The National RibatUniversity

Faculty of Graduate Studies&Scientific Research

Assessment of Nurse’s Knowledge and Practice

Regardingcare ofPremature Baby in Neonatal

Intensive Care unitAt Omdurman Maternity Hospital

and AlribatUniversity Hospital

A Thesis Submitted in Partial

fulfillment for Requirement of Master

Degree in Pediatric Nursing

Prepared By:ZubaidaAbohmiedaBabeker

Supervisor:AssistantProf. SaidaAbdelmjeedElrufaie

2015

بسم هللا الرحمن الرحيم

-: ق ال تعالي

فردا تذرني رب ال "وزكريا اذ نادي ربه " وأنت خير الوارثين

صدق اهلل العظيم

(98)اآلية

سورة االنبياء

CONTENETS

Acknowledgement i

Dedication ii

Abstract in Arabic iii

Abstract in English iv

Abbreviations v

CHAPTER ONE

Introduction 1

CHAPTER TOW

Literature Review 4

CHAPTER THREE

Methodology 14

CHAPTER FOUR

Results 16

Discussion 36

CHAPTER FIVE

Conclusion and Recommendation 38

References 39

Acknowledgement

Firstly, with great appreciation I would like to thank National AL Ribat

University Faculty of graduate studies and scientific research and faculty of nursing

science

I would like to express special thanks to my supervisor Dr Saida Abdelmgeed

Elrufaie, for her continuous guidance ,close supervision and sustained advice during

this study. Immense gratitude goes to general manager of Omdurman maternity

hospital and AL ribat university hospital, for offering me permission to carry out this

study, great thanks to all the team work in neonatal intensive care units in both

hospitals.

I

Dedication

To

my father

My mother

My husband

Sisters and brothers,

For their blessing and support.

Ii

ملخص االطروحة

ىو ألخش دوسج حضح. وعذ ي أول اسثىع ي 73انخذح هى انطفم انىنىد حا قثم

كثش عذد حاالخ دخىل انعاح انكثفح نهىانذ . االطفال انخذج رعشضى نعذد ي انشاكم أ

داء ورنك ال اعضائهى ىها غش كاف .انعاح انرشضح انصححح دة ا ذأسس عه األ

هذفد انذساسح انىصفح ان انرقى انعشف وانعه نهشضاخ وفقا نهعاح وندذ انرشض ا

انرشضح نهطفم انخذح ف وحذج انعاح انكثفح نهىانذ ف يسرشفى انىالدج او دسيا

.و4102اش ان و4102ويسرشفى انشتاط اندايع ف اغسطس

وا اثاء فرشج انذساسح , وسكضخ انذساسح يشضح ي انز وخذ 21انرغطح انكايهح

عه انركشاس انشوذ نإلخشاءاخ انرشضح يثم )غسم االذي , إدخال االثىب االف ساسا أ

يعىي, انرغزح انعىي ,إعطاء األكسد, سعاح انطفم ف انحضاح, سعاح انطفم عذ انعالج

سراسج يشاقثح اااخ تىاسطح االسرثا وخعد انث .ذحد انضىء وذعهى انشضاعح انطثعح(

االداء ي خالل إحصائح ذحهم انثااخ تىاسطح انكثىذش واسرخذاو تشايح انرحهم اإلحصائ

ن سعاح انطفم انخذح وضحد انذساسح ا يرىسظ سثح انعشفح عذ انشضاخ وفقا أ و

ن سعاح انطفم انخذح وفقا % و ا يرىسظ سثح اناسسح عذ انشضاخ2424اويذس

نهشعاح ان سىاء يعشفح وياسسح انشضاخ وفقا وخهصد انذساسح %. 2122ساويذ

وصد انذساسح تانثشايح انرطىشح انسرشج نالصطفاف ,صادج أانرشضح نهطفم انخذح. و

خ.ادائهى انعه و وصادج ذع انشضاخ انؤهال وذىفش انعذاخ نرحس

iii

ABSTRACT

Premature is a live born infant delivered before 37 weeks from the first day of

last menstrual period .It accounts for the largest number of admissions to neonatal

intensive care unit (NICU) . Premature infants can develop a range of problems

because their organs are not mature enough. the proper nursing care of premature

baby should be established by good nursing performances. The descriptive study was

aimed to assess nurse's knowledge and practice regarding care of premature baby in

neonatal intensive care unit (NICU) at Omdurman maternity hospital and AL Ribat

University Hospital from august 2014 to January 2015.

Total coverage 50 nurses who were available during study period. The study

focused mainly on frequent and routine nursing process such as (hand washing nose

gastric tube inserting, gavage feeding, oxygen administration, care of baby in

incubator, care of baby under photo therapy and learning of breast feeding). Data

was collected by questionnaire and observation chick list within statistic data analysis

by computer using spss program. Based on the study result ,the study showed that

percentage of nurses knowledge regarding care of premature baby equal to 42,2%.

and the percentage of nurses practice regarding care of premature baby equal to

40,04%. So there were poor nurse’s knowledge and practice regarding care of

premature baby . The study recommended that continuous education program for

staff development availability of equipment to improve nurses practice and

recruitment of qualified nurse .

iv

ABBREVIATIONS

BPD

BRONCHO PULMONARY DYSPLSSIA

G F

GAVAGE FEEDING

HMD

HYALINE MEMBRANE DISEASE

KMC

KANGAROO MOTHER CARE

NICU

NEONATAL INTENSIVE CARE UNIT

NGT

NOSE GASTRIC TUBE

NEC

NECROTIZING ENTEROCOLITIS

PDA

PATENT DUCTUS ARTERIOSUS

ROP

RETINOPATHY OF PRMATURITY

TPN

TOTAL PARENTERAL NUTRITION

WHO

WORLD HEALTH ORGANIZATION

RDS

RESPIRATORY DISTRESS SYNDROME

v

CHAPTER ONE

Introduction

1. Introduction

Prematurity is a major health problem, it is a leading cause of infant mortality.

Preterm birth, defined as child birth occurring less than 37 completed weeks or 259

days of gestation, it is a major determinant of neonatal mortality and morbidity and

has long-term adverse consequences for health (Stacy &et al, 2010).

It represents the highest percentage of high risk group and accounts for the

largest number of admissions to neonatal intensive care unit (NICU).The true

incidence of preterm birth among the developing countries varies from country to

another and from one geographic region to another within a country. However, about

7–12 % of deliveries in developing countries are preterm (Gray et al., 2007).

Preterm infants are at great risk for medical complications and future

developmental disabilities. They can develop a range of problems, their organs are not

mature and an unfavorable environment in the neonatal intensive care unit, may

compound this morbidity. It has been recognized that for many years the environment

of neonatal intensive care unit can have an important influence on the development of

premature infants (Aita & Sinder, 2003).

Each year 15 million babies are born preterm and their survival chances vary

dramatically around the world. 1.2 million babies born in high income countries,

increasing complexity of neonatal intensive care over the last quarter of the 20th

century has changed the chances of survival at lower gestational ages. Middle-income

and emerging economies around 3.8 million preterm babies each year, and whilst

some countries such as Turkey and Sri Lanka have 50% deaths for preterm babies,

other countries have made minimal progress (Lawn JE, 2013) .

South Asia and sub-Saharan Africa account for almost two-thirds of the world's

preterm babies and over three-quarters of the world's newborn deaths due to preterm

birth complications , and even for those born in facilities, essential newborn care is

often lacking )Blencowe H, 4101).

This is descriptive study about evaluation of nurse’s knowledge and practice

regarding care of premature baby. Carried out in Khartoum teaching hospital January

2009. total coverage 50 nurse who were available during study period .The study

focused mainly on frequent and routine nursing process such as vital signs

monitoring , Nose gastric tube inserting, Gavage feeding ,oxygen administration,

suctioning ,cannula insertion and weighing of the baby . Data was collected by

questionnaire and Observational chick list within statistic data analysis. The study

showed that there was poor nursing care of preterm baby. The study recommended

that training facilities and enough staff must be providing (MAREIA HUSSAN,

2009).

Problem statement:

1.Worldwide Studies

The prevalence in the world about 15 million premature babies are born every

year.Recent data from England have confirmed that survival of premature babies born

between 22 to 25 weeks has increased since 1995 (40% to 53% overall) but the

pattern of major neonatal morbidity and the proportion of survivors affected remain

unchanged )Costeloe kl,2006).

2. Development countries studies

The prevalence of prematurity in Kingdom of Saudi Arabia is about 7-12 %

from the total births which account 574000 per year. This is a serious and big problem

which leads to increase in mortality and morbidity rate among group of newborn

(Ministry of health of KSA, 2011).

3. Studies done in Sudan

The prevalence of prematurity in Sudan is about 126 (3.8%) were preterm birth.

And the rest (19.0%) were medically indicated preterm births. (Amel M. Alhaj, and I

shag Adam ,2010).

Justification

The prevalence of premature babies exists universally in all population. Low

birth weight with high mortality and morbidity, continuous to be a major public health

problem in the world this is a serious and big problem which leads to increase in

mortality and morbidity rate among this group of newborn. So I want to assess nurse's

knowledge and practice regarding care of premature babies to reduce this mortality

rate and improve their outcomes (Blencowe H, (4101 .

General objectives

To study nurse’s knowledge and practice regarding care of premature baby In

neonatal intensive care unit(NICU) at Omdurman maternity hospital and ALRibat

university hospital - august 2014 – january 2015.

Specific Objectives:

To assess nurse’s knowledge regarding frequent and routine nursing process such as

(hand washing ,nasogastric tube inserting, gavage feeding, oxygen administration,

care of baby in incubator, care of baby under photo therapy and teaching of breast

feeding)

To assess nurse’s practice regarding frequent and routine nursing process such as

(hand washing ,nasogastric tube inserting, gavage feeding, oxygen administration,

care of baby in incubator, care of baby under photo therapy and teaching of breast

feeding).

CHAPTER TOW

Literature Review

2. LITERATURE REVIEW

2.1. Definition of premature baby:

Premature baby is a baby born alive before 37 weeks of pregnancy are completed

from the first day of last menstrual period (Goldenberg RL, 2008).

Premature baby is the birth of a baby before the developing organs are mature enough

to allow normal postnatal survival. (WH O, 2013).

2.2. Incidence and Risk factor of premature

Often, the cause of preterm labor is unknown, about 15% of all premature births

are multiple pregnancies (twins, triplets, etc). Health conditions in the mother, such as

diabetes, heart disease, and kidney disease may contribute to preterm labor. Different

pregnancy-related problems increase the risk of preterm labor or early delivery such

as a weakened cervix dilate early, also called cervical incompetence, birth defects of

the uterus. History of preterm delivery, infection (such as a urinary tract infection or

infection of the amniotic membrane, poor nutrition right before or during pregnancy,

Preeclampsia, high blood pressure and protein in the urine that develop after the 20th

weeks of pregnancy. Premature rupture of membranes (placenta previa), age of

mother (mothers who are younger than 16 or older than 35) ,being African-American,

lack of prenatal care, low socioeconomic status, use of tobacco or cocaine (Kimberly

G. Lee, MD,2012).

2.3. Characteristics of premature

Premature baby may have very little body fat, this can make the infant appear

very thin. The baby will not weigh nearly the amount of a full-term baby. Premature

babies who born between 30 and 32 weeks are likely to have thin skin as a result of

the limited body fat, the ribs may be easy to see under the skin, the tissue may appear

red. the skin is often wrinkly, extremely, premature infant who are delivered anytime

between the 24th and 27th weeks; have yet to develop the exterior layer of skin,

which begins solidifying in the 26th week, points out that the skin may appear smooth

and shiny. Premature babies have no hair at all, they lack the lanugo, or fine fuzz that

covers an infant's body beginning around week 24 or shortly after. Premature baby

who arrives closer to term may have fuzz all over the body, even the head. A

premature will not move, the movements of a baby born between 29 and 32 weeks

may appear jerky instead of smooth. Babies born before these weeks may not move

much at all. the arms and legs may remain in an outstretched position from the lack of

muscle tone. Around the 35th week, a premature has enough muscle tone to get into

the fetal position, like a full-term newborn. Sucking may be difficult due to an infant's

poor muscle tone, They have soft flat ears with little cartilage, and small scrotum with

few folds; testes may be undescended in very premature newborns ,girls labia majora

not yet covering labia minora (William Sears, M.D, 2004) .

2.4. Common health problems (short-term complications)

1. Respiratory Distress Syndrome (RDS)

The most common lung problem in a premature baby is (RDS), also known as

hyaline membrane disease (HMD), baby develops HMD when the lungs do not

produce sufficient amounts of surfactant, a substance that keeps the tiny air sacs in the

lung open. the complications of RDS include: (Kimberly, 2011).

a.Pneumothorax:

Pneumothorax is condition develops when a small air sac in the lung ruptures

and air escapes from the lung into a space between the lung and the chest wall. If a

large amount of air accumulates, the lungs cannot expand adequately. The

pneumothorax can be drained by inserting a small needle into the chest. If the

pneumothorax re-accumulates after being drained with a needle, a chest tube can be

inserted between the ribs. The chest tube is connected to a suction device and

continuously removes any air that has accumulated until the small hole in the lung

heals (Kimberly, 2011).

b.Broncho pulmonary dysplasia (BPD):

BPD 1s a chronic lung disease caused by injury to the lungs, it occurs in about

25 to 30% of babies who are born before 28 weeks and weigh less than 1.000 grams

(2.2 pounds). Broncho pulmonary dysplasia is most common in very premature

babies born between 24 and 26 weeks ( Moser K ,2007).

c.Apnea of Prematurity:

Apnea is a "pause in breathing of longer than 10 to 15 seconds, often associated

with bradycardia, cyanosis, or both. It is occurs in almost 100% of babies who are

born before 28 weeks gestation. It is much less common in older premature babies,

especially those born at 34 weeks or later. Apnea usually does not happen

immediately after birth; it occurs more commonly at one to two days of age and

sometimes is not evident until after a baby has been weaned from a ventilator (petrou

S, Henderson 2006).

2. Retinopathy of prematurity (ROP): Retinopathy of prematurity is damage to the retina, perhaps caused by an

imbalance in the blood’s oxygen level or extreme prematurity, it can treat by

examination a pediatric ophthalmologist. If progression of ROP is observed, surgery

by a pediatric ophthalmologist may be required to prevent blindness. (Royal, 2008 ) .

3. Heart problems

The most common heart problems premature babies experience are patent

ductus arteriosus (PDA) and low blood pressure (hypotension). PDA, which tends to

affect babies born before 30 weeks, is a persistent opening between two major blood

vessels (petrou S, henderson 2006).

4. Temperature control problems

Premature babies can lose body heat rapidly; they don't have the stored body fat

of a full-term infant and they can't generate enough heat to counteract what's lost

through the surface of their bodies. If body temperature dips too low, hypothermia can

result. Hypothermia in premature can lead to breathing problems and low blood sugar

levels. In addition, premature may use up all of the energy gained from feedings just

to stay warm, not to grow bigger (petrou S, henderson 2006).

5.Gastrointestinal problems

Premature have immature gastrointestinal systems, so my developed necrotizing

enterocolitis (NEC) in the cells lining the bowel wall are injured, primarily occurs in

premature babies after they start feeding. (Babytalk Magazine, 2008 )

6. Metabolism problems

Premature babies often have problems with their metabolism. Some premature

may develop an abnormally low level of blood sugar (hypoglycemia). This can

happen because premature have smaller stores of glycogen (stored glucose) (Babytalk

Magazine, 2008 ).

7. Blood problems

Anemia is a common condition in which the body doesn't make enough red

blood cells. While all newborns experience a slow drop in red blood cell count during

the first months of life, the decrease may be greater in premature. Jaundice is usually

caused by too much bilirubin in the blood. Bilirubin comes from red blood cells that

have been broken down normally, the liver removes bilirubin from the body, but the

liver of the premature infant is not mature enough to do its usually occurs during the

first 3 to 7 days of life (Babytalk Magazine, 2008 ).

8. Immune system problems:

An under developed immune system, common in premature babies, can lead to

infection. And quickly spread to the blood stream causing sepsis, a life-threatening

complication. Premature don’t fight infections well. however, even with all the

precautions that are taken, many premature will develop one or more serious

infections (Kimberly, 2011).

9. Intraventricular hemorrhage:

Intraventricular hemorrhage is a rupture of still-developing blood vessels in the brain

of premature infants, with blood going into the fluid spaces of the brain, which occurs

within the first few days of life. Is: A rupture of still-developing blood vessels in the

brain of premature infants, with blood going into the fluid spaces of the brain, which

occurs within the first few days of life (Liu L,2010).

2.5 Common health problems (long-term complications):

1.Hearing problems

Premature babies are at increased risk of some degree of hearing loss (Baby

Magazine, 2008 ).

2. Dental problems

Premature have been critically ill are at increased risk of developing dental

problems, such as delayed tooth eruption, tooth discoloration and improperly aligned

teeth (Baby Magazine, 2008 ).

3.Behavioral and psychological problems

Children who experienced premature birth are more likely than full-term

infants to have certain behavioral and psychological problems, such as attention

deficit hyperactivity disorder, depression or generalized anxiety, and difficulties

interacting with kids their own age (Baby Magazine, 2008 ).

2.6 Role of nurses in (NICU)

The nurses has important role in the management of premature babies because

they need special environment, to optimal heat and close observation The neonatal

period is the first 28 days of an infant’s life. The nurses work in (NICU) that provide

different care to babies who range in condition from healthy newborns to premature

babies or babies who have serious birth defects, severe illnesses or other life-

threatening problems ( March of Dimes2011).

2.7. General management of premature baby:

1.Maintenance of stable body temperature

Premature babies easily and quickly suffer hypothermia, when in a cold

environment. Heat loss caused by the baby's body surface relatively larger when

compared to weight, lack of fatty tissue under the skin and brown fat deficiency. To

prevent hypothermia needs to be cultivated environment that is warm enough for the

baby and the consumption of oxygenated at least, so that the baby's body temperature

remains normal. If the baby is cared for in an incubator the temperature can be around

37 ˚ C. Incubator humidity ranged between 50% - 60%. Higher humidity is needed in

infants with respiratory distress syndrome if the incubator is not available, the heating

can be done by wrapping the baby and put the bottles warm surroundings or by

installing lights near the crib. Baby in incubator only applied diapers. It is possible to

control the general condition, changes in behavior, skin color, breathing and seizures

(datta,2009)

2.Maintenance of breathing

RDS is commonest problem in premature, Baby should be positioned with neck

slightly extended and air passage to be cleared by gently suction to remove the

secretion, oxygen therapy should be administered if need, methods for administering

oxygen include head box, nasal prongs, or nasal catheters, Safe oxygen management

is crucial and any baby on continuous oxygen therapy should be monitored with a

pulse oximeter (datta,2009)

3.Prevention of infection

Premature infants infect ed easily. This is caused by the body's resistance to

infection is less, Improved care involves early detection of such danger signs and

rapid treatment of infection, while maintaining breastfeeding if possible,

Identification is complicated by the fact that ill premature babies may have a low

temperature, rather than fever. Premature babies have a higher risk of bacterial sepsis.

Hand cleansing is especially critical in neonatal care units. However basic hygienic

practices such as hand washing and maintaining a clean environment are well known

but poorly done. Unnecessary separation from the mother or sharing of incubators as

these practices increase spread of infections (WHO,2005).

4.Total parenteral nutrition (TPN)

The baby will receives all nutrition through an IV line solutions consisting of

sugar (dextrose) and protein, vitamins (which give the fluid a yellow color), minerals,

and salts dissolved in water. This is called total parenteral nutrition (TPN) or

hyperalimentation

Parenteral fat, a white fluid called intra lipid, is usually given as well. These solutions

can contain all the nourishment that baby needs to grow until oral feedings are

established (datta,2009) .

5.Breast feeding in premature baby

Breast milk is the best food for premature babies. The composition of breast

milk produced by mothers who give birth prematurely is different from the

composition of breast milk produced by mothers who gave birth at term and this

difference lasted for about 4weeks. Often there is a failure of breastfeeding in mothers

who gave birth prematurely. This is caused by maternal stress, no guilt, lack of

confidence, not knowing expressing milk in premature babies sucking and swallowing

reflex does not exist or less, to suck less energy, less gastric volume, frequent reflux,

slow peristalsis. the nurses has important role in teach red mother who gave birth

prematurely can successfully .In premature infants, reflexes suck, swallow and cough

is not perfect, the capacity of the stomach is still small, the power of digestive

enzymes, especially lipase still lacking besides protein needs 3-5 grams / day and

high-calorie (110 cal / kg / day), so that the weight bodies as well as possible

increases. This amount is higher than the required term infants. Provision of drinking

starts when the baby was 3 hours so the baby does not suffer from hypoglycemia and

hyperbilirubinemia. Before administering the first drink to be done imbibing gastric

fluid. It is necessary to determine the presence or absence of esophageal atresia and

prevents vomiting. Inhalation of gastric fluid was also performed prior to each

subsequent drink. In general, infants with a birth weight of 2000 grams or more can

breastfeed. Infants with birth weight less than 1500 grams less able to suck milk or

milk bottles. The amount of fluid administered for the first time is 1-5 ml / h and the

amount can be added bit by bit every 12 hours. The amount of fluid given was 60 mg

/ kg / day, and every day was increased to 200mg / kg / day at the end of the second

week (Krisanne Larimer,2008) .

6.Kangaroo mother care (KMC)

This method is put premature baby in early, prolonged and continuous direct skin-to-

skin contact with her mother or to provide stable warmth and to encourage frequent

and exclusive breastfeeding reduction in risk of post-discharge mortality, about a 60%

reduction in neonatal infections and an almost 80% reduction in hypothermia. Other

benefits included increased breastfeeding, weight gain, mother-baby bonding and

developmental outcomes (datta,2009)

.

2.8 Nursing Care of Premature Baby:

Nursing care of premature in incubator:

1. Change humidifier water daily with distilled water.

2. Keep infant in incubator after pre worming incubator for 15 minutes .

3. Don’t place any clothes on baby except diaper.

4. Check temperature of newborn every hour.

5. Give care for baby by introducing hand through portal holes.

6. Do not drag ,move and pull incubator when baby in side ( kalia,2012).

Nursing care of premature with Gastric lavage:

1. perform hand washing.

2. Measure the tube placing from tip of the nose to ear lobe & then up to

xiphoid.

3. Lubricate the tube with little lubrication jelly.

4. check the correct position of the tube in the stomach

5. withdraw injection air from the stomach and aspirated the gastric content.

6. Fix the tube with adhesive tip.

7. Waste material dispose as per hospital policy (kalia,2012)

Nursing care of premature baby under photo therapy:

1. Check the lights of phototherapy unit before use and place it in proper place

no loose electrical connection should be there.

2. Clean the glass surface of phototherapy unit.

3. The eyes and genitalia should be covered while phototherapy is in use.

4. Eye patch should be removing 4hours.

5. Eye shield should not be tight or too loose.

6. Monitor infant temperature frequently .

7. Fluid balance must be carefully monitored ( kalia,2012).

Nursing care of premature to prevention of infection:

1. Held separation between infants infected with infants not exposed to

infection.

2. Wash hands before and after holding the baby.

3. Cleaning the crib as soon as no longer in use (maximum of a baby wearing

a bed for 1 week and then cleaned with an antiseptic solution).

4. Cleaning the room at certain times.

5. Each baby has his own equipment.

6. Every officer in the baby ward must wear clothing that has been provided.

7. Officers who have a communicable disease are prohibited caring for the

baby.

8. Baby's skin and the umbilical cord should be cleaned as well as possible.

9. The visitors can only see the baby from behind the glass. (kalia,2012).

Parents teaching and support:

1. Teaching mother’s about breastfeeding.

2. Teaching and help mother’s about kangaroo position.

3. Condition explained to the parents to reduce their anxiety.

4. Explain environmental hygiene ,follow-up plan and immunization

5. teaching mother's about any problem (datta,2009).

2.9 Previous studies

First study

This is descriptive study about evaluation of nurse’s knowledge and practice

regarding premature babies care. Carried out in Khartoum teaching hospital January

2009. total coverage 50 nurse who were available during study period .The study

focused mainly on frequent and routine nursing process such as vital signs

monitoring , Nose gastric tube inserting, Gavage feeding ,oxygen administration,

suctioning ,cannula insertion and weighing of the baby . Data was collected by

questionnaire and Observational chick list within statistic data analysis. The study

showed that there was poor nursing care of preterm baby. The study recommended

that training facilities and enough staff must be providing (MAREIA HUSSAN,

2009).

Second study

This descriptive study about evaluation of percentage of preterm birth was done

in May 2012 by WHO and Partnership ( Maternal, Newborn & Child Health ) showed

that the report of preterm birth included the first-ever birth estimates by country. So

WHO is committed to reducing the health assess the quality of care provided to

premature baby(WHO,2012).

CHAPTER THREE

Methodology

3.METHODOLOGY

3.1 Study design:

This is descriptive Study design was conducted to assess nurse’s knowledge and

practices regarding care of premature baby among nurses in neonatal intensive care

unit(NICU) at Omdurman maternity hospital and Ribat university hospital from

august 2014 - january 2015.

3.2 Study area:

The descriptive study was carried out in Omdurman maternity hospital which is

located in Omdurman state. The hospital contain on neonatal intensive care unit

(NICU) which consist of three room , one for premature babies with 10 incubators

and 2 resuscitation ,anther tow for term baby with 2 resuscitation,10 Cots and the

third one septic room has 2 resuscitation 6 Cots. The total nurses work in NICU were

40 nurse divided by tow 16 nurse in morning shift, and 24 nurse changed within 6

days after noon night shift .Also the study was carried out AL Ribat university

hospital located in Khartoum state .The Ribat hospital contains on (NICU) which

consist of two room , septic room, with one resuscitation , 2 Cots and aseptic room

with 2 resuscitation, 6 incubators. The total nurses work in NICU were 10 nurses

divided by tow, 4 nurses in morning shift and 6 nurses were changed within afternoon

night shift.

3.3 Study population:

Qualified nurses who were working in neonatal intensive care unit (NICU) at

Omdurman maternity hospital and AL Ribat university hospital during period of

august 2014 to January 2015.

3.4 Sample size:

Total coverage was taken during study period ( Omdurman maternity hospital

were 4o nurse and Ribat university hospital were10nurse).

3.5 Inclusion criteria :

All qualified nurses who were working in neonatal intensive care unit (NICU)

Omdurman maternity hospital and ALribat university hospital .

3.6 Exclusion criteria:

Any nurse working in other department in hospital.

3.7 Ethical consideration:

Official letter from Ribat University was taken to manager of Omdurman

maternity hospital and Ribat university hospital was taken to. for permission to carry

out this research in their hospital ,then The goal of research has been explain to

responder and inform about the right and confidentiality .

3.8 Data collection technique and tool:

Data was collected by questionnaire which, consist of three parts part one

socio-demographic data of nurses, part two about knowledge of premature baby

and part three Observational chick list consist of nurses practice with premature

baby.

3.9 Statistic data analysis:

The data was analysis by computer using spss program.

CHAPTER FOUR

Discussion and Result

4. RESULT

(N=50)

Figure 4 .1: distribution of the nurses according to their

gender

showed that almost 86% of nurses were female.

(N=50)

Figure 4.2: distribution of the nurses according to their age

by years

showed that 60% of nurse’s age between 25-30 years followed by 26%whose age

range from 31-35 years, 5% of nurse’s age between 36-40 and 2% of nurse’s age

more than40 years.

(N=50)

Fig 4.3: distribution of the nurses according to their

education level

showed that 66% of nurses carried bachelor certificate, and 22% of sample were

post graduate level and 12% were diploma level.

(N=50)

Figure 4.4 : distribution of the nurses according to their

years of experience

showed that 34% of nurses have years of experiences 6-10 followed by32% of

nurses have years of experiences 1-5years ,16% more than 10 years and 18% less

than 1year.

Table 4.1 distribution of the nurses according to their

knowledge about premature baby

Items Frequency Percentage

premature baby:

A baby born alive before 37 weeks 46 92

Births of a baby after the developing organs

are mature enough. 4

8

Apnea is :

Opening between two major blood vessels 1 2

a "pause in breathing of longer than 10 to

15 seconds 49 98

Characteristics of premature baby:

Small head relative to rest of body 9 18

labia majora covering labia minora 3 6

Soft flat ears , with little cartilage 38 76

table 4.1 showed that 92% of nurses define premature baby correctly and rest of

sample define premature baby incorrect , 98%of nurses define apnea is correctly too

and rest of sample define opnea incorrect , 76% of nurse know characteristics of

premature baby, and 24%of nurses not know characteristics of premature.

Table 4. 2: distribution of the nurses according to their

knowledge about premature baby

Items Frequency Percentage

common problems of premature

Hypothermia 4 8

Respiratory distress 2 4

All of the above 44 88

Early feeding premature baby prevent to :

Esophageal atresia 4 8

Necrotizing enter colitis 3 6

Dehydration 43 86

Retinopathy of prematurity my lead to :

Blindness 50 100

Causes of heat loss of premature:

He rest in more flexed attitude. 8 16

He has more subcutaneous fat tissue. 3 6

He doesn’t have the stored body fat. 39 78

Premature baby can feed by bottle if :

He stayed in NICU more than 2 weeks 3 6

He was demonstrated co-ordinate sucking and

Swallowing reflex. 45 90

His weight less than 80 gm. 2 4

assessment of premature before the first drink

Determine the presence or absence of umbilical cord

bleeding

21

42

Determine presence or absence of edema. 6 12

Determine the presence or absence of esophageal

atresia 23 46

Contraindications of gavage feeding in premature

Hypoglycemia 1 2

Dehydration 4 8

Intestinal obstruction 45 90

Table 4. 2 showed that 88% of nurses know correct answers regarding to common

problems of premature, 86% answered correct about feeding of premature 100%

know that retinopathy my lead to blindness,78% of nurses know causes that lead to

heat loss, 90% know correct answer about bottle feeding, 46% know the necessary of

assess premature before the first drink and 90% of the nurses know contraindications

of gavage feeding in premature.

Figure 4.5: nursing care of premature in incubator (change

humidifier water daily)

shows that 19 nurses change humidifier water daily and 31 nurses not done.

figure 4.6: nursing care of premature in incubator (care of

baby by introducing hand through portal holes)

showed that all of nurses care of baby by introducing hand through portal holes.

Figure 4.7: nursing care of premature in incubator

shows that all of nurses keep baby in incubator by diaper only.

Figure 4.8 nursing care of premature in incubator

shows that 25of nurses check temperature of newborn every hour and 25 nurses not

check temperature of newborn every hour.

Table 4.3: nursing care of premature with gavage feeding

Items Done Not done

No. % No

.

%

Perform hand washing.

34

68

16

32

Check gavage feeding tube, must be fixed with

adhesive tip.

42

84

8

16

Check the correct position of the tube in the stomach.

47

94

3

6

Aspirate the contents of stomach, before each

feeding.

44

88

6

12

Flow of formula by gravity.

27

54

23

46

table 4.3: showed that 68% of nurses perform hand washing, 84% check gavage

feeding tube for fixed with adhesive tip, 94% check the correct position of the tube in

the stomach, and 88% aspirated stomach contents before each feeding 54% flow

Formula by gravity.

Table 4.4 : nursing care of premature baby under photo

therapy

Items Done Not done

No. % No

.

%

Eyes and genitalia covered while phototherapy in use.

47

94

3

6

Eye patch removal every 4hours.

17

34

33

66

Monitor infant temperature frequently.

49

98

1

2

Fluid balance monitored carefully.

47

94

3

6

table 4.4 : shows that 94% of nurses covered eyes and genitalia while phototherapy ,

66% not remove eye patch every 4hours ,98% monitor infant temperature frequently

and 94% monitor infant Fluid balance carefully .

Table 4.5: nursing care of premature to prevention of

infection

Items Done Not done

No

.

% No

.

%

held separation between infected infant with healthy

infant.

41

82

9

18

wash hands before and after holding the baby

27

54

23

46

each baby has spatial equipment

48

96

2

4

nurses must wear clothing that has been provided.

42

84

8

16

Baby’s skin and the umbilical cord cleaned as well as

possible.

47

94

3

6

table 4.5: shows that 82% of nurses held separation between infected infants and

healthy infants,54% of nurses wash hands before and after holding baby 96% of

nurses use spatial equipment for each baby,84% of nurses wear clothing that has been

provided, and 94% cleaned baby’s skin and the umbilical cord .

figure 4.9: teaching and support of parents

shows that the teaching and support of parents ,47 nurses teaching mother's about

breast feeding .

Figure 4.10 :nurses teaching and help mother's about

kangaroo position

shows that 46 nurses teaching and help mother's about kangaroo position and ,4

nurses not teaching and help mother's about kangaroo position .

Figure 4.11: explain baby condition to the parents to reduce

their anxiety

shows that 41 nurses explain baby condition to the parents to reduce their anxiety.

figure 4.12: teaching mother's about any problem

shows that 39 nurse teaching mother's about any problem should be managed

immediately and 11nurse not do that .

Figure 4.13: explain environmental hygiene , follow-up plan,

immunization to the parents

shows that 40 nurses explain environmental hygiene , follow-up plan, immunization

to the parents.

Discussion

4.2 DISCUSSION

Premature is a live born infant delivered before 37 weeks from the first day of

last menstrual period .It accounts for the largest number of admissions to neonatal

intensive care unit (NICU). Premature infants can develop a range of problems

because their organs are not mature enough.

The study revealed that the majority of 60% of nurse’s age between 25-30

followed by 26% there age range from 31-35 years and almost 86% of nurses were

female. Regarding level of education, was observe that 66% of nurses had bachelor

degree, 22% of sample were post graduate level and 12% were diploma level.

Regarding the years of experiences 34% of nurses between 6-10 years

followed by32% 1-5years ,16% more than 10 years and 18% Less than 1year. The

study showed that there is statistically highly significant relationship between the

years of experiences of nurses and their performance. So more qualified nurses had

many years of experiences and study showed that there is statistically were the post

graduate nurses more skills than undergraduate nurses. The study showed that 46

nurses define premature baby correctly and rest of sample 4 nurse define premature

baby incorrect , 49 nurse define apnea is correctly too and one nurse define opnea

incorrect , 38 nurse know characteristics of premature baby, and 12 nurse not know

characteristics of premature. also 44 nurses know correct answers regarding to

common problems of premature and 6nurse were answered un correct , 43nurse had

well knowledge about the problems of early feeding of premature baby and 7 nurses

not know, 50 nurse know that retinopathy my lead to blindness,39 nurses know causes

of heat loss of premature and 11 nurses not known, 45 nurses know that premature

baby can feed by bottle if he was demonstrated co- ordinate sucking and swallowing

reflex and 5 nurses answered un correct , 23 know the necessary of assessment

premature before the first drink and 27 nurses not known the necessary of assessment

premature before the first drink , 45 nurses know contraindications of gavage feeding

of premature baby and 5 nurse not known contraindications of gavage feeding of

premature baby.

The mean of nurses knowledge of prematur equals to

46+49+38+44+43+50+39+45+23+45= 422/10 equals to 42,2. nursing care premature

in incubator showed that 19 nurses change humidifier water daily, 50 nurses care of

baby by introducing hand through portal holes, 50 nurse keep baby in incubator by

diaper only and 25 nurses check temperature of newborn every hour.so the mean

nurses practice including care premature in incubator .So the mean equals to

19+50+50+25= 144/4=36

Table( 4.3): including nursing care premature with gavage feeding showed that 43

nurses Perform hand washing, 42 nurse check gavage feeding tube for fixed with

adhesive tip, 47nurse check the correct position of the tube in the stomach, 44 nurse

aspirated stomach contents before each feeding and 27 nurse flow formula by gravity.

The mean equals to 43+42+47+44+27 =203/5=40,6

Table( 4.4) :Including nursing care of premature baby under photo therapy showed

that 47 nurses covered eyes and genitalia while phototherapy in use , 17 nurse remove

eye patch 4hours ,49 nurse monitor infant temperature frequently and 47nurse monitor

infant Fluid balance carefully.

The mean equals to 47+17+49+47= 160/4=40. Table( 4.5): Including nursing care of

premature baby to prevention of infection showed that 41 nurses held separation

between infants infected with infants not exposed to infection, 27 nurses wash hands

before and after holding baby 48 nurses use especial equipment for each baby,42

nurses wear clothing that has been provided and 47nurse cleaned baby’s skin and the

umbilical cord.

The mean equals to 41+27+48+42+47= 205/5= 41, teaching and support of parents

showed that 47 nurses teaching mother's about breast feeding,46teaching and help

mother's about kangaroo position,41 nurses explain baby condition to the parents to

reduce their anxiety, 39 nurse teaching mother's about any problem identified should

be managed immediately and 40 nurse explain environmental hygiene , follow-up

plan, immunization should to the parents.

The mean equals to 47+46+41+39+40=213= 42,6. So the mean of nurses knowledge

regarding care of premature baby equals to 42,2 % and the mean of nurses practice

regarding care of premature baby equals to 40,04%, regarding to necessary of

proper care of premature baby.

There was poor both nurses knowledge , nurses practice. So comparing with the

descriptive study done by(MAREIA HUSSAN, 2009) showed that there was poor

nursing care of preterm baby, also this study showed that poor nurses knowledge and

practice regarding care premature baby .

CHAPTER FIVE

- conclusion

- recommendation

- references

Conclusions and Recommendations

5.1 Conclusions:

Based on the study result ,the study showed that percentage of nurses

knowledge regarding care of premature baby equal 42,2.and the percentage of nurses

practice regarding care of premature baby equal 40,04.SO there was poor nurse’s

knowledge and practice regarding care premature baby .

5.2 Recommendations:

Based on the study result ,the study recommended that:

1.Continuous education program for staff development.

2. availability of equipment to improve nurses practice.

3. recruitment of qualified nurse .

References

- Aita,M. & Sinder,L.(2003): The art of developmental care in the NICU: a concept

analysis. Journal of AdvancedNursing, 1(3):223-232.

- Baby Magazine, 2008 http://www.academicjournals.org/SRE .

- Goldenberg RL, Culhane JF, Iams JD, Romero R (2008). "Epidemiology and causes

of preterm birth". The Lancet 371 .

- Gray, L., Watt,L. & Blass, E (2007): Available at

www.pediatrics.org/cgi/content/full/105/1/e14.

- World Health Organization (November 2013). "Preterm birth". who.int. Retrieved

19 September 2014.www.who.int.mider center.

- Kimberly G. Lee, (1998). Shelov, Stephen P.; Hannemann, Robert E., eds. Caring

for Your Baby and Young Child: Birth to Age 5. Illustrations by Wendy Wray and

Alex Gray (Revised ed.). New York, NY: Bantam. ISBN 0-553-37962-3. OCLC 90-

47015.

- Ministry of health of KSA,( 2011) , Available line at

http://www.academicjournals.org/SRE.

- Petrou S, Henderson J,( 2008 )Bracewell M, Hockley C, Wolke D, Marlow N.

Pushing the boundaries of viability: the economic impact of extreme preterm birth.

Early Hum Dev. 2006;82:77–84. [PubMed] 18. Krisanne Larimer,. author of

“Kangarooing Our Little Miracles”,www.marchofdimes.com/prematurity .

- Parul Datta , (2009) , Pediatric nursing 2end edition : jaypee Brothers .

- Royal College of Ophthalmologists (2008),Guideline for the screening and treatment

of retinopathy of prematurity

- Raman Kalia , (2012) , Pediatric nursing procedures 1st edition : jaypee Brothers .

- Stacy &et al, (2010) ,Lippincott Company ,pp. 120-140. Gouchon, S., Gregori, D,

Picotto, A., Patrucco, G.,Nangeroni, M.& Di Giulio.P

- William Sears, M.D, et al, (2004) The March of Dimes: Preemies: The Essential

Guide for Parents of Premature Babies .Medline Plus: Premature Infant

.HealthyChildren.org: Caring For A Premature Baby.The Premature Baby Book.

Appendices

List of figure

Page NO Name of figure NO of

figure

16 distribution of the nurses according to their gender

Fig 4 .1

17 distribution of the nurses according to their age by years

Fig 4.2

18 distribution of the nurses according to their education level

Fig 4.3

20 distribution of the nurses according to their years of experience

Fig 4.4

24 nursing care of premature in incubator (change humidifier water

daily)

Fig 4.5

25 nursing care of premature in incubator(introducing hand throw

portal holles)

Fig 4.6

26 nursing care of premature in incubator ( keep baby in incubator

by diaper only)

Fig 4.7

27 nursing care of premature in incubator(check temp every hour)

Fig 4.8

31 teaching and support of parents

fig4.9

32 nurses teaching and help mother's about kangaroo position

Fig4.10

33 explain baby condition to the parents to reduce their anxiety

Fig 4.11

34 teaching mother's about any problem

fig 4.12

45 explain environmental hygiene , follow-up plan, immunization to

the parents

Fig 4.13

List of Tables

Page NO

Name of table NO of table

21 distribution of the nurses according to their knowledge about

premature baby

table 4.1

22 distribution of the nurses according to their knowledge about

premature baby table 4.2

28 nursing care of premature with gavage feeding

table 4.3

29 nursing care of premature baby under photo therapy

table 4.4

30 nursing care of premature to prevention of infection

table 4.5

Questionnaire About assessment of

Nurses knowledge regarding Care of premature baby

Put cercal arrowed the correct answer:

Sociodemograghic data:

1. Gender

a. male ( ) b. female ( )

2. Age by years:

a. 25 – 30 ( ) b. 31 – 35 ( )

c. 36 - 40 ( ) d. >40yeaes ( )

3. Educational level:

a. diploma degree ( ) b. bachelor degree ( )

c. post graduate ( )

4. Years of Experience:

a. less than 1 ( ) b.1 – 5years ( )

c. 6 – 10years ( ) d. >10years ( )

5. Definition of premature baby is:

a. a baby born alive before 37 weeks of pregnancy.

b. birth of a baby after the developing organs are mature

enough.

6. Definition of apnea is:

a. opening between two major blood vessels .

b. a "pause in breathing of longer than 10 to 15 seconds.

7. Characteristics of premature baby are:

a. small head relative to rest of body

b. labia majora covering labia minora

c. Soft flat ears, with little cartilage.

8. The common problems of premature baby are:

a. Hypothermia

b. Respiratory distress

c. All of the above

9. Early feeding premature baby is better to prevent to:

a. Esophageal atresia.

b. necrotizing enterocolitis.

c. Dehydration

10. Retinopathy of prematurity my lead to:

a. deafness

b. blindness

c. cough

11. Premature baby can lose body heat rapidly because:

a. he rest in more flexed attitude.

b. he has more subcutaneous fat tissue.

c. he don't has the stored body fat.

12. Premature baby can feed by bottle if:

a. he was demonstrated co-ordinate sucking- swallowing reflex .

b. he stayed in NICU more than 2 weeks.

c. his weight less than 80 gm .

13. Assessment of premature before the first drink it is

necessary to:

a. determine presence or absence of edema

b. determine the presence or absence of umbilical cord bleeding

.

c. determine the presence or absence of esophageal atresia

14. Contraindication of cavage feeding in premature is:

a. Hypoglycemia

b. Dehydration.

c. Intestinal obstruction.

Observation check list about assessment of nurse’s practice

regarding care of premature

baby

Not

Done

Done The general care procedures

1- Nursing care premature in incubator:

- change humidifier water daily.

- baby care by introducing hand through portal holes.

- keep baby with diaper only.

- check temperature every hour.

2- Nursing care premature with gavage feeding:

- perform hand washing.

- check gavag feeding tube, must be fixed with adhesive tip.

- check the correct position of the tube in the stomach.

- aspirate stomach contents before each feeding.

- flow of formula by gravity.

3-Nursing care of premature baby under photo therapy:

- the eyes and genitalia should be covered .

- eye patch removal every 4hours.

- monitor infant temperature frequently.

- fluid balance carefully monitored.

4.Nursing care of premature to prevent of infection :

- held separation between infected infants with healthy infant

- wash hands before and after holding the baby.

- each baby has especial equipment

- every officer in the baby ward must wear clothing that has been

provided.

- baby's skin and the umbilical cord clean as well as possible.

5-Teaching and parents support

- teaching mother's about breastfeeding.

- teaching and help mother's about kangaroo position.

- baby condition explained to the parents to reduce their anxiety.

- teaching mother's about any problem identified should be

managed immediately

- explain to the parent’s environmental hygiene, follow-up plan,

immunization.