INTRODUCTION:

Pre- term babies are babies born before completion of 37 weeks of gestation (WHO FACTSHEET 2014). About 8-10% of babies in our country are born preterm. These infants are anatomically and functionally immature leading to high neonatal morbidity and mortality. They are more prone to develop impaired sleep pattern, hypothermia, fluctuation of heart rate, hypoxia etc. Premature babies have more difficult settling in to a pattern of waking and sleeping pattern.

Contributing factor for this is, premature babies brains are going through maturation and also disturbed hospital environment .These ultimately leads to poor brain development and behavioral problems in children [1].

Globally preterm birth continues to increase despite advances in modern medicine. In Caucasian infant 7%of live birth, African American that become doubled to 14%. In the world 10% of all the white babies and 20% of all black babies born prematurely (National Vital Statistics Reports 2015)[2].

In India, National center for health statistics shows that preterm birth rate in 2004 was 12.5% that increased to 12.8% in 2006(M KELLY, M. (2006). In India infant mortality rate in low and middle income countries was approximately 88/1000 live birth .of these 28 death occurred in the early neonatal period (National Vital Statistics Reports)[3].

According to WHO neonatal causes of death were infections 34%, asphyxia 28% problems linked with preterm birth 23 % (Mathews, T., F, M., and Thoma, M. (2015).More premature babies survive but serious health problems remain unchanged, survival rate shows in 19995 -40% and 53% in 2006, but the proportion of survivors leaving hospital with major health problems is unchanged. Preterm birth is associated with respiratory complications and lung disease. Problems with bowel function and long term neurological damage etc [4].

Nesting facilitates transformation of sleep pattern from erratic disturbed spells to deep peaceful nights and contented days thus conserving energy and minimizing weight loss (Prasanna, K., and M, Radhika. (2015)). Again the flexed posture reduces the surface area exposed to the environment, minimizing the heat loss which prevents huge weight loss [5].

OBJECTIVES:

Find out the effect of nesting and non nesting on sleep pattern and physiological parameters among premature babies.

OPERATIONAL DEFINITIONS:

Effect:

It means a change produced by an action or cause, a result or an outcome In this study it refers to the extent to which nesting intervention has achieved the desired effect in the sleeping pattern, thermoregulation heart rate, respiratory rate, oxygen saturation and weight as measured by observational checklist and bio-physiological measures.

Nesting:

It means to create and settle in to a warm and secure refuge (American Heritage Dictionary)

In this study it refers to the application of snug and secure boundary or an enclosure using a rolled blanket around the immediate physical environment of the neonate.

Sleep pattern:

It refers to a pattern of sleeping and waking especially a regular pattern of sleeping and waking designed to promote health In this study it refers to a pattern of sleeping and waking, as sleep cycle consist of active sleep, quiet sleep, and indeterminate sleep as measured by observational checklist[6]

Physiological parameters:

In this study physiological parameters refers to the parameters such as body temperature, heart rate, respiratory rate and oxygen saturation.

Thermoregulation:

It refers to the maintenance of constant internal body temperature, independent of environmental temperature (American Heritage Dictionary) in this study it refers to the maintenance of constant internal body temperature of a neonate independent of the environmental temperature during nesting and non nesting as measured by thermal skin probe

Pulse rate:

It refers to the rhythmical throbbing of arteries as blood is propelled along them as felt on the wrist or temples (oxford English dictionary) In this study it refers to rhythmic throbbing of the arteries as blood is propelled along them as measured by pulse oximeter.

Respiratory rate:

It refers to the rate at which air drawn in-to and sent-out of lungs during the process of breathing

In this study it refers to the rate at which air drawn into and sent out of lungs during process of breathing as measured by pulse oximeter

Oxygen saturation:

It refers to the concentration of oxygen in the blood

In this study oxygen saturation refers to the concentration of oxygen in the blood as measured by percutaneous pulse oximeter

Premature neonate:

Premature neonate refers to baby born before completion of 37weeks of gestation [7]

In this study it refers to neonate born before completion of 37 weeks of gestation and weight between 1.25 to1.5 kg.

HYPOTHESES:

H1- There is significant difference in scores of sleep pattern and physiological parameters of premature infants with nesting and non nesting.

CONCEPTUAL FRAMEWORK:

System model of Ludwig Von Bertalanffy (1968)

Assumptions:

1. Nesting may help to improve sleep pattern of premature neonates

2. Nesting may help to maintain normal physiological parameters

3. Care with nesting may help to reduce the incidence of neurological impairment

Delimitations:

The study is delimited to premature neonates with weight between 1.25- 1.5kg

RESEARCH METHODOLOGY:

Research approach: Quantitative approach

Research design: Cross over design

Subject	Treatment schedule
Sub-1	Treatment-A	Treatment -B
Sub-2	Treatment-B	Treatment-A

Population: Premature infants admitted in Neonatal ICU

Sample size: 100

Sampling technique: Simple random sampling will be used for selection of study participants for intervention

Setting: NICU of MOSC Medical College Hospital, Kolenchery

Inclusion criteria:

1. Premature neonates with weight between 1.25kg to1.5 kg

2. Premature neonates admitted in NICU

3. Premature neonates who are not on ventilator and critically ill

Exclusion criteria:

1. Premature neonate with chronic illness

2. Neonates who are unstable

RESEARCH TOOLS AND TECHNIQUES:

Tool 1: Structured questionnaire to collect demographic variables

Tool2: Observational checklist to assess sleeping pattern of premature infants

Tool 3: Pulse oxymeter to assess heart rate, respiratory rate, oxygen saturation

Tool 4: Temperature probe to check temperature

Pilot study:

A pilot study will be conducted in NICU to check feasibility and practicability of the study

Plan for data collection:

After obtaining ethical clearance from IRB of MOSC Hospital and IRB of Saveetha University and consent from the parents of premature neonates. The study subjects will be selected simple random sampling technique. Subjects will be allotted randomly for intervention and then nesting will be done on subject 1 and subject 2 will be kept on usual wrapping method. These babies will be allowed to sleep after feed Sleeping pattern and physiological parameters will be observed during sleep waking period for 3hours between two feeds.

Plan for data analysis:

The data will be analyzed by using descriptive and inferential statistics

Ethical consideration:

Ethical clearance will be obtained from institutional Review board of MOSC Medical College hospital and IRB of Saveetha University, Chennai, India. Informed consent will be obtained from parents of premature babies.

REFERENCES:

1. Bertalanffy, L. (1973). General system theory: Foundations, development, applications (Rev. ed.). New York: G. Braziller.

2. Burns, N., and Grove, S. (2011). Understanding nursing research: Building an evidence-based practice (5th ed.). Maryland Heights, MO: Elsevier/Saunders.

3. Definition of Preterm. (2014, November 1). Retrieved August 4, 2015, from http://www.who.int/mediacentre/factsheets/fs363/en/

4. M Kelly, M. (2006). Preterm birth statistics. Journal of Pediatric Health Care, 20(4), 238-244.

5. Mathews, T., F, M., and Thoma, M. (2015). Infant Mortality Statistics From the 2013 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports, 64(9).

6. Polit, D., and Beck, C. (n.d.). Nursing research: Generating and assessing evidence for nursing practice (Tenth Ed.).

7. Prasanna, K., and M, R. (2015). Effectiveness of nesting on posture and motor performance among new born babies. International Journal of Scientific Research, 46-50.

Received on 29.10.2017 Modified on 19.12.2017

Int. J. of Advances in Nur. Management. 2018; 6(2): 149-151.

DOI: 10.5958/2454-2652.2018.00035.5