RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,

KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE & ADDRESS / Ms.WANGKHEIMAYUM ASHAKIRAN DEVI
GOLDFINCH COLLEGE OF NURSING,
#150/24 KODIGEHALLI MAIN ROAD,
MARUTHI NAGAR, BANGALORE-92.
2. / NAME OF THE INSTITUTION / GOLDFINCH COLLEGE OF NURSING,
#150/24, KODIGEHALLI MAIN ROAD,
MARUTHI NAGAR, BANGALORE-92.
3. / COURSE OF STUDY & SUBJECT / M.SC NURSING IST YEAR,
PAEDIATRIC NURSING.
4. / DATE OF ADMISSION TO COURSE / 15/6/2008
5. / TITLE OF THE TOPIC / A STUDY TO ASSESS THE KNOWLEDGE REGARDING NURSING CARE OF LOW BIRTH WEIGHT BABIES AMONG STAFF NURSES IN SELECTED HOSPITAL
IN BANGALORE.
6. / BRIEF RESUME OF INTENDED WORK:
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6.2 / INTRODUCTION:
Neonate signifies the beginning of life as an important individual who is the future citizen of a nation. Neonatal period is the single most hazardous period of life: never again in life is the individual confronted with more dramatic challenges than in the transition from dependent intrauterine existence to independent extra uterine life. This neonatal period is a continuation of fetal growth and development. This is the period for the neonate to face many life threatening problems which leads to increased mortality and morbidity if proper care is not given.
Neonatal care in India has improved considerably in last two decades. The neonatal care practices in India have evolved gradually from realization of effective use of tetanus immunization for the pregnant mother and meticulous asepsis of neonatal tetanus, which was a major killer disease.
An infant whose birth weight is less than 2500g regardless of gestational age is known as low birth weight infant. Infant with low birth weights may be full term (small for gestational age (SGA) or preterm (PT).
Early identification of high risk fetus and optimal care of high risk fetus and neonate are matters of utmost importance if the levels of perinatal morbidity and mortality related to be reduced. Threat to wellness and indeed life can occur at any time prenatally, perinatally and postnatally between the time of viability of the fetus to 28 days after birth.
There are two reasons why a baby may be born with low birth weight i.e. premature birth- the baby is born before 37 completed weeks of pregnancy, fetal growth restriction-babies may be full term but they are under weight.
The factors which are contributing to the low birth weight are, had a premature baby in a previous pregnancy, pregnant with twins, triplets or more, certain abnormalities of the uterus or cervix. And also the other factors include birth defects, chronic health problem in the mother, smoking, alcohol and illicit drugs, infections in the mother, infections in the fetus, placental problem, inadequate maternal weight gain, socio-economic factors.
Low birth weight babies are more likely than babies of normal weight to have health problems during the new born period. Many of these babies required specialized care in a newborn intensive care unit (NICU). Some of the problems which are common in babies born at low birth weight are respiratory distress syndrome (RDS), bleeding in the brain, patent ductus arteriosus (PDA), necrotizing entercolities; retinopathy of prematurity, reflex activity is not fully developed.
Care of low birth weight infants is one of the most serious challenges in maternal and child health in both developed and developing countries even today.
Premature neonates and those having low birth weight account for the highest mortality rate among infants during 1st year of life because weight is often indicated of prematurity and physiologic immaturity, a premature or low birth weight infant is considered to be one who weights 2500gm (5 pounds or 8 ounces) or less at birth. The length from crown to heel is likely to be closed to 47cm (18.5 inches) although this depends on the gestational age and hereditary background of the neonate. The new born infants behaviors is evidence of immaturity in that the normal reflexes and the ability to carry on vital function are lacking.
The new born death is of 36% due to infection and 23% due to birth asphyxia. The low birth weight babies are cared in the hospital in order to reduce the death rate.
WHO estimates that globally about 25 million low birth weights are born each year. Consisting 17% of all live births, nearly 95% of them in developing countries especially in India it is quite enormous. It constitutes about 40% of live birth.
The low birth weight babies are care in hospital as well as in home. The hospital care includes, at birth-providing suitable place of delivery ‘in utero’ transfer to a place with optimum facilities of a low birth weight delivery is anticipated, prevention of hypothermia, efficient resuscitation. Appropriate place of care is provided like birth weight>1800g, home care, if the baby is otherwise well, birth weight 1500-1800g, secondary level newborn unit. Birth weight<1500gm, tertiary level new born care (or intensive care), thermal protection-delay bathing, maternal contact, kangaroo mother care, warm room, external heat source (incubator, radiant warmer). Fluids and feeds-intra venous for very small babies and those who are sick, expressed breast milk with gavage or katori spoon, direct breast feeding. Monitoring and early detection of complications-weight and other clinical signs, electronic monitoring, biochemical monitoring, appropriate management of specific complications. The other care includes handling and touch-kangaroo care is used to promote closeness between baby and mother and involves placing the nappy clad baby upright between the maternal breast for skin to skin contact .Noise and light hazards, the time spent in a postnatal ward should be a time of rest and recuperation for both the mother and her low birth weight baby. In dimmed lighting conditions, preterm babies are more able to improve their quality of sleep and alert status. Reduced light levels at night will help to promote the development of circadian rhythms and diural cycle. Light levels can be adjusted during the day with curtains or blinds to shade windows and protect the room from direct sunlight. Screens to shield adjacent babies from phototherapy lights are essential. Sleeping position-preterm babies have reduced muscle power and bulk, with flaccid muscle tone; therefore their movements are erratic, weak or flailing. They exert energy to maintain their body position against the pull of gravity.
Having low birth weight infants is more challenging for the nurses as most of low birth weight babies are hospitalized and need specialized care. And also it is universally accepted by trained personnel especially in hospitals.
Nurses play critical roles in perinatal-neonatal care at all levels of the health system, from being skilled attendants at birth, to treating sick neonates, from counselling mothers about breast feeding to advising home care of a low birth weight baby, and from helping mother of a low birth weight neonate in kangaroo mother care, to transporting a preterm newborn, global initiative calls for promoting institutional deliveries and care of the small and sick neonates at small hospitals. Most of hospitals will be operationalized for round the clock delivery of services by ensuring continuous nursing coverage hence nurses need to be aware about knowledge and practice of essential newborn care. Their observation skill and knowledge sharpened by experienced facilities, the quality and component care to these neonates.
NEED FOR THE STUDY:
Neonatal nursing being a specialized branch of nursing demands a high standard of nursing care. A neonatal nurse is expected to have a high sense of responsibility, devotion to work, keen sense of observation, alertness and readiness to take a quick decision. Nurses play a vital role in the health care of neonates.
Low birth weight (i.e. birth weight less than 2500g) is a major public health problem in many developing countries. About 30 percent of babies born in India are low birth weight as compared to 4% in some developed countries. In countries where the proportion of low birth weight is high, the majority are suffering from fetal growth retardation.
Low birth weight is the single most important factor in determining the survival of the child. The infant mortality rate is about 20 times greater for all low birth weight babies than for other babies.
In countries where the proportion of low birth weight is low, most of them are pre-term. Although we do not know all the causes of low birth weight, maternal malnutrition and anemia appear to be significant risk factors and its occurrence. The proportion of infants born with low birth weight has been selected as one of the nutritional indicators for monitoring progress towards health for all by the year 2000. The goal of the national health policy is to reduce the incidence of low birth weight infant to about 10 percent by the year 2000.
The world health organization (WHO), on the basis of world wide data, had recommended that infants with birth weights less than 2.5 kg may be considered to fall in the low birth weight category-carrying relatively greater risk of perinatal and neonatal mortality and substandard growth and development.
Some studies suggest that individuals who were born with low birth weight may be at increased risk for certain chronic conditions in adulthood. The conditions include high blood pressure, type 2 diabetes, when this conditions occur together, they are called metabolic syndrome. One study found that men who weighed less than 6 and half pounds at birth were 10 times more likely to have metabolic syndrome than the men who weighed more than 9 and half pounds at birth.
It is not yet known how low birth weight contributes to these adult conditions. However, it is possible that growth restriction before birth may cause lasting changes in certain insulin sensitive organs like the liver, skeletal muscles and pancreas. Before birth, these changes may help the malnourished fetus use all available nutrients. However, after birth these changes may contribute to health problems.
Parents need encouragement in learning to handle a small, delicate neonate when they visit in nursery, although by the time of discharge, their infant will be almost the size of a full term newborn infants. In many hospitals area are set aside where parents can attend demonstrations of infant care, including bathing, dressing and feeding techniques. As they practice these techniques, they gain confidence in their own abilities and have less anxiety about their infants care.
9.7 million Children dying globally before they reach the age of five, India accounts for 2.1 million, though the mortality has declined by 34% between 1990 and 2006.
India still carries disproportionate amount of the burden as it accounts for 21 percent of the under five children dying in the world.
According to state of the world’s children 2008 report on child survival , released by the United Nations children’s fund(UNICEF) , urgent action was needed to tackle the under lying causes of deaths of children in the country by increasing investment in child survival and development programmes. As far as low birth weight deaths are concerned, India accounts for 8.3% of the global figure.
More than 19 million infants in the developing world have low birth weight. More than half are in South Asia, 8.3 million are in India.


1.India- 8.3 million
2.South Asia 2.7 million
3.Sub Saharan Africa- 4.1 million
4.East Asia Pacific- 1.7 million
5.Middle East/North America- 1.4 million
6.Latin America- 1.0 million
7 .CEE/CIS-200000
Neonatal nursing involves a variety of unique functions, skills and responsibilities that are essential in order to assess, understand and safety support the new born infant and family during this critical time. Neonatal intensive care unit nurses must anticipate problems and systematically evaluate the neonate and all the support systems to identify any new problems.
Murray S F (1997) has done a study regarding neonatal care in developing countries. He said in world wide, about 8 new born babies die every minute and interventions to reduce neonatal mortality and morbidity are still not give higher priority in most developing countries. And recommended four basic principles of basic care traumatic and clean delivery, maintenance of body temperature, maintenance of spontaneous respiration and breast feeding shortly after birth. And this could be facilitated by nurse midwives or by traditional birth attendants at the health center.
Nurse are the best monitors , while rendering care to low birth weight babies they can come across various emergency situations like caring low birth weight infants with respiratory difficulty . If the nurses are knowledgeable she can be alert enough to monitor such incidence and intervene accordingly in taking remedial measures.
Through extensive review of literature investigator found that survival of low birth weight babies could be promoted by trained personal involved in health care delivery system.
These facts made the investigator to do a study to assess the knowledge regarding nursing care of low birth weight babies.
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REVIEW OF LITERATURE:
David .L. Mohag.H.Edwards H.(2003) in their article stated that the aim of the article into undertake an historical overview of premature infant care practices to increase neonatal nurses knowledges of the crucial role of mothers and families in the care of their premature infants . Three major knowledge were identified which reflect the development of neonatal care.1
Beal J.N.Richardson D.K (1999) conducted a descriptive survey study. The objective of the study is to describe the unique contribution of the nurse’s practitioners in caring for critically ill infants. Data were collected at five regional level I/II/III NICUs in Rhode Island. Twenty two nurse practitioners were surveyed. Results showed that nurse practioner role including antipartal consultation, delivery room management, transport and follow up. Nurse practitioners were equally involved with patients of all degrees of complexity and birth weights.2
Beckner P.T.Grunwald P.C. (1997) outcomes a experimental study to assess the numerous aspects of intensive care environment. The purpose of this study was to determine whether staff education in care protocols designed to make the environment less stressful and thereby support the infants development , 21 infants (<1500) were studied. During pre-education period and 24 hours were studied after staff education. Findings showed the experimental infants had more optional respiratory and feedings status. Lower levels of morbidity, shorter hospitalizations.3