many challenges but is essential for guiding future interventions. Research in such contexts is needed to address health disparities and supporting vulnerable populations, emphasizing the need for dedicated funding and innovative research approaches in times of crisis.

Determinants of human papillomavirus vaccine hesitancy among Lebanese parents.

INTRODUCTION: Human papillomavirus (HPV) is the most common sexually transmitted infection. HPV is responsible for cancer of cervix uteri. Despite its safety and immunogenicity, HPV vaccine hesitancy is one of the most challenging topics that pediatricians face. METHODS: We aimed to describe the impact of knowledge, attitude, and practice towards vaccines in general, on practice related to HPV vaccination in Lebanon. A questionnaire addressed to parents of students (3-18 years of age) was distributed in 2 public and 2 private schools randomly selected from the greater Beirut area during the school year 2017-2018. Questionnaires covered knowledge, attitude, and practices of vaccination in general and HPV vaccine in particular. RESULTS: Out of 400 distributed questionnaires, 306 (76.5%) were returned. Of the 185 parents aware of HPV vaccine, 60% hadn't given or were not planning to give the HPV vaccine to their children. Of parents not in favor of HPV vaccine, 7.5 thought that vaccines aren't necessary versus none among those in favor of HPV vaccine(p = 0.02). Thirteen percent of those not in favor of HPV vaccine thought that vaccines are not safe versus 2.7% in the group in favor (p = 0.02). An effect of gender on vaccine acceptance was noted: mothers vs fathers and daughters vs sons. Lack of recommendation by pediatricians and the thought that too little is known about the vaccine were the most selected reasons for parents not wanting to vaccinate their children against HPV, whereas cost and religious and cultural beliefs seemed to have no impact. CONCLUSION: Most parents in our study did not vaccinate or weren't willing to vaccinate their children against HPV even when they were in favor of vaccines in general. Physician recommendation was shown to be one of the most important predictors of vaccination. Effort should be put into educating parents about the importance of the vaccine and its well-established safety and efficacy regardless of gender. Lebanese physicians should also be educated and empowered to recommend HPV vaccine more strongly and consistently.

A Quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit in a low-and-middle-income country.

BACKGROUND: Premature and sick neonates in the neonatal intensive care unit (NICU) are in need of central lines placing them at high risk of contracting a central line-associated bloodstream infection (CLABSI). CLABSI extends length of stay to 10-14 days post negative cultures and increases morbidity, use of multiple antibiotics, mortality and hospital cost. To reduce CLABSI rate at the American University of Beirut Medical Center NICU, the National Collaborative Perinatal Neonatal Network developed a quality improvement project to reduce CLABSI rate by 50% over a 1-year period and to sustain reduced CLABSI rate. METHODS: Central line insertion and maintenance bundles were implemented for all infants admitted to the NICU necessitating central lines placement. Bundles included hand washing, wearing protective material and sterile drapes during central lines insertion and maintenance. RESULTS: CLABSI rate decreased by 76% from 4.82 (6 infections; 1244 catheter days) to 1.09 (2 infection; 1830 catheter days) per 1000 CL days after 1 year. Following the bundles' success in reducing CLABSI rate, they were incorporated permanently to NICU standard procedure and bundle checklists were added to the medical sheets. CLABSI rate was maintained at 1.15 per 1000 CL days during the second year. It then decreased to 0.66 per 1000 CL days in the third year before reaching zero in the fourth year. In total, zero CLABSI rate was sustained for 23 consecutive months. CONCLUSION: Reducing CLABSI rate is necessary to improving newborn quality of care and outcome. Our bundles were successful in drastically reducing and sustaining a low CLABSI rate. It was even successful in achieving a zero CLABSI unit for 2 years.

Music as an adjunct to combination analgesia for neonatal circumcision: A randomized controlled trial.

INTRODUCTION: Neonatal circumcision is one of the most frequently performed procedures in male infants; it is also particularly painful. In a previous trial, we showed that the combination of Eutectic Mixture of Local Anesthetics (EMLA) + Sucrose + Ring Block (RB) was significantly effective in reducing pain during circumcision. OBJECTIVE: In this study, we added music as an adjunct aiming to further reduce the pain scores. STUDY DESIGN: This was a double-blinded randomized controlled trial comparing EMLA + Sucrose + RB (Control) to EMLA + Sucrose + RB + Music (Intervention). The trial setting was the normal nursery of a university teaching hospital. One hundred and three healthy newborn males were randomized to each of the intervention and control groups. Babies were videotaped (face and torso) during the procedure for assessment of pain by two blinded and independent reviewers. The primary outcome measure was the NIPS score; secondary outcomes included heart rate, oxygen saturation and crying time. RESULTS: The NIPS score of the intervention group (EMLA + Sucrose + RB + Music [2.6 ± 1.6]) was significantly higher than that of the control group (EMLA + sucrose + RB [1.4 ± 0.9]) (p = 0.00). Inter-rater reliability was high (κ .89). The intervention group registered significantly higher mean heart rate (142 bpm) and increased mean crying time (5.44 s) compared to the control group (135 bpm and 1.63s, respectively) (p = 0.01) and (p = 0.00). No adverse events were noted. Delivery music medicine by playing it from an iPad in the procedure room did not reduce pain during circumcision. DISCUSSION: There is overwhelming evidence in the literature describing the effectiveness of music on pain management especially in the NICU. However, our results did not align with the general trend; not only did music medicine fail to enhance analgesia but it might have had the opposite effect, further agitating the infants, as indicated by the significantly increased heart rate, crying time and NIPS scores of the participants in the intervention group. Limitations of our study include the fact that this is a single center study and the method of delivering music via iPads instead of noise-canceling headphone. CONCLUSION: Our results showed that music, delivered in this manner, may have increased agitation. We affirm the fact that the combination of EMLA + Sucrose + RB is highly effective for managing pain during circumcision and further reduction of already low scores might not be possible. CLINICAL TRIAL REGISTRATION: Registry Name: ClinicalTrials.gov; Registration number: NCT04252313; link: https://clinicaltrials.gov/ct2/show/NCT04252313.

Knowledge, attitude and practice of influenza vaccination among Lebanese parents: A cross-sectional survey from a developing country.

BACKGROUND: A growing number of parents refuse vaccination due to concerns about side effects. Influenza vaccine is no exception and remains one of the most controversial vaccines. Data regarding influenza vaccine uptake and parental knowledge, attitude and practice towards vaccination in the Lebanese population is lacking. The aim of this study was to assess the rate of vaccination refusal and potential associated factors among Lebanese parents of school-aged children, in general and with a focus on influenza vaccine. METHODS: A parent questionnaire was distributed in randomly selected 2 public and 2 private schools from the greater Beirut area during the school year 2017-2018. Questionnaires covered knowledge, attitude (including themes of efficacy, hesitancy and trust), and practice of vaccination in general and influenza vaccine in particular. RESULTS: The response rate was 76.5% (306/400). Overall, 29.4% parents reported vaccinating their children against influenza (62.2% in private and 37.7% in public schools). Younger age, paternal employment and higher household income were associated with higher vaccination rates (p = 0.01, 0.02 and <0.0001 respectively). Lack of vaccine recommendation by the physician was the most common reason for not taking it (47%). Parents who accepted influenza vaccination had higher scores in efficacy, hesitancy and trust and were more compliant with other vaccinations. CONCLUSION: One third of parents of school aged children in the greater Beirut area vaccinate their children against influenza. This rate is likely lower in rural remote areas. Physician's recommendation is the single most important predictor of such vaccination. Future studies tackling physicians' attitude and practice are needed to help improve influenza vaccination rates in the Lebanese population.

Knowledge and attitudes of Lebanese women towards Baby Friendly Hospital Initiative practices.

BACKGROUND: The World Health Organization and United Nations Children's Fund launched the Baby Friendly Hospital Initiative (BFHI) to encourage best infant breastfeeding practices immediately after birth. In Lebanon, few hospitals are currently accredited as Baby Friendly. AIM: To assess the knowledge of Lebanese women of BFHI steps, and to explore their attitudes towards Baby Friendly Hospitals, Skin-to-Skin Contact and Kangaroo Care practices. METHODS: A cross-sectional survey of a random sample of healthy pregnant women from Lebanon's six governorates. RESULTS: The mean (SD) age of the participants (N = 517) was 28.6 (4.7) years. Most participants were unfamiliar with the terms Baby Friendly hospital (93.7%), skin-to-skin contact or kangaroo care (75%), or were inadequately instructed on how to initiate (54.2%) or continue (46.2%) breastfeeding. However, when provided with information about the benefits of BFHI practices, most mothers (> 90%) stated that they would deliver in Baby Friendly hospitals. About 68.4% of mothers refused to give donor human milk to their sick premature infants because of religious beliefs. Knowledge of Baby Friendly hospitals was significantly associated with university education (p = 0.029), higher monthly income (p = 0.042), and previous experiences of skin-to-skin contact (p<0.001), rooming in (p = 0.037), or breastfeeding support (p = 0.036). CONCLUSION: There is a need for national awareness campaigns that address both the numerous advantages of the BFHI practices and Lebanese women's knowledge gaps about these practices. Such knowledge will help scale up the implementation of BFHI practices in hospitals in Lebanon, thus increasing breastfeeding rates and positively impacting the health of infants and mothers.

Validation of the Arabic version of the breastfeeding behavior questionnaire among Lebanese women.

BACKGROUND: The Breastfeeding Behavior Questionnaire (BBQ) assesses women's perceptions of their breastfeeding behavior. It was adapted to several languages and used in different settings, but has not been validated in Arabic-speaking populations. None of the previous studies that used the BBQ in other cultures examined its ability to predict the actual breastfeeding behaviors of mothers postpartum. This study validated the BBQ in a cohort of Lebanese pregnant women between December 2013 and January 2016, and examined whether it can predict exclusive breastfeeding at one, three and six months. METHODS: The internal consistency reliability and construct validity of the Arabic BBQ (BBQ-A) were tested on 354 pregnant women. Its predictive ability was assessed by correlating the women's BBQ-A scores with their breastfeeding outcomes at one, three and six months post-delivery. RESULTS: The BBQ-A had a good internal consistency reliability (Cronbach's alpha = 0.78). Exploratory factor analysis revealed that it is unidimensional. Inter-item correlations ranged between - 0.016 and 0.934, with corrected-item total correlations ranging from 0.273 to 0.678. Perceived positive breastfeeding behavior correlated with positive breastfeeding attitudes, good breastfeeding knowledge and stronger breastfeeding intention supporting its external validity. However, in binomial multivariate logistic regression analysis, the BBQ-A did not predict exclusive breastfeeding at one, three or six months. CONCLUSIONS: The BBQ-A is a reliable and valid instrument to assess women's perceptions of their breastfeeding behavior in an Arab context. Availability of this instrument is important for investigators conducting breastfeeding research in the Arab world. However, the BBQ-A does not predict exclusive breastfeeding at one, three or six months. Further research on the Breastfeeding Behavior Questionnaire is needed to examine its predictive validity in other cultures.

Implementing NIDCAP training in a low-middle-income country: Comparing nurses and physicians' attitudes.

BACKGROUND: The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) provides developmentally supportive environment for preterm infants and their families. Few studies evaluated staff perceptions about NIDCAP implementation and its effect on infant and parents and working conditions. AIMS: To assess the perception and experience of NICU staff during the NIDCAP implementation. STUDY DESIGN: Cross-sectional anonymous online survey. SUBJECTS: 57 NICU staff (29 nurses and 28 doctors) who were present at least one year prior to and during the implementation of NIDCAP training in a tertiary care center. OUTCOME MEASURES: A standard questionnaire addressing attitude, perceived behavioral control, subjective norm, intention, behavior and NIDCAP impact related to NICU conditions was used after initiating developmental care activities and NIDCAP training in the unit from June 2014 to May 2018. RESULTS: Forty-six doctors and nurses filled the questionnaire; they scored ≥3 out of 5 on all the questionnaire items. Nurses scored significantly higher than doctors (mean 4.00 ± 036) versus (3.57 ± 0.30) (p < 0.001) on the overall NIDCAP score. Specifically, nurses scores were significantly higher for attitude (p < 0.001), perceived behavioral control (p = 0.029); subjective norm (p = 0.011), intention (p = 0.024) and behavior (p < 0.001) questions. CONCLUSION: The implementation of NIDCAP in a low-middle income country was perceived as a positive experience for both nurses and doctors: It was thought to have improved infant care and wellbeing as well as the staff relationship with parents, however working conditions remained a challenge. More studies are needed to address areas of improvement for implementation.

Validation of the Arabic Version of the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU).

The Neonatal Intensive Care Unit (NICU) is a highly stressful environment for parents. The Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) has been validated and used in several languages aside Arabic. This study aimed at translating the scale to Arabic (A-PSS: NICU) and validating it using a cohort of parents of infants admitted to the NICU. Between August 2015 and May 2017, the reliability and construct validity of the A-PSS: NICU were tested on 207 mothers and fathers in two tertiary care hospitals within Greater Beirut. Participants answered the A-PSS: NICU questionnaire, and were interviewed by a clinical psychologist who used the Hamilton Anxiety Rating Scale (HAM-A). An exploratory factor analysis revealed that the A-PSS: NICU is composed of four factors. The A-PSS: NICU overall reliability was excellent (Cronbach's alpha .92). The A-PSS: NICU scores correlated positively and significantly with those of the HAM-A (r = .24, p < .0001). The A-PSS: NICU is a valid and reliable measure of parents' stress in the NICU. Using this scale may prove to be beneficial to Arabic-speaking parents as it assists health professionals in identifying potential stressors that can be addressed during the infants' stay within the NICU.

The psychometric properties of the Ages and Stages Questionnaires-3 in Arabic: Cross-sectional observational study.

BACKGROUND: Screening for developmental delay is recommended for pediatricians, yet validated screening tools in Arabic are scarce. AIMS: Assess the reliability, validity, sensitivity and specificity of the Arabic ASQ-3 in detecting developmental delays in children aged 4-33 months. STUDY DESIGN: Cross-sectional observational study. SUBJECTS: A sample of 491 children from all Lebanese governorates from five age groups (4, 10, 18, 27 and 33 months). OUTCOME MEASURES: Internal consistency using Cronbach's alpha (Cα), convergent construct validity using Pearson Correlation Coefficient (CC) comparing ASQ-3 in Arabic (A-ASQ-3) to Bayley scale for infant development (BSID-III) scores were computed. A subset sample (n = 35) underwent assessment with BSID-III for convergent validity, and sensitivity and specificity. A-ASQ-3 scores were compared to the US mean cutoff scores. RESULTS: Subjects' mean age was 17.75 ±â€¯10.6 months. Cα was 0.85; Pearson CC showed positive moderate correlation between A-ASQ-3 gross and fine motor scores and BSID-III composite motor scores (r = 0.42, p = 0.002; r = 0.39, p = 0.004, respectively); and positive moderate correlation between A-ASQ-3 problem solving and BSID-III cognitive scores (r = 0.43, p = 0.001). A-ASQ-3 had 100% sensitivity and 50% specificity for cognitive scores; 60% sensitivity and 70% specificity for motor scores. CONCLUSION: A-ASQ-3 has adequate reliability and validity for the tested age groups. It is plausible that this would hold true for the rest of the questionnaires. Further testing is needed to make the five clusters more aligned with the US sample scores and to improve the sensitivity and specificity.

A multi-component intervention to support breastfeeding in Lebanon: A randomized clinical trial.

BACKGROUND: Effective evidence-based breastfeeding support interventions can bolster breastfeeding practices. This study investigated the effect of a multi-component breastfeeding support intervention delivered in hospital and home settings on six-month exclusive breastfeeding (EBF) relative to standard care. METHODS: This is a parallel group, randomized clinical trial, in which 362 healthy pregnant women with singleton pregnancy were randomly allocated to a multi-component intervention that included antenatal breastfeeding education, professional, and peer support, delivered in hospital and home settings for six months (experimental, n = 174), or to standard care (control, n = 188). The primary outcome was six-month EBF rate. Secondary outcomes were exclusive and any breastfeeding rates at one and three months, maternal breastfeeding knowledge, attitude, and behavior at six months, and satisfaction with the intervention. RESULTS: The crude six-month EBF rate was similar in both groups (35.2% vs. 28.1% in the experimental and control groups, respectively, p = 0·16). In adjusted analysis, six-month exclusivity was twice as likely in the experimental group relative to standard care (OR = 2.02; 95%CI: 1.20 to 3.39); whereas the odds for any breastfeeding were similar. Participants compliant with all three components were six times more likely to practice EBF for six months relative to standard care (OR = 6.63; 95% CI: 3.03 to 14.51). Breastfeeding knowledge of the experimental group, at six months, was significantly improved compared to the control. No changes were observed in breastfeeding attitude or behavior. CONCLUSIONS: Combining education with peer and professional breastfeeding support improved six-month breastfeeding exclusivity and knowledge.

Establishing an ECMO program in a developing country: challenges and lessons learned.

AIM: The ECMO (extracorporeal membrane oxygenation) Program at the American University of Beirut Medical Center was established in November 2015 as the first program serving adult and pediatric population in a low-resource setting. The aim of the study is to describe the challenges faced during the establishment of the program and factors leading to its success. METHODS: The program establishment is described. The preparation phase, included the strategic, financial, and clinical planning by administration, nursing, and a multidisciplinary team of physicians. The training and education phase included all the involved nurses, perfusionists, and physicians. Concerns were heard from various stakeholders, and the challenges were analyzed and discussed. RESULTS: The preparation committee chose the adequate equipment, responded to the concerns, defined roles and responsibilities through credentialing and privileging, wrote policies and protocols, and established a strategy to decide for the ECMO indication. Selected team of nurses, physicians, and perfusionists are identified and trained locally, and abroad. A full-time ECMO physician was recruited to launch the program. Twelve patients (6 adults, 3 children, and 3 neonates) were supported by ECMO, for cardiac and respiratory indications. Eleven patients were supported by veno-arterial ECMO, and 1 patient (a neonate) with veno-venous ECMO. Overall, 75% survived to decannulation and 41% survived to discharge. CONCLUSION: With limited human and financial resources, new ECMO centers need to carefully establish selection criteria that may differ from those used in developed countries. Indications should be discussed on a case by case basis, taking into account clinical, social, and financial issues. This experience might help other institutions in developing countries to build their own program despite financial and human limitations.

Targeted educational program improves infant positioning practice in the NICU.

QUALITY PROBLEM OR ISSUE: Infant positioning may interfere with neuromotor development. Bedside education and Infant Positioning Assessment Tool (IPAT) improve nurses' and doctors' proficiency in applying proper infant positioning. INITIAL ASSESSMENT: Nursing compliance with proper positioning is suboptimal due to many factors. One factor was the inadequate knowledge and practice of infant positioning, since the baseline mean IPAT score was 3.4. CHOICE OF SOLUTION: Three experienced neonatal intensive care unit (NICU) nurses were chosen as position champions to help other NICU nurses apply proper positioning and monitor IPAT scores. Education and hands-on demonstration sessions were developed based on the observed baseline practice. IMPLEMENTATION: Periodic education with hands-on demonstration was given to NICU nurses and residents. Infants' positions were objectively scored using IPAT. Two Plan, Do, Study and Act cycles were completed and adjustments were made based on each cycle's achieved results. EVALUATION: Mean IPAT scores increased from 3.4 at baseline and 6.3 in the second cycle to 7.3 in the third cycle of intervention. LESSONS LEARNED: A systematic approach targeting infants' positioning succeeded in improving nurses' and residents' clinical performance. Not reaching significant change until after 18 months highlights the difficulty and complexity in changing behaviors.

Children born to mothers in their 20s and fathers in their 40s: Evidence for an increased low birth weight and Cesarean Section deliveries in Lebanon.

PURPOSE: Much less is known about the effect of advanced paternal age (APA) (≥40 years) than advanced maternal age on neonatal morbidity. More specifically, the correlation with low birth weight remains inconsistent. This study aims to determine whether APA among mothers aged 20-29 years is associated with a higher risk of low birth weight and other neonatal outcomes. METHODS: Data from 2004 to 2008 database of the National Collaborative Perinatal Neonatal Network were used. Fifteen thousand two hundred eighteen live birth singleton pregnancies by primigravida mothers aged 20-29 years were analyzed. Study variables include paternal age (years), C-section delivery (yes/no), low birth weight (<2500 g), and preterm births (<37 weeks of gestation). Regressions were generated controlling for birth defects, consanguinity, maternal education, prenatal care, gender, and maternal smoking. RESULTS: Adjusted odds of Low Birth Weight (LBW) and Cesarean Section Deliveries (CSD) were significantly higher in infants of APA fathers compared to those of fathers aged 30-35 years [adjusted odds ratio (95% confidence interval) = 1.5 (1.1, 2.3) and 1.4 (1.1, 1.7), respectively]. Paternal ages of 35-39 years compared to less than 30 years were associated with higher odds of CSD [adjusted odds ratio = 1.4 (1.2, 1.5)]. APA was not associated with preterm birth after adjustment. CONCLUSIONS: This study supports the association between APA and increased risk for LBW and CSD.

Structured Educational Intervention Leads to Better Infant Positioning in the NICU.

PURPOSE: The purpose is to test the effectiveness of an educational intervention in improving infant positioning because positioning may interfere with neuromotor development. METHODS: A quality improvement (QI) project was initiated to increase knowledge and improve the compliance of nurses and physicians in infant positioning using the Infant Positioning Assessment Tool (IPAT). The project was part of Neonatal Individualized Developmental Care Assessment Program (NIDCAP) training. It included informal discussion and practice about infant positions. MAIN OUTCOME VARIABLES: Staff knowledge, IPAT score. RESULTS: Fifty-two pediatric residents and 39 NICU nurses participated in this project. The mean knowledge assessment test score improved significantly for both nurses (p < .0001) and residents (p < .0001) postintervention; IPAT scores increased significantly from 3.4 (±2. 5) to 8.1 (±2.7) (p < .001). CONCLUSION: Nurses' education with hands-on practice improved infant positioning in the NICU; this may lead to fewer positional deformities and possibly an improved developmental outcome.

Higher Incidence Rates of Hypothyroidism and Late TSH Rise in Preterm Very-Low-Birth-Weight Infants at a Tertiary Care Center.

BACKGROUND/AIMS: Preterm newborns with a very low birth weight (VLBW) of < 1,500 g have an atypical form of hypothyroidism with a delayed rise in TSH, necessitating a second newborn screening specimen collection. The aims of this study were to survey the compliance with second newborn screening to detect delayed TSH rise in VLBW preterm infants at a tertiary care center, and to determine the rate of atypical hypothyroidism. METHODS: Retrospective review of the records of 104 preterm VLBW infants. Late TSH rise was defined as an increase in TSH concentration after 14 days of age in the presence of a normal initial screen. RESULTS: The compliance rate was 92% for the second screening. High rates of hypothyroidism (16.3%) and of late TSH rise (4.8%) were detected. Patients with hypothyroidism had a significantly lower birth weight (p = 0.01) and longer hospital stay (p = 0.004). Patients with late versus those with early TSH rise had a significantly lower mean birth weight (851 ± 302 vs. 1,191 ± 121 g, p = 0.004). CONCLUSION: The rates of early and late TSH rise in this VLBW population were higher than those in the literature and could be due to the use of povidone-iodine disinfectants. The yield of a second TSH screening in this study was high indicating the need for vigilance in screening VLBW preterm infants.

Is the Effect of Postpartum Depression on Mother-Infant Bonding Universal?

PURPOSE: Although the negative consequences of maternal depression on infants has been documented in several Western societies, similar studies have not been conducted in Middle-Eastern countries where cultural norms and traditions may differ. The main objective of this study was to determine the risk factors for postpartum depression (PPD) and its relationship to mother -infant bonding in a Lebanese population. METHODS: One hundred and fifty participants were administered the Edinburgh Postpartum Depression Scale (EPDS), and the social support scale at 2-3 days postpartum. At 10-12 weeks mother-infant bonding using the Postpartum Bonding Questionnaire (PBQ) and depression using the Beck Inventory (BDI-II) were assessed during a telephone interview. RESULTS: The prevalence of depression was 19% with an average score of 10.9 ±â€¯6.02 on the EPDS. At 10-12 weeks 2.7% of the whole sample was depressed with an average score of 18.60 ±â€¯16.87 on the BDI-II. Risk factors of PPD on the EPDS were; history of alcohol use, complications during pregnancy, not a good marital relationship, baby admitted to an intensive care unit, history of depression and low social support. Risk factors for impaired bonding were age, history of depression, BDI-II scores above 20 and low social support. The multiple regression analysis found that impaired bonding was associated with older age, history of depression and low social support, which explained 39% of the variance, F = 7.12, p = 0.02. CONCLUSION: The prevalence of PPD was higher than previously reported at day 2-3 post-delivery, but lower at 10-12 weeks postpartum. Impaired mother- infant bonding was associated older mothers, history of depression, low social support and BDI-II scores above 20 which should alert practitioner to assessing these factors in post-partum mothers.

When a physician and a clinical ethicist collaborate for better patient care.

Bioethics is a relatively new addition to bedside medical care in Arab world which is characterized by a special culture that often makes blind adaptation of western ethics codes and principles; a challenge that has to be faced. To date, the American University of Beirut Medical Center is the only hospital that offers bedside ethics consultations in the Arab Region aiming towards better patient-centered care. This article tackles the role of the bedside clinical ethics consultant as an active member of the medical team and the impact of such consultations on decision-making and patient-centered care. Using the case of a child with multiple medical problems and a futile medical condition, we describe how the collaboration of the medical team and the clinical ethics consultant took a comprehensive approach to accompany and lead the parents and the medical team in their decision-making process and how the consultations allowed several salient issues to be addressed. This approach proved to be effective in the Arab cultural setting and indeed did lead to better patientcentered care.