Polyethylene Cap on Hypothermia among Low birth weight Babies

 

Mrs. P. Karthika1, Mr. Moses kandula2

1M.Sc (Nursing), Lecturer, Metas Adventist college of Nursing, Athwalines, Surat, Gujarat - 395001

2M.Sc (Nursing), Nurse Educator, Metas Adventist Hospital, Surat, Gujarat - 395001

*Corresponding Author Email: mose_kana2000@yahoo.com

 

ABSTRACT:

Background: “Children's health is tomorrow's wealth” is one of the World Health Organization (WHO)'s slogans of recent years. Birth weight is generally used as a yardstick of maturity and is an important determinant of child survival and development. Its rates 17 million infants born are with low birth weight. Neonatal hypothermia after birth is a worldwide issue across all climates. Apart from all the alternative measures, polyethylene cap was highly effectiveness to prevent hypothermia among low birth weight babies.

Objectives: The present study aimed to assess the effectiveness of polyethylene cap on hypothermia among low birth weight babies.

Design: Quasi-experimental design, where Pre and Posttest with control Group design was used.

Participants: 30 low birth weight babies were included in the study.

Methods: Convenient sampling technique was used in the study. Experimental group polyethylene cap was applied for an hour to low birth weight babies.

Results: The data was obtained by using a demographic proforma and hypothermia scale for low birth weight babies, 100% of babies were in need of urgent attention, and 100% were in non urgent and vital parameters are stable in experimental group. The calculated unpaired’ test value showed that there is significant effectiveness of polyethylene cap (t=35.2, tv=2.042) on hypothermia among low birth weight babies. After intervention Results showed in control group

Conclusion:  Polyethylene cap is an effective intervention to reduce the level of hypothermia among low birth weight babies. 

 

KEYWORDS: Low birth weight babies, hypothermia, polyethylene cap

 

 

BACKGROUND OF THE STUDY:

“Every child born into the world is a new thought of God, an ever fresh and radiant possibility.”

 

Low birth weight babies are considered to be one who weighs below 2500 grams. (WHO, 2011) Low birth weight babies start out life with greater odds of having health problems such as hypothermia, birth trauma, birth asphyxia, necrotizing enterocolitis, patent ductus arteriosus. Neonatal hypothermia after birth is a worldwide issue across all climates. (Shiva Rafati, 2005)

 

 

Hypothermia is due to excessive heat loss, poor metabolic heat production, deficiency of brown fat, CNS damage due to anoxia, intra cranial hemorrhage and malformations. A new born is more prone to develop hypothermia because of large surface area per unit of body weight. A low birth weight baby has decreased thermal insulation due to less subcutaneous fat and reduced amount of brown fat. Brown fat is the site of heat production. (Carroll P.D, 2011)

 

Hypothermia is defined as the core body temperature falls below 36.50c. Hypothermia during the newborn period is widely regarded as major contributory cause of significant morbidity and mortality (Tafari, 2009) Among all alternative measures, polyethylene cap was highly effectiveness in prevent hypothermia. Polyethylene cap is made up of thermoplastic polymer lined with aluminium silver swaddle is applied to the low birth weight babies which minimizes evaporative and convective heat losses(Thomas, 2011) Indian Academy Of Pediatrics (2009) recommended that polyethylene cap is effective in reducing heat loss among < 29 weeks of gestation. Global incidence of low birth weight babies are estimate that 9.6% of all births in 2011. in India 17 million infants are born every year with LBW, 16% LBW in developing countries. Nearly 80% LBW at term are born in Asia. (WHO, 2011).

 

Mullany LC (2006), conducted a Longitudinal cohort study in Nepal to quantify incidence, age, and seasonality of neonatal hypothermia. A total of 23 240 LBW babies born between September 2, 2002, and February 1, 2006 were involved. Measurements lower than 36.5 degrees C were observed in which half (48.6%) had moderate or severe hypothermia and risk peaked in the first 24 to 72 hours of life. Risk increases mortality by 41.3% (95% confidence interval, 40.0%-42.7%)

 

Mccall EM (2010), conducted a  quasi-randomised allocations to test a specific intervention designed to prevent hypothermia, (apart from 'routine' thermal care) applied within 10 minutes after birth in the delivery suite to infants of < 37 weeks' gestational age or birth weight </=2500g.), To assess efficacy and safety of interventions, designed for prevention of hypothermia in low birth weight infants, applied within 10 minutes after birth in the delivery suite compared with routine thermal care. Data were analysed with risk 95% confidence limits were calculated for each dichotomous outcome and mean differences (MD) with 95% confidence limits for continuous outcomes. Polyethylene cap were effective in reducing heat losses in infants < 28 weeks' gestation (n = 159; WMD 0.76 degrees C; 95% CI 0.49, 1.03). There is a need to conduct large, high quality randomised controlled trials looking at long-term outcomes.

 

Mori R (2006), conducted a Meta-analysis of the four studies found that polyethylene caps were statistically  significantly more effective than routine care in reducing heat losses in infants aged < 28 weeks’ of gestation [weighted mean difference (WMD) 0.68oC; 95% confidence interval (CI) 0.45–0.91], but this way the risk of death during hospital stay is reduced. Further researcher while working in NICU found that there is no alternative treatment for low birth weight babies apart from incubator and warmer. So, the researcher took up this study to prove polyethylene cap is effective in low birth weight babies to prevent hypothermia.

 

STATEMENT OF THE PROBLEM:

“Effectiveness of Polyethylene cap on hypothermia among low birth weight babies at Government Head Quarters Hospital, Erode”

 

OBJECTIVES:

1.      To assess the level of hypothermia among low birth weight babies in experimental and control group before and after polyethylene cap.

2.      To compare the effectiveness of polyethylene caps on hypothermia among low birth weight babies in experimental and control group before and after polyethylene caps.

3.      To find out the association between posttest scores of hypothermia among low birth weight babies in experimental and control group with their demographic variables.

 

HYPOTHESIS:

H1:

There is a significant level of pretest and posttest scores on hypothermia among low birth weight babies in control and experimental group before and after polyethylene caps.

 

H2:

There is a significant effectiveness of polyethylene caps on hypothermia among low birth weight babies in experimental group than control group.

 

H3:

There is a significant association between post test scores on hypothermia among experimental and control group with their selected demographic variables.

 

DELIMITATIONS:

The study is delimited to,

ü  Assess the effectiveness of polyethylene cap

ü   Identify changes in vital parameters

ü   Low birth weight babies.

ü  Government head quarters hospital, Erode

 

MATERIALS AND METHODS:

Research approach:

A quantitative research approach was selected to collect the data from the low birth weight babies to evaluate hypothermia.

 

Research design:

A Quasi experimental design, where one group pre and posttest with control group was used

 

Setting of the study:

The study was conducted in Government Head Quarters Hospital, Erode

 

Population:

The population for the present study was the low birth weight babies with hypothermia

 

Sample:

The sample consists of 30 low birth weight babies with hypothermia

 

Sampling technique:

Convenient sampling technique was used to select the sample for the study

 

Exclusion

criteria:
Low birth weight babies with Congenital anomalies, Respiratory distress, Brain injury, Incubator, Ventilator

 

Development of the tool:

A baseline proforma and checklist on Hypothermia on low birth weight babies was prepared with the help of review of literature, clinical experience and discussion with experts.

 

Description of the tool:

Section-A1:

Demographic variables of Mother

 

Section-A2:

Demographic variables of Newborn

 

Section-B:

Hypothermia scale for low birth a weight babies. 

 

Section-A1: Demographic variables of Mother

It contained items for obtaining information regarding age in years, Parity of mother, Mode of delivery, history of hypothermia in siblings at birth and Maternal complications 

 

 

 

Section-A2: Demographic variables of Newborn

It consists of variables such as Gender of the baby, Gestational weeks of newborn, Birth order of child.

 

Section- b: Hypothermia scale for low birth a weight babies:

It consists of 6 parameters such as “temperature”, “heart rate”, “respiratory rate”, “cry”, “activity”, “skin colour”. Each parameter has 4   point rating scale.

 

Scoring Procedure of Hypothermia Scale for Low Birth Weight Babies:

Based on the percentage of scores the hypothermia for low birth weight babies was graded in three categories i.e, “non urgent”, “urgent” and “very urgent”.

 

Grades

Actual Score

Percentage

Non urgent (Vital parameters are stable)

17-24

70-100%

Urgent ( Needs attention )

9-16

30-69%

Very urgent ( Life threatening conditions )

6-8

0-29%

 

PLAN FOR DATA ANALYSIS:

The data were analyzed by using both descriptive and inferential statistics.

v  Assess the level of hypothermia among experimental and control group of low birth weight babies before and after polyethylene cap was analyzed by using frequency and percentage.

v  Assess the effectiveness of polyethylene cap on hypothermia among low birth weight babies in experimental and control group was  analyzed by using mean, standard deviation, mean percentage, paired ‘t’ test and unpaired ‘t’ test.

v   Association between post test scores of hypothermia among control and experimental group of low birth weight babies with their demographic variables was analyzed by using Chi-square test.

 

 

 

RESULTS:

Section A: Frequency and percentage distribution of control and experimental group of newborn according to their demographic variables

S. No

Demographic variables

Control group

Experimental group

Frequency(N1)

Percentage (%)

Frequency (N2)

Percentage (%)

1.

Gender

a)                 Male

b)                 Female

 

7

8

 

47

53

 

10

5

 

67

33

2.

Gestational weeks

a)                 >37

b)                 37 – 38

c)                 38- 39

d)                 > 39

 

-

5

4

6

 

-

33

27

40

 

-

1

11

3

 

-

7

73

20

3.

Birth order

a)                 1st

b)                 2nd

c)                 3rd

 

8

6

1

 

53

40

7

 

7

7

1

 

47

47

6

 

SECTION B: Compare the effectiveness of polyethylene cap on hypothermia among control and experimental group of low birth weight babies.

 

Low birth weight babies

“t” TEST

Level of significant

Paired ‘t’ test value

Unpaired ‘t’test value

Calculated value

 Table value

Calculated value

Table value

Control group (N1)

6.6

2.145

35.2

2.042

P < 0.05  significant

Experimental group (N2)

7.03

2.145

P < 0.05  significant

Control group and experimental group posttest

-

-

 

 

P < 0.05  significant

 

 

 

Paired’ test was calculated to analyze the effectiveness between pre and post test scores of control and experimental group on level of hypothermia among low birth weight babies. The paired’ test value was 9.8 and 14.9 in control group and experimental group, when compared to table value (2.145) both are high. This shows that there was a significant effectiveness between pre and post test scores of level of hypothermia among low birth weight babies in both the control and experimental group with or without polyethylene cap.

 

CONCLUSION:

•        In control group most of the mothers were in the age group of 22-25 years and 26-29 years, they are in primipara, they underwent caesarean section, they have no history of hypothermia in siblings and they had maternal complications.

•   In experimental group most of the mothers were in the age group of 26-29 years, they are in primipara and multipart, they underwent caesarean section, they have no history of hypothermia in siblings and they had maternal complications.

•   In control group most of the low birth weight babies were female, they are born before >39 weeks and they are in 1st order of birth.

•        In experimental group most of the low birth weight babies were male, they are born before 38-39 weeks and they are in 1st and 2nd order of birth.

•      In control group most of the low birth weight babies with hypothermia had taken more than an hour to regain temperature.

•   In experimental group most of the low birth weight babies with hypothermia had taken less than an hour to regain temperature.

•        There was a significant effectiveness of polyethylene cap on hypothermia among low birth weight babies in experimental group than control group.

·        There was no significant association between post test scores on hypothermia among experimental group and control group with their selected demographic variables

 

 

RECOMMENDATIONS:

•   A study can be conducted with large samples to generalize the findings.

•   A similar study can be conducted in normal birth weight babies.

•   A similar study can be conducted among babies with small for gestational age.

•   A similar study can be compared with biological environmental interventions like kangaroo care, skin to skin and mother and baby.

•   A comparative study can conducted to assess the effectiveness of polyethylene cap with various types of methods to prevent hypothermia like warmer, Incubator , warm room, transwarmer mattress, and polyethylene bag.

•   A comparative study can be conducted to assess the effectiveness of polyethylene cap among low birth weight babies Vs normal birth weight babies.

 

REFERENCES:

1.       Adelli pilleteri, (1999). Maternal child health Nursing care of child bearing & child rearing. 3rd    Edition. Lippincott publisher, Philadelphia.

2.       OP Ghai, (2003). Text book of paediatrics, 5th Edition. Mehta Publishers, New Delhi.

3.       Dorothy R. Marlow, (2002). Text book of paediatric nursing. 6th Edition. Elsevier Publications. Noida.

4.       Potter, A. Patricia and Perry G Anne, (1991), Basic nursing theory & practice, 2nd edition. Mosby publications. (p) Ltd, New Delhi.

5.       Toronto.Sundar Rao and Richard J, (2000).  An Introduction to Biostatistics. 5th edition.  Prentice Hall, New Delhi.

6.       Carole Kenner, (1998), Protocols in Neonatal Nursing. 2nd edition. Saunders publications, New Delhi.

7.       Scott M. Nelson. (2011). Predicting Low Birth Weight babies in infants born from in vitro fertilization   Indian Journal of paediatrics. Pp: 28- 30.

8.       J. A. Rogowski, (2012).  "Cost-Effectiveness of Care for Very Low Birth Weight Infants," Journal of Paediatrics,  Pp: 382- 412

9.       Fehrija Skwe, Selma muratoric (2010). Low Birth Weight babies in remote areas. International Journal of paediatrics. ID- 789183

10.     /www.Urbanchildinstitute.org/ 2009/ vol-4- issue-3

11.     /www.ncbi.nlm.nih.gov/pubmed /2012/vol-2- issue-1

 

 

 

 

 

Received on 26.04.2015                Modified on 12.05.2015

Accepted on 20.05.2015                © A&V Publication all right reserved

Asian J. Nur. Edu. and Research 5(4): Oct.- Dec.2015; Page 495-498

DOI: 10.5958/2349-2996.2015.00101.9