6. BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION:
“KEEP ME WARM TO HELP ME SURVIVE”
Nursing Journal of India – 2003.
Improving newborn survival is a natural priority in child health
today. A staggering 26 million babies are born in our country every
year. Of these 1.2 million babies are dying in the first 28 days of life
accounting for 20 percent of the global burden of newborn deaths. 1
Nature is supreme the way it looks after all the needs of the
baby in the warm amniotic fluid & is well protected from infection &
effectively shielded against light & sound.1
The virtues of the womb, cushioned & comfortable aquatic
abode thermal comfort, zero insensible water loss, shielded from light,
protected from sound & isolation.2
The urine blood flow provides a smoothening music akin to
a waterfall while ticktack of the maternal heartbeats provides him
constant smoothening beats of a cuckoo clock.
A newborn is precious not only to his parents but also to
community, nation & to the world at large. The maintenance of child
health is not only desired but also positively valued by every society &
improved level of child health is the accepted goal of all communities. 3
“A healthy child has a sure future” is one of the themes of WHO.
Neonatal care starts in premarital age & continues from conception
through suitable care during pregnancy, childbirth & childhood.4
If primary neonatal care is inadequate, it leads to unacceptable
high neonatal morbidity & mortality. The important cause of this is
ignorance related to newborn care.5
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The transition from intrauterine to extra uterine life is perhaps the
greatest challenge any human being can fall in the curse of lifetime.
Approximately 3% to 7% of all newborns require some form of support.6
Hypothermia is a risk for new born in any climate whether in the
tropics or in cool mountainous areas. An important objective of
appropriate care of the newborn is to avoid hypothermia for the
moment of birth by using procedures that will prevent the heat loss &
maintain the body temperature within the normal range thus conserving
the infant’s energy for growth & development.
Newborn may suffer from hypothermia. They loose heat because
of little subcutaneous fat; poorly developed autonomic thermoregulatory
response, body surface area is more in relation to weight.7
6.1 Need for the study:
“Good Quality Neonatal Care, Better Our Children Fare”
Neonatal period is very crucial. It is accurate to say that during the
firs few minutes especially when a risk situation exists prompt & adequate
care should be carried out. 8
Thermoregulation is an enticed physiological function that is
closely related to the survival of the infants. An understanding of the
physiological function of temperature control in neonates is essential in
helping the mothers to provide an appropriate environment to promote
thermal stability.9
Newborn period encompasses the first four weak of extra uterine
life but it is an important link in the chain of events from conception to
adulthood. The physical & mental well being of an individual depends on
the correct management of events in the perinatal period. The morbidity
& mortality rates in newborn infants are high predicament is worse in the
developing countries where because of poor antenatal & neonatal care 10
out of 100 infants do not see their first birth day & nearly 60 % of deaths
occur in the newborn period. 10
According to WHO reports most of the newborn deaths are due to
hypothermia that is about 42 % & 3.6 million develop moderate to severe
hypothermia. 11 - - 4/-
It is also found that hypothermia increases the risk for metabolic
acidosis, jaundice, respiratory distress, hypoglycemia, pulmonary
hemorrhage & death, regardless of the newborn’s weight & gestational
age. 12
Neonatal hypothermia is a common & wide spread problem even
in developed counties. WHO reported hypothermia was found as
common cause of death in all the age groups. But most of the health
personnel are not aware of it. There are different health programmes
accepted & propagated by different sections of government at state &
central level by voluntary agencies. Today it is a real challenge to the
health personnel to improve the primary care of the newborn.
Studied revealed that a total of 763 neonates were observed of
whom 40 died ( MMR 52.4 / 1000 ). The primary causes of death were
sepsis / pneumonia 21 ( 52.5 % ), asphyxia 8 ( 20 % ), Prematurely < 32
weeks 6 (15%), Hypothermia 1 (2.5%) & Other / not known (10%).
Most of the deaths occurred during the first 3 days of life. 13
Thermoregulation is one of the challenging aspects of neonatal
care. Mastering the art of maintaining the neutral thermal environment is
one of the most influential interventions the mothers can perform for the
term & preterm infants. 14
“Every birth is a medical emergency”. So effective management
of newborn babies at birth is essential to prevent many of the causes of
neonatal mortality rate. High neonatal mortality rate in our country is
reflection of very poor neonatal care & inadequate knowledge of mothers
in neonatal care. 15
There is an urgent need to train mothers & all levels of neonatal
care staff to control this problem in our country.
6.2 Review of literature :
Review of literature is defined as broad comprehensive, in depth
systemic & critical review of scholarly publications, audio visual materials
& personal communication.
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The purpose of this study is to identify the effectiveness of
planned teaching programme on prevention of hypothermia among the
mothers of neonates through structured questionnaires. Also the purpose
of revive of literature is to obtain comprehensive knowledge base & in
depth of information from previous studies.
6.1.1 Kumar V, et.al. (2006 Oct.)
Conducted a study on introduction of community based skin–to
-skin care in rural Uttarpradesh, India. The objective of the study were to
describe the acceptance of skin – to – skin care in rural Uttarpradesh.
The researcher had used descriptive design for this study. The study
results showed that incidence of hypothermia was high in both low birth
weight infant & normal birth weight infants & acceptance of skin-to-skin
care was universal. He concluded that skin–to-skin care was highly
acceptable in rural India when introduced through appropriate cultural
paradigms.
6.2.2 Huang YY, Haung CY, Lin SM Wu SC. (2006)
Explained an experimental design to compare the effectiveness of
using early kangaroo care for extra uterine temperature adaptation
against that of using radiant warmers. The study subjects included was 78
consecutive caesarean newborn infants with hypothermia problems. The
kangaroo care group received Skin-to-skin contact with their mothers &
the control group received routine care under the radiant warmers. The
mean temperature of kangaroo group was slightly higher than that of the
control group. After 4 hours the kangaroo care group infants reached the
normal body temperature compared to control group. The results of this
study demonstrate that the positive effects of kangaroo care for extra
uterine temperature adaptation in hypothermia infants.
6.2.3 Ludington-Hoe SM,Lewis T,Moragan K, Cong X,
Anderson L,Reese S.(2006)
Investigated a study to determine the temperatures of twins
simultaneously kangarooed & the temperature of maternal breasts during
shared kangaroo care. He watched two sets of premature twins receiving
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shared kangaroo care for 1.5 hours. The infant temperature were recorded
from incubators, breast temperature were recorded from thermister. The
study concluded that twins can be simultaneously held in kangaroo care
without thermal compromise because each breast responds individually
to the infants thermal needs.
6.2.4 Kadam S,Biony S,Kanbur W,Mondkar JA,Fernandez
A.(2005 Jan)
Proposed a comparative study to determine the feasibility &
acceptance of kangaroo care in India. The methodology used was
randomized controlled trial performed over one year period in that 89
neonates were randomized into 2 groups, kangaroo mother care &
conventional method of care. In that 44 babies to kangaroo mother care
group & 45 babies to conventional method of care. The results showed
that significant reduction in hypothermia among kangaroo mother care
vs. Conventional method of care group (p – value < 0.01).79 % of mothers
felt comfortable during the kangaroo mother care & 73 % felt they are able
to give kangaroo mother care at home also. The study concluded that
kangaroo mother care is a simple & feasible intervention & it is accepted
by most of the mother admitted in the hospitals.
6.2.5 Fransson AL, Karlsson H, Nilsson K. (2005 Nov)
Done a study on importance of physical contact with the mother.
The objective of this study was to determine normal patterns of temperature
variation in newborn babies & influence of external factors. The
methodology used for this study was abdominal & foot skin temperature
were continuously recorded in 27 healthy full term babies during the first 2
days of life & related to the care situation. Ambient temperature was close
to 23 degree C during the study period. The result showed that mean rectal
& abdominal & foot skin temperature were lower on day 1 than day 2. The
foot skin temperature was directly related care situation ; it is significantly
higher when the baby was with the mother. The abdominal skin
temperature was much less influenced by external factors. The study was
concluded that, for temperature regulation during the first few days
physical contact with the mothers is essential.
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6.2.6 Zayeri F,Kazemnejad A,Ganjali M,Babaei G,khanafshar
N,Nayeri F.(2005 Sep)
Investigated a study to determine the incidence rate & factors
associated with hypothermia in Iranian newborns & to discover the effect
of hypothermia on neonatal morbidity & mortality. They have selected a
random sample of 1952 neonates using a multistage sampling technique
from February 2004 to February 2005 in Iran. The researcher measured
rectal temperature of these newborns repeatedly. At each time of
measurement the infants rectal temperature < 36 degree C were considered
as hypothermic. The study results showed that approximately one third of
newborns became hypothermic immediately after birth. The researcher has
concluded that there is an urgent need to train mothers to control this
health problem.
6.2.7 Bergman NJ, Linley LL, Fawcus SR. (2004 Jun)
Proposed a study on care of prematurely born infants involves
extended maternal infant separation & incubator care. The methodology
used was a prospective unblended, randomized controlled clinical trail.
The result of this study revealed that 34 infants were analyzed in
comparable groups, all 18 skin-to-skin care subjects were stable in the
sixth hour, & 8 out of 13 incubators subjects were experienced
hypothermia. The study concluded that newborn care provided by skin –
to – skin contact on mother’s chest results in better physiological outcome
than the same care provided by the incubators.
6.2.8 Lang N, Bromiker R, Arad I. (2004 Nov)
Explained a study on the effect of wool vs. Cotton head
covering & length of stay with the mother following delivery on infant
temperature. The investigator has measured rectal temperature of 126 term
infants on admission to the nursery fallowing variable periods of stay with
the mother. 59 infants who wore with woolen hats had higher rectal
temperature than 67 infants whose head was covered by loosely applied
cotton diapers. Among them there were fewer infants admitted with rectal
temperature 36 degree C. The researcher used the multiple regression
analysis & concluded that covering heads of newborns with simple woolen
hats may reduce or prevent heat loss & adequate warming of infants is
achieved by prolonged stay with the mother.
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6.2.9 Kambarami R, Chidede O (2003 Sep)
Conducted a descriptive study to determine the prevalence
of hypothermia, factors associated with hypothermia & risk factors for
mortality in hypothermic newborns. The study subjects were 313
consecutive newborns. The researcher results showed that prevalence of
hypothermia on admission was 85 % & mortality rate was 18.3 %. Study
concluded that there is need for increase awareness among mothers &
nursing staff about the hypothermia, particularly in low birth weight
newborns.
6.2.10 Kumar R, Aggarwal AK. (1998)
Studied on body temperature of home delivered newborns in
north India. They have conducted a prospective study, auxiliary
temperature of home delivered infants were recorded by a field worker
once in a period of 24 hours after the birth in 10 villages of Haryana &
family members were informed to record the newborn care. The study
samples were 189 babies among them 11.1 % were found to be hypothermic
& 22.8% were hypothermic. A strong correlation was observed between the
room air temperature & neonatal temperature. The study results said that
58.2 % babies were wiped soon after birth, 97.3 % were wrapped in cloth,
59.1 % cases were covered their head in winter & 10.5 % in summer, 97.3%
babies were kept with mother in the same bed but not to skin–to–skin
contact & 65 % were bathed within 24 hours after birth. The researcher
concluded that guidelines for thermal control in home births should be
provided for specific environmental situation.
6.3 Objectives of the study:
The investigator attempted to “Evaluate the effectiveness of
planned teaching programme on prevention of hypothermia among the
mothers of neonates in selected hospitals at Tumkur.”
The objectives of the study are:
6.3.1 :- To asses the knowledge of mothers on prevention of hypothermia
before administration of a planned teaching programme.
6.3.2 :- To administer the planned teaching programme.
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6.3.3:- To evaluate the effectiveness of planned teaching programme on
prevention of hypothermia in terms of gain in knowledge.
6.3.4:- To associate the knowledge of mothers with the demographic
variables.
6.4 Operational Definitions:
6.4.1 Effectiveness : The ability of an intervention to produce the desired
beneficial effect in actual usage.