RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE ANNEXURE II PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Name of the candidate and address MISS. JISNET P.PAULOSE {in block letters} SAHYADRI COLLEGE OF NURSING SAHYADRI CAMPUS, NH-48, ADYAR, MANGALORE- 575007

Name of the institution

SAHYADRI COLLEGE OF NURSING, SAHYADRI CAMPUS, NH-48,ADYAR, MANGALORE 575007

Course of study and subject

M.Sc NURSING, CHILD HEALTH NURSING

Date of admission to the course

03-12-2011

Title of the topic EFFECTIVENESS OF SUPINE V/S SELECTED POSITIONS ON SELECTED PHYSIOLOGICAL PARAMETERS AMONG LOW BIRTH WEIGHT INFANTS AT SELECTED HOSPITAL IN MANGALORE

BRIEF RESUME OF THE INTENDED WORK: INTRODUCTION : New born period is the most crucial period in a childs life. The most profound physiologic change required of the neonate is transition from fetal or placental circulation to independent respiration. The immediate adjustments includes respiratory system, circulatory system ,thermoregulation, fluid and electrolyte balance, etc .All the systems are trying to adjust to extra uterine life. A low birth weight infant means an infant whose birth weight is less than 2500 g, regardless of gestational age. Low birth weight infants are high risk newborns, who has a greater-than-average chance of morbidity or mortality because of conditions or circumstances associated with birth and the adjustment to extra uterine existence.1 Neonatal mortality in India accounts for 50% of all infant mortality, which has declined to 84/1000 live births. The common causes of neonatal mortality in our country are asphyxia, prematurity, low birth weight and infections. Improvement in neonatal care in India is needed in order to fulfill the National health policy to reduce infant and perinatal mortality and low birth weight babies. Low birth weight accounts for 50-60% of perinatal and infant mortality.2 Three fourth of neonatal mortality in preurban setting in Bangladesh was attributed to preterm neonates as compared to one third of low birth weight infants. Out of 1322 neonatal deaths, 65.4% were contributed by prematurity as a single cause of death over a three year period study in, India. In India ,26 million babies are born every year ,out of which 1.2 million die before completing the first four weeks of life.3 Prolonged supine positioning 2 for preterm infants is not desirable, since they

6. 3 PROBLEM STATEMENT EFFECTIVENESS OF SUPINE V/S SELECTED POSITIONS ON SELECTED PHYSIOLOGICAL PARAMETERS AMONG LOW BIRTH WEIGHT INFANTS AT SELECTED HOSPITAL IN MANGALORE

6.4 OBJECTIVES OF THE STUDY The objectives of the study are to : assess the physiological parameters of low birth weight infants in supine position. assess the physiological parameters of low birth weight infants in lateral position. assess the physiological parameters of low birth weight infants in prone position. compare the physiological parameters of low birth weight infants in supine, lateral and prone positions. Find the association between the physiological parameters and the selected demographic variables.

6.5 OPERATIONAL DEFINITION 1. Effectiveness: In this study effectiveness refers to the extent in which the change of body positions will produce an effect on the heart rate, respiratory rate and oxygen saturation, measured in terms of physiological parameters by a stethescope, trunk movement observation and pulse oxymeter.

2. Position: In this study position refers to the placement of a low birth weight infant in supine, prone and lateral position. Supine position: In this study supine position refers to placing a low birth weight infant on his/her back on an even surface of a radiant warmer bed. Prone position: In this study prone position refers to placement of a low birth weight infant on his/her abdomen with head turned to one side on an even surface. Left lateral position: In this study left lateral position of a low birth weight infant refers to the position in which the left arm and leg will be in contact with the bed with an exposure of right arm and leg to the environment. 3. Physiological parameters: In this study physiological parameters refers to the measurement of heart rate, respiratory rate and oxygenation of the low birth weight infants. Heart rate: In this study heart rate refers to the manual measurement of heart beats of a low birth weight infant for one single minute through auscultation. Respiratory rate: In this study respiratory rate refers to the manual assessment of respiratory movements in low birth weight infants for a period of one minute. Oxygen saturation: In this study oxygenation refers to the oxygen saturation in the neonatal blood as revealed by the readings of the pulse oxymetry. 4. Low birth weight infant: In this study low birth weight infants refers to an infant whose birth weight is less than 2500 g, regardless of their gestational age.

6.6 Assumptions: The study assumes that: Change of positions influence physiology of cardiovascular system and respiratory system. 6.7 Delimitations The study is delimited to, The stable low birth weight infants admitted to the NICU of the selected hospital.

6.8 Hypotheses (all the hypotheses will be tested at 0.05 level of significance) H1: There will be significant relationship between physiological parameters in supine and other selected positions among low birth weight infants. H2: There will be significant difference in the physiological parameters with supine, lateral and prone positions among low birth weight infants. H3: There will be a significant association between physiological parameters and selected demographic among low birth weight infants.

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MATERIALS AND METHODS 7.1 Sources of data The sources of data are low birth weight infants at selected hospital in Mangalore. 7.1.1 Research designs The research design is pre-experimental one group pre-test post-test design O1 O2 X1O3O4 X2O5O6 O1: Assessment of physiological parameters during 1st minute in supine position. O2: Assessment of physiological parameters during 15th minute in supine position. X1: Administration of lateral position. O3: Assessment of physiological parameters during 1 st minute after giving lateral position. O4: Assessment of physiological parameters during 15 th minute after giving lateral positions. X2: Administration of prone position. O5: Assessment of physiological parameters during 1st minute after giving prone position. O6: Assessment of physiological parameters during 15th minute after giving prone positions. 7.1.2 Setting The study will be conducted in selected NICU of Mangalore. 7.1.3 Population The population consists of low birth weight infants admitted to the selected hospitals in Mangalore.
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7.2 METHOD OF DATA COLLECTION 7.2.1 Sampling procedure Non- probability purposive sampling will be used to select the samples 7.2.2 Sample size Sample consists of 30 low birth weight infants of selected hospitals in Mangalore. 7.2.3 Inclusion criteria for sampling An inclusion criteria for sampling refers to low birth weight infants whose weight is less than 2500 g 7.2.4 Exclusion criteria for sampling An exclusion criteria for sampling refers to low birth weight infants who are having cardiovascular and respiratory diseases on mechanical ventilation.

7.2.5 Instruments used Baseline Performa Clinical Performa Stethoscope Pulse oxymeter

7.2.6 Data collection method. The investigator would get the permission prior to data collection from concerned authority The investigator will introduce herself to the parents and obtain consent from
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them. Different positions are given to check the effect on physiological parameters. Biophysiological observation of the physiological parameters. Comparison of the positions to identify best position for the low birth weight infants. 7.2.7 Data Analysis Plan Demographic data will be analyzed using frequency, percentage. Effect of positions on the physiological parameters will be assessed using mean, median, standard deviation and ANOVA. Chi-square test will be used to find out association between positions and selected demographic variables. 7.3 Does the study require any investigation or interventions to be conducted on patient or other human or animals? If so please describe briefly. Yes. The researcher has to administer three different positions to the low birth weight infants. 7.4 Has ethical clearance been obtained from your institution in case of 7.3? Yes. Ethical clearance will be obtained from the concerned authority.

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REFERENCES 1. Hockenberry MJ, Wilson D. Wongs essentials of pediatric nursing. New delhi: Mosby Elsevier; 2010. 250-259. 2. Bhargava SK, Ramjee S, Sachedev HP. Current status of neonatal care and alternate strategies for reduction of neonatal mortality in the decade of nineties. Indian Pediatr.1991 dec; 28(12): 1429-1436. 3. Pity K. Teaching curriculum in neonatal nursing does it require change. Journal of neonatology 2005; 19(3). 4. Shrivastava SP, Kumar A, Ojna AK. Perinatal determinants of neonatal mortality in India, Sep 2011. Available from http :/// www.indian pediatrics.net 5. Nair MKC, Jana AK, Neswade AK. Neonatal survival and beyond. Indian paediatrics 2005; 42: 985-988. 6. Marynard V, Rignall S, Kitchen S. Effect of positioning on respiratory synchrony in non ventilated preterm infants Physiother Res Int. 2000; 5(2) : 96-110. 7. Pandey A. Positioning premature babies. Which position is best? NNT Mar 5: 24-27.
8. Masterson J, Zucker C, Schulze K. Prone and supine positioning effects on energy

expenditures and behavior of low birth weight neonates. Paediatrics 1997; Nov 80(5): 689-692.
9. Chong A, Murphy N, Maeehews T. Effect of prone sleeping on circulatory control in

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Effect of position on sleep, heart rate variability, and QT interval in preterm infants at 1 and 3 months' corrected age. Available from http://www.ncbi.nlm.nih.gov/pubmed.
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the stable ventilated very-low-birth-weight infant. Effect on transcutaneous oxygen and carbon dioxide. Am J Dis Child. 1988 Feb; 142(2):200-2. 12. Leipala JA, Bhat RY, Rafferty GF Hannams, Greenough A. Effect of posture on respiratory function and drive in preterm infants prior to discharge. Paediatric pulmonology 2003 Oct; 36(4): 295-300.

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