RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISERTATION
DISSERTATION PROPOSAL
“A STUDY TO ASSES THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING KNOWLEDGE ON CARE OF LOW BIRTH WEIGHT BABIES AMONG POSTANATAL MOTHERS IN SELECTED HOSPITAL, AT BANGALORE.”
SUBMITTED BY
Ms. J.INDIRA,
1st YEAR M.Sc. NURSING,
OBSTETRICES AND GYNAECONOGICAL NURSING,
SRI LAKSHMI COLLEGE OF NURSING,
BANGALORE.
2008-2009.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE
ANNEXURE-II
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / Ms. J.INDIRA,1st YEAR M.Sc. NURSING,
SRI LAKSHMI COLLEGE OF NURSING, SUNKADAKATTE,
BANGALORE.
2. / NAME OF THE INSTITUTION / SRI LAKSHMI COLLEGE OF NURSING.
3. / COURSE OF THE STUDY AND SUBJECT / 1st YEAR M.Sc. NURSING,
OBSTETRICES AND GYNAECONOGICAL NURSING,
4. / DATE OF ADMISSION TO THE COURSE / 16/06/2008
5. / TITLE OF THE STUDY / “A STUDY TO ASSES THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING KNOWLEDGE ON CARE OF LOW BIRTH WEIGHT BABIES AMONG POSTANATAL MOTHERS IN SELECTED HOSPITAL, AT BANGALORE.”
“Children’s health is tomorrow’s wealth”
6. BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION
Good health habits can help you to avoid having a low birth weight baby, but nothing can ensure a perfect birth. A low birth weight baby may be born too soon, or for some reason the baby may not gain enough weight before he or she is born. “Premature babies are the most common low birth weight babies.” The survival of low birth weight infant has improved considerably in the last two decades. However, there was no recent follow up of these babies, we under took a long term follow up of low birth weight in 1988 along with normal control
“A baby’s low birth weight can result from an infection the mother has or poor blood flow to the uterus. Smoking, drinking using drugs and poor nutritional habits also can contribute to low birth weight” Women who use cocaine are taking a big risk because can cause the placenta to separate from the wall of the uterus. The placenta is an organ that attaches to the uterus. The umbilical cord provides a link between the placenta and the baby. Nourishment and waste products are transport through the cord between mother and baby.
All infant born before thirty-seven weeks of pregnancy, may be considered as pre-term or premature. The diagnosis of prematurity depends not only on the period of gestation. When the child is born out on its weight at birth as well. The main aim here was to screen babies for developmental delay using Bayley scales of infant development (Baroda Norms) and for tone abnormalities using Amiel -Tison method, So that early intervention could be started.
The international standard laid down for prematurity is a birth weight of less than 2.500 gram. The WHO Expert committee of maternal and child health has suggested the term, “Low birth weight” for the level of birth weight that is taken to be low, Which may vary in different communities.
6.1 NEED FOR THE STUDY:
Low birth weight is a major health problem in developing countries, constituting as much as 30% of birth especially in the developing countries. Low birth infants include both preterm and term-growth impaired infants. Almost two third of the low birth weight babies impaired growth and their morbidities are distinct from those suffered by preterm infants. Hypothermia is not being breast-feed are the major underlying contributors to morbidity and pre dispose them to infection and mortality during both the neonatal period and infancy. Providing conventional hospital care to these infants in under resourced situations is high. Owing to lack of sufficiently skilled nursing personnel, these infants do not receive optimal is therefore a need to explore alternative, cost effective strategies that allow greater participant mothers and families in the care of low birth weight babies and that can improve prognosis for such infants.
“Room-in” mothers and their infants. This allows the infant to be in physical with the mother for thermal protection, facilitates exclusive breast-feeding and allows planned early discharge from hospital. This method may be especially where the burden of low birth weight infants is made up largely of growth-retarded infants. It may be evaluate and compare such alternative stratergies for low birth weight care in under resourced settings.
The percentage of babies who are born with low birth weight has not substantially changed over the last three decades of the 20th century. Over the last thirty years the percentage decreased from 7.93% in 1970 to approximately 7.6% in 1999. This statistic however makes the disparities that exist in the percentage of low birth weight babies among different racial groups. For example the percentage of black babies, Who were born with low birth weight is more than double that of white babies mothers with 12 or more years of education are considerable less likely to have children with low birth weight babies then those mothers who have not completed high school.
Low birth weight is caused by diverse factors, among them low-Socio –Economic status poor maternal nutrition, Lack of prenatal care, cocaine use and cigarette smoking, including passive smoking. Teenagers are more likely to have low birth weight babies than are women in their twenties and thirties and indeed, teenagers account for almost a quarter of low birth weight babies. Women weighing under 100 pounds are at higher risk than heavier women. Other variables, such as water pollution economic insecurity and employment as a manual worker in the electronics, metal and leather good industries, may also contribute to low birth weight.
Particularly at risk the very low birth weight infants those weighing less than 1,500 grams (3.3 pounds) who numbered about 53,000 in 1991. Five year mortality in this group is greater than 20%, and those who do survive are more prone to complications than are the moderately under weight.
In south India, the average term birth weight among the low- socio- economic class is only 2,736 gram as compared 2,948 gram in the high-socio-economic classes.
If the international standard of prematurity is applied, then in India, based on hospital data, the incidence of prematurity ranges in the different regions of the country from 25% to 36%.
During adolescence, about 18% to 20% of adolescents in the general population have the condition however, in the study, salt sensitivity was present in 37% of all low birth weight and 47% of children … who were small gestational age (SGA).
Low birth weight babies born to black mothers occur at approximately twice the rate as low birth weight babies born to white mothers. For very low birth weight babies, this is closer to a three to one ratio. While all of the reasons for babies being born too small or too early, are not known, there are some co-relations, multiple births are often born at low birth weight, and medical advances have made multiple births of three or more babies have increased five fold2. Nationally statistics indicate that mothers under 17 have a higher risk of pre-term birth as well as those having multiple births.
The children were divided in 4 groups. Full term small for gestational age, preterm small for gestational age, Preterm appropriate for gestational age and controls. The children with mental retardation were now eliminated from the study, as they could not do the complicated tests for cognitive development. Two hundred and one children and 90 controls. Were assessed using Stanford Binet test for IQ and Bender gestalt test for visuo motor perception. 17% of children had below normal IQ compared to 5.6 % in controls. Visuo- motor perception was poor, so also pre school skills and language development was poor in low birth weight children compared to controls.
A study on effectiveness of the Kangaroo mother care method with conventional care for reducing neonatal mortality and severity of illness and improving infant growth and development in low birth weight infants. Conventional care in this review-included thermal care of the infant by incubator and use of thermal cots, Bulb heated cots or warm rooms with open cots.
6.2 REVIEW OF LITERATURE:
1. SUCHITRA NELSON (2007) ; Conducted a study on a babies born weighing three pounds or less to see if low birth weight babies are pre disposed to oral health problems that might have an impact on dental care.
One of the factors that Nelson’s group will look at is enamel defects in the first teeth. These defects make the teeth susceptible to dental carries. The researchers will also study the feeding, diet, oral hygiene practices, access to dental care and mother and child oral bacteria levels to sec if these factors impact dental disease in the early moths of these children’s lives.
2. CAROLINE HEICK (2002); Conducted study on in 16 babies (6.1%) born in Canadian hospitals was under weight, weighing less than 2.500 grams. According to new analysis from the Canadian institute for health information this represents a study increase in the rate of low birth weight babies over the past five years, up from 5.7% of hospital births in 2001-2002. The low birth weight rate had been declining between 1997 and 1999. Some babies weighing less than five and a half pounds at birth may have difficulties ahead” Canadian Institute for health information directors of Acute and Ambulatory care information Services.
3. DOYLE (1996) Conducted a study on low birth weight, is the chief contributors to infant illness and, mortality of the more than 4.1 million babies born in the US in 1991, almost 300,000 weighed less than 2.500grams Compared with those of normal weight, these infants are more likely to suffer Physical and emotional disabilities including cerebral palsy, mental retardation speech impairment, Problems with vision and hearing and behavioral difficulties. Recent research has even suggested that low birth weight can increase the chances of Coronary heart disease, Hypertension and Diabetes later in life.
4. SHIN CHEN CHANG, KIMBERLY O’BRIEN, JERI MANCINI, et al, (2003) ; conducted study on effective intervention programs to reduce the risk factors contributing to low birth weight and other poor pregnancy out comes in this population. Babies born weighing less than 5 pounds, 8 ounces and premature babies born before 37 weeks of gestation may face serious health problems and suffers developmental problems later in life. Inadequate utilization of prenatal care was evident in more than half the girls in the study under age 15 and 35 percent of those ages 15-17. Among these girls, the number of preterm births was twice the national rate. Infant birth weight was also affected by risk taking behaviors during pregnancy more than two thirds of all of the girls did not have appropriate weight gain during pregnancy. Nearly 30% gained too little weight and 40% gained more than recommended amount (25-35) pounds for normal weight women. Those who did not gain adequate weight had three times the risk for preterm birth than those who had appropriate weight gain during Pregnancy.
5.DURE SAMINAKRAM, ARIF FEHMINA; (2005) Conducted study on ratio of disproportionate versus proportionate Intra uterine growth retardation among low birth weight babies medical records of babies with weight < 2.5 Kg delivered in the obstetric department were reviewed. Ponderal index was calculated to determine disproportionate and proportionate Intra uterine growth retardation among low birth weight babies. A total of 227 babies were included male and female ratio was equal. Sixty seven percent were delivered vaginally only 12 mothers 5.3% had a history of maternal illness. 89 low birth weight babies 39.9% had a low ponderal index. Ponderal index in full term babies was < 2.2 in 54.3% and in preterm <2.0 in 34.9%. This group of babies according to fetal origins of diseases may be predisposed to diabetes, hypertension and coronary artery disease.
6.CONDE-ANGDELO, et al; (2001) Conducted a study on kangaroo care to reduce morbidity and mortality in Low birth weight babies is used to promote closeness between the baby and mothers and involves placing the happy-clad baby up right between the maternal breasts for skin-to-skin contact. Placing the baby for 24 hours in skin-skin contact between her breasts in hot humid from India, the intervention of skin to skin contact at least four hours and warmer / incubator care for the rest of the time was well accepted. Although kangaroo care appears to lesson mother and baby morbidity without any deleterious effects, much of the available evidence has been obtained from studies using different variables and modalities that have reflected the various clinical settings. Kangaroo care appears to be the control mediator for all the crucial elements needed to maintain healthy status in low birth weight babies, namely thermo regulation, effective breast feeding and prevention hypoglycemia. A well-designed randomized controlled trail of kangaroo care is needed soon to strengthen this view empirically.
7. YUELIAN SUN (2008) ; Conducted study on low births weight babies have higher Epilepsy risk infants with impaired growth in the womb, indicated by low birth weight, appear to have an increased risk of epilepsy in early childhood. To investigate further, they studied 1.4 million babies born in Denmark between 1979 and 2002 who were followed up to 24 years of age. 14,334 were hospitalized with epilepsy at some point over the follow up period. The rate of epilepsy diagnosis increased consistently with decreasing gestational age and birth weight. However, the association became weaker as the age at epilepsy diagnosis increased. Sum’s group found that epilepsy in the first year of life was more than five-times more frequent among infants with gestational age at birth of 22 to 32 weeks compared with those with a gestational; age at birth of 39 to 41 weeks a similarly the occurrence rate was five fold higher among children whose birth weight was less than 2000 grams compared to those birth weight was between 3000 and 3900 gram. The association of low birth weight and short gestational age with the risk of epilepsy was particularly strong with in the age of first 5 year of life.