RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

ANNEXURE-II

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.

1. / NAME OF THE CANDIDATE AND ADDRESS / Mrs.SHEEBA JAMES.
1ST YEAR M.Sc. NURSING STUDENT
RAJEEV COLLEGE OF NURSING,
K.R PURAM, HASSAN, KARNATAKA
2. / NAME OF THE INSTITUTION / RAJEEV COLLEGE OF NURSING,
K.R PURAM, HASSAN, KARNATAKA
3. / COURSEOF THE
STUDYAND SUBJECT / MASTER OF SCIENCE IN NURSING,
OBSTETRICS AND GYNECOLOGICAL NURSING
4. / DATE OF ADMISSION
TO COURSE / 31st MAY 2010
5. / TITLE OF THE TOPIC / KNOWLEDGE REGARDING SELECTED MINOR PROBLEMS OF THE NEWBORN AMONG PRIMI PARA MOTHERS WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET.
5.1 / STATEMENT OF THE
PROBLEM / “A STUDY TO ASSESS THE KNOWLEDGE REGARDING SELECTED MINOR PROBLEMS OF THE NEWBORN AMONG PRIMI PARA MOTHERS WITH A VIEW TO DEVELOP INFORMATION BOOKLET,IN SELECTED HOSPITALS OF HASSAN, KARNATAKA.”

6. BRIEF RESUME OF THE INTENDED WORK:

“Experiences have clearly shown that an approach which “demedicalizes” birth, restores Dignity and Humanity to the process of child birth and returns control to the mother is also the safest approach”.

Michael Dent. MD.

INTRODUCTION:

Most mothers observe their babies carefully and are often worried by the minor physical or physiological peculiarities which are of no consequence. It is important that her complaints are listed carefully, and they are not ignored lightly with out doing proper evaluation of the baby. She must be given reassurance, and advice regarding the minor problems and difficulties that may be bothering her.1

The knowledge regarding various developmental variations and physiological conditions and their evolution is important for giving proper advice, guidance and reassurance to the mother.2

Today’s small and scattered families mean that most new mothers have no previous experience of caring for the young babies. Literature for parents tends to stress the positive, the reality of 24 hrs a day care of constantly crying baby, laundry, the difficult in nipping out of the house, anxiety about what is or is not normal can be overwhelming. So adequate reassurance and explanation of the mother is important and necessary to allay her anxiety which may lead to lactation failure.3

The new borns and infants posses’ unique physiological capabilities to adapt to stress both internal and external. Occasionally however interventions are necessary to ensure or ease a return to wellness. Many problems identified during the neonatal and infant periods can be managed through education and information methods such as Information booklet on minor problems of new born and their management.4

As the new born are prone for some physical or physiological peculiarities which are of no consequence even though there are some conditions which can threaten the life of the baby if not managed at earliest. Hence the conditions need to be evaluated to detect any possible pathology underlying.

As mothers are the primary care takers for the new borns they should have adequate knowledge to identify even minor changes and its consequences if neglected. For this purpose, the Health care professionals should create awareness among primi Para mothers regarding Minor problems of new borns, its early identification, causes, prevention, management, and complications if neglected and mother needs adequate reassurance in order to over come her anxieties.

6.1 NEED FOR THE STUDY:

Minor Problems in new born are a common Problems, which usually occurs during the early stages of life and which are found to threat mothers with regard to its treatment, but does not actually cause any life threatening condition in new born babies and they subside with out requiring any special treatment. The minor disorders include- Conjunctivitis, Skin conditions- diaper dermatitis, thrush, perianal dermatitis, Physiological jaundice, Constipation, Infantile regurgitation, Diarrhea. 5

Relatively these trivial disorders of the new born babies may be magnified in a mothers mind to cause intense worry and suffering, which often remain unvoiced unless the opportunity is given. In the first week of life the newborn babies continue a process of adjustment to independent existence, which begins abruptly at the moment of birth. Some of the Minor problems during this period are due to incomplete adaptation to the new environment. The primary minor problem of new born is Neonatal conjunctivitis which presents during the first month of life and may aseptic or septic.5

Aseptic neonatal conjunctivitis most often is a chemical conjunctivitis. Bacteria, Chlamydia and viral infection are major causes of septic neonatal conjunctivitis in which, Chlamydia is found to be most frequent. The incidence of infectious neonatal conjunctivitis ranges from 1-2% depending on socio-economic character area. The incidence of ophthalmic neonatrum exists in developing countries. In a Nairobi Hospital, the incidence of Gonococcal and Chlamydial conjunctivitis were 40/1000 & 80/1000 per live Newborn. 5

The second minor problem among newborn babies is diaper dermatitis. It results from prolonged contact with irritant such as moisture, chemical substances and friction. Urine ammonia formed from the breakdown of urea by fecal bacteria is irritating to sensitive infant’s skin, infrequent diaper changes and constant urine & feces contact prone to damage the skin.5

The next common prevailing problem in newborn babies is physiological jaundice. Epidemiological studies provided a frame references for estimated incidence in 1986 by Maiseles and Gifford, who reported that 6.2% of newborns had serum bilirubin levels of more than 220µ mole (12.9mg/dl). In 2003, study in United States showed 4.3% of 47,801 infants with serum bilirubin levels in a range, in which phototherapy was recommended by American Academy of Pediatrics.5

The other chief complaints in newborns are constipation which is found to be 3% of general population, and which is found to be more common in bottle fed and formula fed infants. Epidemiological research shows 16% of parents with children from birth to 22 month old reported constipation in their babies with a male to female ratio of 1:1.5

The alimentary tract and abdominal problems are common in newborn babies. The commonly and frequently prevailing condition is infantile regurgitation or spilling of milk, which has become a source of some worry in first week of life to the parents. Spilling of milk, regurgitation of milk soon after feeding is of course entirely normal, which could have been attributable to either bad feeding technique or large amount of air swallowed by the newborn during feeding or due to lack of burping or handling the baby immediately after feeding. Vomiting with bile is always a danger signal at this age which probably indicates high intestinal obstruction (For ex: Duodenal Artesia) and which requires immediate management of the condition. Hence the small regurgitation in newborn needs to be considered and managed.5

Diarrhea is found to be a commonest cause of mortality among the newborns. UNICEF proposed a target by 2015 to reduce the mortality rates among these high risk groups by 2/3rd from 93 infants & newborns of every 1000 dying before the age of 5 in 1990 to 31 of every 1000 in 2015.5

Hence newborn period is a period whereby the babies due to their low immunity are prone for many common minor problems. These problems appear minor if the prompt action is taken at earliest by the mother or health care professionals, or else they can emerge as a serious life threatening complications in newborns. Hence the knowledge of mother regarding this aspect is very much essential.5

A study was conducted on “Incidence and bacterial etiology of neonatal conjunctivitis”. About 229 infants born consecutive at maternity ward of the MIDDLE HEIM HOSPITAL in Antwerp, over a period of 5 months and an additional 55 randomly selected infants born at the same hospital were clinically investigated before leaving maternity ward. All infants born at this maternity ward received eye drops immediately after birth 26 (11%) of infants consecutively investigated as neonatal conjunctivitis. While another infants were reported to have developed sticky eyes and/or red eyes. The result of this study stated that overall one or more bacterial species could be isolated from eyes of 143 (48%) of infants. But only viridians streptococci and staphylococci were cultured significantly. More often from eyes of cases with conjunctivitis than from eyes of infants without conjunctivitis.6

A study was conducted to evaluate the frequency of diaper dermatitis among newborns visited the outpatient department, with specialties’ of pediatricians providing services, demographic of babies and leading agents used in treatment. The study included approximately 8.2 million newborns visiting OPD and who were diagnosed to have diaper dermatitis, and pediatrician provided treatment for diaper dermatitis. Nystatin was a leading treatment agent prescribed, followed by clotrimazole, a combination product of Nystatin and triamcinolone and hydrocortisone. Hence finally study concluded that visits for diaper dermatitis are frequent among newborns and frequent use of potent corticosteroids containing combination agents is a potent target for improving the management of diaper dermatitis.7

Hyperbilirubinemia is the commonest morbidity in the neonatal period and 5-10% of all new borns require intervention for pathological jaundice. Neonates on exclusive breast feeding have different patterns of physiological jaundice as compared to artificially fed babies. Study included guidelines from American Academy of pediatrics (AAP) for management of jaundice in a normal term newborn .study stated that management protocol of hyperbilirubinemia have to be validated in Indian babies before they are accepted for wide spread use.8

An epidemiological study was conducted to identify the models of postnatal continuity of care, most likely to prepare mothers for discharge, to reduce new borns readmission for jaundice. The study comprised of eligible mothers participated in telephone interviews. Newborns who had presented with signs of jaundice, were identified from theirs mothers. The results of the study showed that ‘Of participating newborns, 45.5% presented with signs of jaundice and 3.2% were readmitted for jaundice during first week of life and follow up procedures were given through community based phototherapy services offered at home and there was no readmission Hence the study concluded that an effective co ordination of community based perinatal services and hospital linked home phototherapy in the form of integrated networks, is an essential condition for monitoring of new born not only for jaundice but also for other new borns problems.9

Assessing and Providing knowledge to the primipara mothers about selected “Minor problems of new born” will help in decreasing anxiety among mothers. And since mothers are the one caring the new borns, it is important that the education is best provided to the mothers, so that they can care the new born babies in better way, there by will be able to manage the condition. Thus it is essential for the student investigator to enhance the knowledge of the primi Para mothers regarding Selected Minor problems of newborn babies. Hence the investigator has decided to design study on knowledge of primipara mothers on selected minor problems of new born.

6.2 REVIEW OF LITERATURES:

1. Studies related to incidence and prevalence of selected minor problems of new borns.

2. Studies related to knowledge of mothers on selected minor problems of new borns.

3. Studies related to management of selected minor problems of new born.

1. Studies related to incidence and prevalence of selected minor problems of new borns.

A study was conducted to identify the prevalence of causative agents of ophthalmia neonatrum. The study included 114 neonates with conjunctivitis in first 4 weeks of life and 2 swab specimens containing epithelial cells of conjunctiva was obtained and bacterial culture and gram staining was performed and bacterial isolated were identified. The results of the study showed that of 114 neonates with positive eye swab Chlamydia trochomatis was the common cause of neonatal conjunctivitis. Hence the study was concluded that prevalence of Chlamydia trochomatis in newborns was 14.9% and hence Chlamydia trochomatis is a common causative organism in acute neonatal conjunctivitis.10

A study was conducted to document the earliest stage of rash in cohort of 31 healthy term newborns over the first 28 days of life. The diaper area was evaluated using a standardized diaper rash grading scale. The anal, buttock, genital, waist band, leg areas were assessed separately. At birth average grade was 0.1 and none of the infants were had specific features of advanced rashes .19%had dryness and or slight redness. By day 7, 7%of the infants had some features of skin compromise. Both the frequency and over all grade increased during postnatal weeks of 2 and 3. Over all scores for day 21 and 28 were same. The perianal had highest over all regional rash grades. The study concluded that a better understanding of the mechanisms conferring epidermal barrier protection at birth may be important for developing skin care products and practices to the extend this protection later in to life.11

Physiological jaundice is a common problem faced by newborns, approximately 60% full term and 80% preterm babies. Critical reviews of five research papers were performed in an attempt to explore clinical uncertainties and reach a conclusion. This study showed that, 1st the strongest review of research paper showed that near term newborns were at significant risk for hyperbilirubinemia, 2nd review of research papers showed the usefulness of predictive nomograms to identify infants at risk of significant hyperbilirubinemia. 3rd review of research papers highlighted uncertainties among the practitioner to the management and treatment of hyperbilirubinemia. Thus this study concluded that new guidelines are required and should incorporate individual guidance for near term newborn as they have been shown to be at increased risk of developing significant hyperbilirubinemia.12

A study was conducted to know the relationship between Breast feeding, dietry fiber intake and constipation in new born babies. The study population consists of 275 babies consecutively enrolled in two primary care clinic in city of Embu. The feeding patterns were classified as breast feeding, partial breast and cows milk feeding and artificial feeding. The results of the study showed that constipation was found in 25% (69/275). False constipation was found only in 1st semester of life in 5.1% of 159 babies. The prevalence of constipation was higher between 6 and 24 months than in the first semester of life. The results showed that infants under artificial feeding were 4.53 times more liable for constipation than infants who were breast fed.13