INTRODUCTION:

All hospital personnel involved with delivery of newborn should be able to identify them in any assistance and quickly establish normal vital functions in babies who need help. Reversal of asphyxia, normalization of cardiac function and correction of shock are the major considerations in initial management of the compromised newborn in the delivery room. In today’s scenario birth asphyxia is one of the major problem and nurses working in neonatal intensive care units need to have adequate knowledge to manage neonatal emergencies¹.

Birth asphyxia is one of the most important causes of neonatal brain injury whose incidence ranges from 3.7 to 9 per 1000 deliveries in the west. In developing countries it is considerably higher because of negligible antenatal care and poor perinatal services. According to world health organization (WHO), birth Asphyxia as failure to initiate and sustain breathing immediately after birth. It is the third major cause of neonatal death after infections. Preterm births in developing countries accounts for an estimated 23% of the annual 4 million neonatal deaths. WHO estimates that 120 million infants born in every year develop birth asphyxia in developing countries and require resuscitation, an estimated 900,000 die each year. The risk of dying due to birth asphyxia varies countries to countries. High neonatal mortality rate (NMR) have an estimated eight times higher risk than babies in low NMR settings. Based on a literature it is estimated that 24% - 61% of prenatal mortality is attributed to asphyxia. The cause of specific prenatal mortality rate associated with asphyxia is generally between 10 and 20 per 1000 births.¹ Prenatal asphyxia are terms that are used to describe the time period as which the baby suffered the asphyxia injury. Birth asphyxia generally refers to lack of oxygen close to the time of labour and delivery².

New born babies may not breathe at birth due to many causes originating at different periods of the pregnancy. Birth asphyxia may primarily be due to complications occurring during the ante partum (50%) intrapartum (40%), and post partum (10%) periods. Therefore to reduce the incidence of birth asphyxia, interventions must be directed towards addressing the conditions that occur during each period when birth asphyxia occurs. Mothers of the new born need to recognize the importance of interventions that lead to the prevention of birth asphyxia. However, the primary focus of this issue is on the management of birth asphyxia that is new born resuscitation and not on prevention.³

Although birth asphyxia can be predicted for certain conditions such as fetal distress and preterm child birth, most cases of birth asphyxia cannot be predicted. Therefore, every newborn should be considered as risk of asphyxia. Any infant can have neonatal asphyxia without warning signs during labour. Therefore all the attendants must be competent in newborn resuscitation and must have the necessary equipment ready for the resuscitation of the newborn baby. Approximately resuscitation equipment is essential for optimal management of asphyxia; however, asphyxiated babies can be resuscitated without the use of equipment.⁴

The preventive aspects of neonatal asphyxia are very important. Intensive antenatal care to detect risk factors and adequate interventions or referral and vital aspects of prevention. Intranatal assessment of fetal hypoxia and management of fetal distress should be done promptly. Special attention should be paid for avoidance of preterm delivery, care of preterm and low birth weight infant to prevent birth asphyxia. Nursing personnel should work in all levels of care to prevent this life- threatening condition⁵.

NEED FOR THE STUDY:

Birth asphyxia is the fifth largest cause of neonatal death. Birth asphyxia accounts for an estimated 0.92 million neonatal deaths annually and is associated with another 1.1 million intrapartum stillbirths, as well as an unknown burden of long- term neurological disability. Perinatal asphyxia is an insult to the fetus or the newborn due to lack of oxygen (hypoxia) and /or a lack of perfusion (ischemia) to various organs. The common denominator of hypoxic ischemic injury is deprivation of the supply of oxygen to the centre nervous system. An oxygen deficit may be incurred by either hypoxemia or ischemia. Hypoxemia is defined as a diminished oxygen content of the blood and ischemia is characterized by reduced perfusion to a particular tissue; generally the two tend to occur simultaneously or in sequence. Asphyxia is an impairment of gas exchange that results not only in the deficit of oxygen in blood but also an excess of carbon dioxide causing acidosis. The acidosis further leads to hypotension and ischemia culminating in hypoxic-ischemic injury. The brain is especially vulnerable to damage by hypoxia and ischemia because it has one of the highest oxygen requirements and base line blood flow than any other organs in a term fetus⁶.

Birth asphyxia is a dangerous situation and if it is not managed correctly and promptly can be responsible for brain death, cardiac, lungs and kidneys failure and even death can occur. Neonatal intensive care unit (NICU) is a highly technical specialized unit in a hospital that provide medical/nursing care and technologies support to sick and high risk infants and premature even emergency like birth asphyxia. The common causes of neonatal mortality in each Country are asphyxia, prematurity and low birth weight, infections like pneumonia and gastroenteritis and verity of surgical problems. Taking into consideration the fact that the neonatal intensive care unit (NICU) is more expensive that any health care system can provide.⁷

Nursing constitutes a major role among team members in caring the neonates, with growing demand for quality care, nurses need to be oriented to quality care concept. The nurses who work in NICU require a high level of knowledge about the physiological changes that occurs in newborn as well as keen assessment skills to detect subtle changes in the newborn. The nurses must be able to communicate effectively with family members and members of the entire interdisciplinary NICU team. This will enable quality care which increase likelihood of newborns survival and promote optimal quality care.⁸

A community-based inquiry was conducted in a rural area of north India to estimate extent of the problem of birth asphyxia. Births and neonatal deaths were recorded in 54 villages. Trained field workers contacted birth attendants/family members within 15 days after the birth, and recorded the symptoms and signs related to birth asphyxia on a pre-coded questionnaire. Detailed descriptive history of birth events in chronological order was recorded in cases suspected to be asphyxiated or stillborn. 2 pediatricians reviewed the case histories independently to assign the diagnosis. Out of the 1977 recorded live births, field workers suspected 53 babies to be asphyxiated, 39 of these were diagnosed as asphyxiated, four as not asphyxiated by both the experts and 10 were considered as asphyxiated by one of the experts. Prevalence of birth asphyxia was estimated to be at least 2 %( 39/1977). Case fatality in these cases was 74%. In India this enquiry suggests that birth asphyxia is still unsolved problem so proper management of birth asphyxia can reduce the mortality and morbidity rates.⁹

Neonatal mortality and morbidity are increasing day by day. In India mortality rate is still high compared to developed countries. Birth asphyxia is the third largest cause of death after infections and preterm births. As birth asphyxia is one of the causes of neonatal death, many of the staff nurses are unaware or without much knowledge and skill in resuscitation of the asphyxiated babies¹⁴. Even though birth asphyxia is one of the leading causes of neonatal mortality, many of the nurses are announce, or unskilled in resuscitation of the asphyxiated babies¹⁰.

The management of birth asphyxia consists of supportive care to maintain temperature, perfusion, ventilation and a normal metabolic state including glucose, calcium and acid-base balance. Early detection by clinical and biochemical monitoring and prompt management of complications must be done to prevent extension of cerebral injury¹¹.

In view of the above reasons the investigator is interested to take up this problem to assess the knowledge regarding management of birth asphyxia among the staff nurses working in NICU and labour room in KLE hospital, Belgaum.

STATEMENT OF PROBLEM:

A descriptive study to assess the knowledge regarding management of Birth Asphyxia among the Staff Nurses working in NICU and Labour room in KLES Dr. Prabhakar Kore Hospital, Belgaum

OBJECTIVES OF THE STUDY:

1. To assess the level of knowledge regarding management of birth asphyxia among staff nurses working in NICU and Labour room.

2. To find out the association with the level of knowledge regarding management of birth asphyxia among staff nurses with their selected demographic variables.

3. View to develop information booklet regarding management of birth asphyxia

OPERATIONAL DEFINITION:

Birth asphyxia

It refers to the baby failure to initiate and sustain breathing at birth.

Assess

It is organized, systemic and continuous process of collecting data from the staff nurses related to knowledge regarding management of birth asphyxia.

Knowledge

It refers to the level of understanding of staff nurse about management of birth asphyxia.

Staff nurses

NICU

It refers to Neonatal Intensive Care Unit, a highly technical specialized unit in a hospital that provides Medical/Nursing care and technological support to sick and high risk infants and premature babies.

Neonates

It refers to an infant in the first 28 days after birth.

Newborn

It refers to the baby who is in first 24 hrs of life after birth.

Labour room

A hospital room that is utilized for labour and delivery.

Management

It refers to the activities which are carried out by Staff Nurses of NICU and Labour room in relation to the birth asphyxia.

Hypothesis:

H1: There will be a statistically significant association between level of knowledge scores of staff nurses and their demographic variables at 0.05 level of significance.

Assumptions:

· Staff nurses may have inadequate knowledge regarding management of birth asphyxia.

Delimitation:

· Who are working in NICU and labour room of KLE Prabhakar hospital Belgaum.

· Who are willing to participate in the study

· Who are available during the period of study.

RESEARCH METHODOLOGY:

Research Approach:

A descriptive approach was adopted in this study.

Research Design:

A non experimental descriptive survey research design was adopted to carry out the present study.

Research Setting:

Setting are the more specific places where data collection occurs based on the nature of the research question and type of information needed to address it .Based on the geographic proximity, feasibility to conduct the study and familiarity with the setting, the investigator selected KLES DR. Prabhakar Kore Charitable Hospital Belgaum.

Population

The staff nurses who are working in NICU and labour room at KLES Dr. Prabhakar Kore Charitable Hospital Belgaum.

Sample

In this study the sample consists of staff nurses who are working in NICU and labour room at KLES Prabhakar Kore Charitable Hospital Belgaum.

Sample technique

Non probability convenient sampling technique.

Sample size

The sample size in this study is 30 Staff nurses who are working in NICU and labour room at KLES Prabhakar Kore Charitable Hospital Belgaum.

Description of Tool:

The final tool consists of two sections;

Section I	:	Demographic data
Section II	:	Structured knowledge questionnaire to assess the level of knowledge regarding management of birth asphyxia among staff nurses.

RESULTS:

Findings related to demographic variables.

Table1: Frequency distribution of staff nurses according to demographic variables.

SL No:	Demographic variables	Frequency	Percentage
1.	Age
	a)20-25yrs	20	66.67%
	b)26-30yrs	10	33.33%
2.	Gender
	a)Male	8	26.67%
	b)Female	22	73.33%
3.	Qualification
	a)Diploma	24	80%
	b)Degree	6	20%
4.	Year of experience
	a)1-5yr	28	93.33%
	b)6-10yr	2	6.67%

· Most of the staff nurses 20 (66.67%) were in the age group 20-25yrs and only 10 staff nurses are in the age group 26-30yrs (33.33%).

· Majority of the sexes are females 22 (73.33%) and males 8 (26.67%).

· Majority of the staff nurses are diplomats 24 (80%) and degree holders are 6 (20%).

· Majority of the staff nurses are having 1-5yr of experience ie,28 (93.33%) and only 2 are having experience of 6-10yr (6.67%)

Table2: frequency and percentage distribution of knowledge scores on management of birth asphyxia among staff nurses.

Knowledge	Score	Frequency	Percentage
Good	19-25	7	23.33%
Average	13-18	18	60%
Poor	1-12	5	16.67%

Table 2 revealed that in test majority of staff nurses is 18 (60%) had average knowledge, 7 (23.33%) had good knowledge and 5 (16.67 %) had poor knowledge

Testing of Hypothesis

Table 3: Association between the existing pre-test knowledge of staff nurses and demographic variables. n=30

Sl no:

Demographic variable

Good

Average

Poor

Cal. value

Tab. value

AGE

a)20-25yrs

b)26-30yrs

16.86622

5.991^*

GENDER

a)Male

b)Female

18.40724

5.991^*

QUALIFICATION

a)Diploma

b)Degree

67.06667

5.991^*

YEAR OF EXPERIENCE

a)1 – 5 yr

b)6 -10 yr

29.58

5.991^*

Table 3 revels that the calculated chi-square value for age, gender, qualification and year of experience is more than table value. Hence H1 is accepted, there is an association between the demographic variables and knowledge regarding management of birth asphyxia among staff nurses.

DISCUSSION:

The results were supported with the study conducted to assess the incidence of birth asphyxia in the Canadian Institute of health information in Canada between 1991 and 2005. The study results show that between 1991 and 2005, the incidence of birth asphyxia decreased significantly, from 43.8 to 2.4 cases per 1000 live births. The rate of decrease was highest between 1991 and 1998⁸.

In the present study revealed that among 50 elderly clients residing in old age home, 28 (56%) had severe level of depression and 22 (44%) had moderate level of depression. Among 50 elderly clients staying with the family, 28 (56%) had moderate level of depression and 22(44%) had mild level of depression. The results were supported with the study by Bekaroglu M, Uluutku N, Tanriover S, Kirpinar I, revealed that around 41% of the elderly clients residing in the old age institutions had severe depression were as compared to elderly residing in the home 29% had mild depression.⁷ The results were also supported with the study by M C Dougall FA and Matthews FE, revealed that around 27.1% elderly residing in old age home had depression were as compared to the elderly staying with the family 9.3% had low level of depression.⁸

CONCLUSION:

Conclusions were derived from the findings and are the synthesis of findings. The major findings of the study were:

· Maximum of the staff nurses 20 (66.67%) were in the age group 20-25yrs and only 10 staff nurses are in the age group 26-30yrs (33.33%).

· Majority of the sexes are females 22 (73.33%) and males 8 (26.67%).

· Majority of the staff nurses perceived diploma nursing 24 (80%) and degree holders are 6 (20%).

· Majority of the staff nurses are having 1-5yr of experience ie, 28 (93.33%) and only 2 are having experience of 6-10yr (6.67%)

· The calculated chi-square value for age, gender, qualification and year of experience is more than table value. Hence H1 is accepted, there is an association between the demographic variables and knowledge.

REFERENCES:

1. Meharban Singh, Text Book of care of Newborn, New Delhi, Sagar Publication, Page No. 31-46.

2. World Health Organization, Care in Normal birth, Geneva, 1999.

3. Whaley and Wongs, Essential of Pediatric Nursing, New Delhi, Mosby Publication, Page No.186-192.

4. Park. K, Text book of Preventive and Social Medicine, 18^th edition, New Delhi, Bhanot publication,2005, Page No. 242-246.

5. Deorari, National movement of Neonatal Resuscitation in India, Journal of Pediatrics, 2004, Page No. 30-36.

6. World Health Organization, The World Health Report, Geneva, 1998.

7. Senath, Textbook of Newborn care, 1^st edition, New Delhi, Jaypee Publication, 2007, Page No. 48-49.

8. Chelapa, Text book of Pediatric Nursing, Calcutta, Vora Medical Publication, 2004, Page No. 48-49.

9. Shilpa, A descriptive survey to identify the availability of programmatic, financial, knowledge and human resources, Journal of Perinatology,2007, Page No. 86-88.

10. Das, Neonatal Morbidity and Mortality, Journal Of Medicine, 2007, Page No. 86-88.

11. Panna Choudhury, Principles Of Pediatric Neonatal Emergencies, 2^nd Edition, New Delhi, Jaypee brothers publishers,2006, Page No.28-29.

Received on 22.08.2014 Modified on 08.10.2014

Asian J. Nur. Edu. and Research 5(1): Jan.-March 2015; Page 82-86

DOI: 10.5958/2349-2996.2015.00018.X

A Descriptive Study to Assess the Knowledge regarding Management of Birth Asphyxia among the Staff Nurses Working in Labour Room and NICU