زنجیره امید

Reduction of Mortality Rate among Neonates with Cardiac Problems and the Establishment of an NICU at Children Medical Center

After conduction of studies on the post-op mortality rate of newborns with cardiac problems by the institute's academic board and comparison with developed countries' standard rates, the institute decided to carry out a project titled "reduction of neonatal mortality rate after cardiac surgeries". After evaluation of mortality causes, the institute rolled out a project to reduce mortality rate among cardiac children and find a solution to this issue through efficient measures.

Measures taken in this project are as follows:

-          Construction and equipment of NICU at Children Medical Center

-          Training programs for nurses and medical teams in and outside the country

-          Missions of the international medical teams to Iran

-          Incentive pays to nurses for three consecutive years

-          Full equipment of cardiac operation room

Following a joint agreement between Tehran University of Medical Sciences and “Zanjireh Omid” charity in 2013, a project titled “Reduction of mortality rate among neonates with congenital heart defects (CHD) was launched. This project was funded by “Zanjireh Omid Charity institute”.

After selection of a suitable location for establishment of the ICU in an unused, space between two ICUs on 4th floor of Bldg. No. 2 of “Medical Center” by medical center and Zanjireh Omid experts, the project begun in following phases:

  1. Destruction, reconstruction and repair of ICU ward, Interior design and retrofitting of ceiling console and restoration of the mechanical devices which resulted in:

a) Interior design

b) Electric safety

c) Monitoring infection

  1. Equipment of cardiac ICU including: 12 ICU beds, 2 isolated beds, special operations and outpatient surgery room beds as detailed below:
    1. Selection of medical devices from following brands: Atom from Japan, Fukuda from Japan, Toshiba from Japan, Siemens from Germany, Philips from USA, Benet from USA and from domestic products, holding quality certificates from FDA of USA and CE of Europe to decrease mortality.
    2. Portable digital Radiology instrument to facilitate taking digital photos more accessible in the entire wards of the hospital.
    3. Efficient utilization of space for doctors and nurses: all medical instruments were installed on ceiling consoles.

  1. Destruction, reconstruction of central compressed air conditioning system of hospital with oil free high-tech systems, which made compressed air move in entrance and exit paths with full filtration.

  1. Equipment of Cardiac Surgery Room

In order to perform more operations after NICU opening, following Instruments were purchased:

  1. Heart pump machine
  2. Pump accessories
  3. Surgery instruments and digital suction device

  1. Selection and Training of nurses to work in cardiac surgery ICU of Children Medical Center. The trained personnel started working at cardiac ICU after its opening.
  2. Protocols of all cardiac surgery ICU procedures were developed by cardiac ward research committee supervised by hospital research department. Major part of protocols is documented and a book about pediatric cardiac surgery is under publication.
  3. Production of a video tutorial to inform parents of admission process, hospitalization, cardiac surgery, intraoperative care, ICU and postoperative care.
  4. Team travels of doctors and cardiac surgery nurses to Necker Hospital in Paris (a referral center for pediatric cardiac patients) planned, coordinated and financially supported by Zanjireh Omid Charity.
  5. Travel of nurses, Internal, and pediatric cardiac surgery doctors to Necker hospital in Paris to pass complementary courses.
  6.  Conduction of a research project studying stress and tension level among nurses working at ICU and group therapy sessions to instruct how to overcome tension
  7. Yoga courses at children medical center in 2013 which were financially supported by Zanjireh Omid Charity
  8. Monthly incentive pay to all nurses, nursing assistants and service staff of pediatric cardiac surgery ICU and cardiac surgery room of medical center who numbered 130 in total.

After conduction of this project, the mortality rate reduced from 23.4 % to less than 5 %.

Timeline of Increases in Children Medical Center NICU Beds

No Date No.  of active beds No.  of surgeries   No Date No.  of active beds No.  of surgeries
1 Jan 2015 1-3 7   21 Sep 2016 7 24
2 Feb 2015 3 7   22 Oct 2016 7 14
3 Mar 2015 3 7   23 Nov 2016 7 18
4 Apr 2015 3 7   24 Dec 2016 7 26
5 May 2015 4 9   25 Jan 2017 7 18
6 Jun 2015 4 11   26 Feb 2017 7 18
7 Jul 2015 5 16   27 Mar 2017 7 21
8 Aug 2015 5 14   28 Apr 2017 7 12
9 Sep 2015 6 16   29 May 2017 7 20
10 Oct 2015 6 13   30 Jun 2017 7 21
11 Nov 2015 6 18   31 Jul 2017 7 20
12 Dec 2015 7 22   32 Aug 2017 7 24
13 Jan 2016 7 20   33 Sep 2017 7 19
14 Feb 2016 7 27   34 Oct 2017 7 14
15 Mar 2016 7 20   35 Nov 2017 7 13
16 Apr 2016 7 14   36 Dec 2017 7 17
17 May 2016 7 19   37 Jan 2018 7 19
18 Jun 2016 7 18   38 Feb 2018 7 15
19 Jul 2016 7 25   39 Mar 2018 7 6
20 Aug 2016 7 22   40 April 2018 7 11

No Date No.  of active beds No.  of Surgeries
41 May 2018 7 19
42 Jun 2018 7 17
43 Jul 2018 7 17
44 Aug 2018 7 27
45 Sept 2018 7 12
46 Oct 2018 7 18
47 Nov 2018 7 16
48 Dec 2018 7 15
49 Jan 2019 7 18
50 Feb 2019 7 17
51 Mar 2019 7 10

Table of Mortality Rate Reduction among Newborns till March 2019

Year No. of Surgeries High Risk Surgeries Average
Age (Days)
Average
Weight
No. of Deceased
2015 (Dec-Jan-Feb)) 21 7 (33%) 42 Days 3.4 Kgs 2 (9.5%)
Mar2015-Mar 2016 193 98 (61%) 40 Days 3.6 Kgs 14 (7.2%)
Mar2016-Mar 2017 233 148 (63.5%) 50 Days 3.6 Kgs 8 (5.3%)
Mar2017-Mar 2018 201 101 (50%) 54 Days 3.8 Kgs 14 (9.6%)
Mar2018-Mar 2019 197 77 (39%) 107 Days 3.7 Kgs 12 (6,1%)

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