RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

4TH BLOCK, JAYANAGAR, BANGALORE – 41, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 / NAME AND ADDRESS OF THE CANDIDATE / MRS. KHOJA SAHENOOR ASHRAFALI
2ND FLOOR, 5TH CROSS, N.K.PALYA, TASKER TOWN, SHIVAJI NAGAR. BANGALORE 51.
2 / NAME OF THE INSTITUTION / ACHARYA COLLEGE OF NURSING,
CHOLANAGAR, R.T. NAGAR POST,
BANGALORE 32
3 / COURSE OF THE STUDY AND SUBJECT / M.SC. NURSING 1ST YEAR
CHILD HEALTH NURSING
4 / DATE OF ADMISSION / 30/06/2011
5 / TITLE OF THE STUDY / EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMMEME ON KNOWLEDGE REGARDING HOME CARE OF PRETERM BABIES AMONG MOTHERS IN SELECTED HOSPITALS AT BANGALORE.


6. A BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Birth is not only about making babies. Birth is about making mothers--strong, competent, capable mothers who trust themselves and know their inner strength.”

― Barbara Katz Rothman

Growth and development are important aspects of child’s health. Child’s growth and development starts soon after the conception, inside the mother’s womb. Postnatal health of an infant largely depends on the gestational age at the time of birth. The duration of a pregnancy is measured by gestational age (or the amount of time elapsed since the first day of the last menstrual period). A normal gestation lasts 40 weeks or 280 days. If delivery occurs before 37 weeks gestation, the baby is considered prematurely born. The period of gestation is one of the most important predictors of an infant’s subsequent health and survival. In humans, preterm birth refers to the birth of a baby at less than 37 weeks of gestational age. The cause for preterm birth is in many situations elusive and unknown; many factors appear to be associated with the occurrence of preterm birth.1

Premature birth, commonly used as a synonym for preterm birth, refers to the birth of a baby before the developing organs are mature enough to allow normal postnatal survival. Premature infants are at greater risk for short and long term complications, including disabilities and impediments in growth and mental development. Significant progress has been made in the care of premature infants, but still there is a need to give more attention in the special aspects of care of these babies. 1

Preterm birth is an important perinatal health problem across the globe. According to WHO findings, in 2005, 12.9 million births, or 9.6% of all births worldwide, were preterm. Approximately 11 million (85%) of these preterm births were concentrated in Africa and Asia, while about 0.5 million occurred in each of Europe and North America (excluding Mexico) and 0.9 million in Latin America and the Caribbean, where as in India, the rate of preterm birth was 9 million of total births.2

The shorter the term of pregnancy, the greater the risks of mortality and morbidity for the baby primarily due to the related preterm birth. Preterm babies have an increased risk of death in the first year of life (infant mortality), with most of that occurring in the first month of life (neonatal mortality). Worldwide, preterm birth accounts for 10% of neonatal mortality, or around 500,000 deaths per year. In India, according to data and statistics from UNICEF, infant mortality rate (IMR) is still 50, and neonatal mortality rate was 34 in the year of 2009. In the developed and developing countries, where many infections and other causes of neonatal death have been markedly reduced, preterm birth is the leading cause of neonatal mortality. Prematurely born infants are also at greater risk for having subsequent serious chronic health problems.3

According to World Health Organization (WHO) data and statistics of 2010, infant mortality rate( i.e. probability of dying up to one year of age per 1000 live births) in India is still 48. Premature delivery is one of the most important causes of serious illness among newborn infants. The incidence of premature deliveries according to data found in neonatal vital statistic report September 2010 compares the percentage of premature delivery with gestational age. 71.2% of all premature delivery occurs between 34-37 weeks of gestation. Only 16% of premature delivery occurs before 31st week. Rest 12.7% of premature deliveries occurs between 32-33 weeks.4

The degree of Prematurity determines the risk of complications. Babies who are born at only slightly less than 37 weeks gestation are likely to have feeding problem, where as babies born at less than 28 weeks gestation are likely to have more serious problems which may influence their long-term outcome. Almost all premature babies require special care and attention after birth in NICU as well as after discharge till they gain certain weight. After discharge from NICU, the mother has to take special care of baby which includes many aspects like exclusive breast feeding, kangaroo mother care, thermoregulation for prevention of hypothermia, infection control, immunization, follow up care and other treatments.5

6.1 NEED FOR THE STUDY

The percentage of preterm deliveries has risen steadily over the last 2 decades. Most of this increase has been among children born at 32 to 36 weeks gestation. The period of gestation is one of the most important predictors of an infant’s subsequent health and survival. In 2008, more than 5,00,000 infants, or 12.5 percent of all infants, were born preterm, which is considered birth at less than 37 completed weeks of gestation. Preterm birth is the major cause of neonatal mortality in developed and developing countries. Learning about the care and management of preterm babies can help to increase awareness of the unique needs of these babies.8

Compared with infants born at term (37 to 41 weeks of gestation), preterm infants have a much greater risk of death and disability. Approximately, 75 percent(%) of prenatal deaths occur among preterm infants. Almost one-fifth of all infants born at less than 32 weeks gestation do not survive the first year of life, whereas about 1 percent of infants born between 32 and 36 weeks of gestation and 0.3 percent of infants born at 37 to 41 weeks of gestation do not survive the first year of life. Recent data shows that, the infant mortality rate (IMR) per 1,000 live births for infants born at less than 32 weeks of gestation, was nearly 70 times the rate for infants born between 37 and 41 weeks of gestation. 9

There are many major complications of preterm birth. Premature newborns are sometimes given the nickname “preemies”. Mothers who have their baby prematurely are often scared and nervous. It is true that premature newborns face an increased chance of having one or more complications. The risk of complications increases the earlier the baby is born. Any complication that a premature newborn experiences will be treated in the Neonatal Intensive Care Unit (NICU). The major complications are respiratory problems like immature lungs which can causes Respiratory Distress Syndrome (RDS) (can lead to harsh, irregular breathing and breathing difficulties), Transient tachypnea (rapid shallow breathing), Bronchopulmonary Dysphasia (BPD), Pneumonia, Apnea and Bradycardia. The other common complications are infection, jaundice, Intraventricular hemorrhage (IVH), inability to maintain body heat, immature gastrointestinal system, anemia, Patent Ductus Arteriosus (PDA), Retinopathy of Prematurity (ROP), Necrotizing Enterocolitis (NEC), and sepsis.10

These all complications need long term treatment. These can not be completely treated during the stay in NICU. After discharge from hospital the key person to treat these complications is mother. But due to lack of knowledge about the condition of the babies the mothers of preterm babies get stuck in a pattern of negative thinking. Many mothers think that preterm birth of the baby is their own mistake due to lack of care taken during pregnancy. They start comparing their baby features with the other term babies and they find difficult and sometimes impossible to imagine their babies like other normal babies. So by making the mothers eligible to provide special care to preterm babies by giving them knowledge about the same, makes them feel very happy for doing something for their own baby.11

A study was conducted to assess the cause of readmission among preterm babies soon after few days of discharge from NICU. As per the result found, the main cause was knowledge deficit among mothers. The mothers were unaware about the special aspects of care to be taken at home for preterm babies after discharge from NICU. Anxiety and depression of the mothers lead to inappropriate care at home and follow up for the preterm babies after discharge from NICU.12

During pediatric clinical postings, the investigator found many mothers waiting outside the NICU with many questions on their worried faces about the present condition and care their babies require by them after discharge. On other side, investigator also noticed that, many mothers were coming back to NICU with their sick preterm babies for readmission soon after few days of discharge from NICU. After discharge these preterm babies are getting many problems like, feeding problems, infectious conditions, hypothermia and other health problems. This happens due to the lack of knowledge among mothers about special care and attention to be given to preterm babies by them. So after the discharge from the NICU, the mothers are not able to continue to give same care at home. This leads to death or some disabilities among their babies which may last for many years or sometimes lifelong with them.13

The knowledge of mothers about special aspects of care of preterm babies are very effective to prevent complications. As these aspects influence with long term outcome, along with the medical and paramedical personals, the mother can play a main important role in preventing these disabilities among her own baby. This task will also improve the emotional bond between mother and baby. Mother can experience the great feeling of doing something for her baby which will also give a feeling of satisfaction to mother. So educating the mothers regarding special home care aspects for their preterm babies will play a major role in reducing neonatal mortality as well as morbidity rate by nurses. These aspects made the investigator to select this study.13

6.2 REVIEW OF LITERATURE

A review of literature enables one to get an insight into the various aspects of the problem under study. It covers promising methodological tools, throws light on ways to improve the efficiency of data collection and suggests how to increase effectiveness of data analysis and interpretation. Review of literature is therefore an essential step in the development of the research project.

The result of studies conducted in various aspects is presented below. It is mainly divided into,

6.2.1 Studies related to complication of preterm birth.

6.2.2. Studies regarding home care of preterm babies.

6.2.3 Studies related to knowledge of mothers regarding home care of preterm babies.

6.2.1 Studies related to complication of preterm birth.

A retrospective study was conducted between 2005-2007 to compare the short term morbidity of infants born at term with preterm babies. Neonatal complications were compared among those born in late preterm period and those who born at term period. Result obtained showed that preterm birth accounted for 2.2% of births and had higher incidents of respiratory distress syndrome, longer hospital stay, jaundice requiring photo therapy and hypoglycemia than those born at term. Conclusion was made that preterm births are vulnerable group for significant neonatal morbidity. It is necessary to design strategies to improve neonatal outcomes in preterm group. 16

A similar finding was seen in another study, to assess the complications among the late preterm babies compared to the term babies. These infants range in gestational age from 34 to 36 weeks and were at greater risk of morbidity, such as respiratory complications, temperature instability, hypoglycemia, kernicterus, feeding problems, neonatal intensive care unit admissions, and adverse neurological sequelae when compared with term infants. Even a minor increase in the rate of neurological disability and scholastic failure in preterm infants can have a huge impact on the health care and educational systems. There is an urgent need to educate health care providers and parents about the vulnerability of late preterm infants, who are in need of diligent monitoring and care during the initial hospital stay and a comprehensive follow-up plan for post neonatal and long-term evaluations.17

Another study documented the prevalence of a broad range of neurodevelopment impairments in preterm survivors. The spectrum of neurodevelopment disabilities includes cerebral palsy, mental retardation, visual and hearing impairments, and more subtle disorders of central nervous system function. These dysfunctions include language disorders, learning disabilities, attention deficit-hyperactivity disorder, minor neuromotor dysfunction or developmental coordination disorders, behavioral problems, and social-emotional difficulties. Preterm infants are more likely to have lower intelligence quotients and academic achievement scores, experience greater difficulties at school, and require significantly more educational assistance than children who were born at term. Preterm infants have an increased risk of rehospitalization during the first few years of life and increased use of outpatient care. Among the conditions leading to poorer health are reactive airway disease or asthma, recurrent infections, and poor growth. The smallest and most immature infants have the highest risk of health problems and neurodevelopment disabilities. 18