INTRODUCTION:

A neonate undergoes major physiologic changes during transition from intrauterine to extrauterine period.¹ In most of the babies this transition is smooth; however 5-10% needs some assistance in breathing, while 1% requires extensiveresuscitation^2,3. The percentage saturation of hemoglobin takes about 10 minutes to reach a level of more than 90%. This fact is to be borne in mind while resuscitating a new-born with oxygen to avoid its toxicity. It is still unclear whether the oxygen saturation profile could be affected by racial/ethnic variation, birth weight, sex, APGAR score or maternal factors (age, hemoglobin, type of labour) in term healthy babies.³

Hypoxic-ischemic encephalopathy (HIE) is a type of brain damage caused by limited flow of oxygenated blood. In many cases, HIE is the result of a birth injury; that is, a medical complication or malpractice during or around the time of birth. The terms birth asphyxia* and neonatal encephalopathy* are sometimes used synonymously with HIE, although they do not have completely identical meanings.⁴

The first 28 days of life – the neonatal period – is the most vulnerable time for a child’s survival. Children face the highest risk of dying in their first month of life at an average global rate of 18 deaths per 1,000 live births in 2017. Comparatively, the probability of dying after the first month but before reaching age 1 was 12 and after age 1 but before age 5 was 10. Globally, 2.5 million children died in the first month of life in 2017 alone – approximately 7,000 neonatal deaths every day – most of which occurred in the first week, with about 1 million dying on the first day and close to 1 million dying within the next six days.⁵

Hypoxic Ischemic Encephalopathy carries high case fatality rates ranging between 10–60%, with 25% of survivors have an adverse long-term neurodevelopment outcome. Hypoxic Ischemic Encephalopathy (HIE) is a type of brain damage that occurs when an infant’s brain doesn’t receive enough oxygen and blood. It is a dangerous condition that requires immediate medical intervention. Per the Florida Neonatal Neurologic Network, HIE affects 20 out of every 1000 full term births; the incidence rate in premature babies is 60% of all live births^.6

STATEMENT OF PROBLEM:

“A study to assess the impact of selected maternal parameters on neonatal oxygen saturation levels after birth through pre and post ductal saturation monitoring at Pravara Rural Hospital, Loni (Bk)”

OBJECTIVES:

1 Assess selected maternal parameters of mothers of new-born

2 Observe neonatal oxygen saturation levels through pre and post ductal monitoring afterbirth

3 Co-relate selected maternal parameters with neonatal oxygen saturation levels after birth

MATERIAL AND METHODS:

A cross sectional observational descriptive study was undertaken at Pravara rural hospital, Loni (Bk). A total of 60 new-born were selected with the help of non-probability purposive sampling technique to assess the impact of selected maternal parameters on neonatal oxygen saturation levels after birth through pre and post ductal saturation monitoring at Pravara Rural Hospital, Loni (Bk). The investigator used structured questionnaire and observation checklist to collect the data. The data was analyzed with descriptive and inferential statistics wherever required.

STATISTICAL ANALYSIS:

The data were computerized and verified using the SPSS (statistical package for social science) version 16.0 to perform tabulation and statistical analysis. Qualitative variables were described in frequency and percentages, while quantitative variables were described by mean and standard deviation.

RESULTS:

The result of the data was presented under the following headings:

Section A: Description of socio demographic data of mothers of neonates

a. Socio demographic profile of mothers of neonates

b. Baseline data of neonates

Section B: Description of maternal antenatal status of mothers of neonates

Section C: Description of maternal parameters of mothers of neonates

Section D: Description of neonatal parameters

Section E: Correlation of pre and post ductal monitoring with APGAR scoring

1. Socio demographic profile of mothers of neonates:

Majority of mothers 78% belong to <25 years, followed by 20% were 25-30 years and only 2% belongs to 31-35 yrs. Majority (78%) of mothers had gestational age between 38-42 weeks, and significant percent (18%) had less than 37 weeks and remaining (4%) belongs to >42 weeks. Majority (78%) of mothers belong to primipara and significant percent (36%) belongs to multipara. Distribution of weight of mothers depicts that half (50%) had <50kg, followed by 37% had 51-60kg and 10% had 61-70kg of body weight. Distribution of height of mothers depicts majority 57% from 150-175cm and remaining 43% were from >150cm. Distribution of mothers according to their family shows that majority (70%) were from nuclear family and (28%) were from joint family. Distribution of religion of mothers higher 80% belong to Hindu, 10% belong to Christian, 8% belong to Muslim.

Baseline data of neonates:

Distribution of gender of neonates, majority 72% were baby boy and remaining 38% belong to baby girl. Distribution of weight of neonates, majority 27% belong to >2.5kg, 27% belong to <2.5kg and 6% belong to 2.5kg. Distribution of length of neonates, most 97% had to 48-52cm and remaining 3% belong to <48cm. Distribution of head circumference of neonates higher 95% belong to 33-35cm and remaining 5% belong to <33cm Distribution of chest circumference of neonates majority 88% belong to 30-33cm and remaining 12% belong to <30cm

2. Description of maternal antenatal status of mothers of neonates

1. Distribution of danger signs among mother during pregnancy, (70%) them had abdominal pain, (18%) of them had headache and remaining (12%) them had pedal edema.

2. Distribution of abdominal girth among mother during pregnancy, depicts that higher 95% belongs to 70-80cm and remaining 5% belongs to 81-90cm.

3. Distribution of lie of mothers depicts that higher 98% belonged to longitudinal lie and remaining 2% belonged to transverse lie.

4. Distribution of position of mothers depicts that higher 58% belonged to left occiputo anterior and remaining 42% belonged to right occiputo anterior.

5. Distribution of amniotic fluid index of mothers depicts that higher 83% belonged to 10-15 AFI and remaining 17% belonged to 7-10 AFI.

6. Distribution of placental location of mothers depicts that 62% belonged to anterior, 32% belonged to posterior and 6% belong to marginal.

3. Description of maternal parameters of mothers of neonates:

Distribution of vital signs of mothers i.e. A total of 64% mothers had normal temperature, 23% mothers had hypothermia (<970F) and remaining 13% mothers had hyperthermia (>1000F). Respiration depicts majority 89% mothers had normal respiration pattern (16-22 b/m), 8% mothers had bradypnea (<16 b/m) and remaining 3% mothers had (>22 b/m). Pulse depicts majority 86% mothers had normal heart rate (60-100 b/m), 13% mothers had tachycardia (>60b/m) and remaining 1% mothers had bradycardia (<60b/m). Blood pressure depicts majority 87% mothers had normal blood pressure 120-80mm/Hg, 12% mothers had hypertension >140-90 mm/Hg and remaining 1% mothers had hypotension <90-60mm/Hg.

4. Description of neonatal parameters:

B) Early outcome parameter:

At 01-minute SPO2 monitoring of neonates 43% had normal SPO2, 42% had decreased SPO2 (<60%) and 15% had increased SPO2 (>65%)

At 05 minute of SPO2 monitoring of neonates 58% had normal SPO2, 32% had decreased SPO2 (<80%) and remaining 10% had increased SPO2 (>85%). At 10 minute of SPO2 monitoring of neonates 43% had normal SPO2, 40% had decreased SPO2 (<85%) and remaining 10% had increased SPO2 (>95%)

Suction of neonates depicts majority 87% were suctioned by oral route and remaining 13% were suctioned by nasal route.

Vital parameters of neonates i.e. A total of 45% had normal temperature, 50% had hypothermia (<980F) and remaining 5% had hyperthermia (>1000F). Respiration depicts majority 65% had normal respiration pattern (40-60b/m), 33% had bradypnea (<40b/m) and remaining 3% had (>60b/m). Pulse depicts majority 47% had normal heart rate (120-160b/m) and 53% had tachycardia (<120 b/m).

APGAR scoring of neonates majority 82% neonates APGAR score was normal and remaining 18% neonates AGAR score was 4-6 mild depression.

C) Late outcome parameter:

I) Specific assessment

Distribution of transitional assessment of neonates i.e. Urine majority 78% neonates had normal urine pattern, 18% neonates passed urine after 48hours and 4% neonates not passed urine after 48 hours too. i.e. Stool majority 98% passes stool before 48 hours and remaining 2% neonates not passed stool.

II) Neurological assessment:

Neurological assessment of neonates i.e. reflexes like moros, startle and Babinski reflex present in 100% neonates. i.e. macewens sign was present in 15% and absent in 85%. i.e. Anterior fontanel indicates 15% had bulged fontanelles and 85% were with normal. i.e. Scalp vein indicates 85% neonates was normal and 15% neonates scalp vein was dilated.

Correlation of pre and post ductal monitoring with APGAR scoring

S. N.	Time	r value	Remark
1	01 minute	0.29	Positive weak correlation
2	05 minute	0.58	Positive moderate correlation
3	10 minute	0.15	Positive weak correlation

DISCUSSION:

Description of socio demographic data of mothers of neonates

a) Socio demographic profile of mothers of neonates:

1. Majority of mothers 78% belong to <25 years, followed by 20% were 25-30 years and only 2% belongs to 31-35 yrs. It was consistent with the study conducted by Richard D, Poets CF, Neale S who has also observed the highest percentage 76% of mothers age was <25 years.⁷

2. Majority (78%) of mothers had gestational age between 38-42 weeks, and significant percent (18%) had less than 37 weeks and remaining (4%) belongs to >42 weeks. It was well supported by Thilo EH, Park-Moore B, Berman ER who also observed that (78%) of mothers had gestational age between 38-42 weeks.⁸

3. Majority (78%) of mothers belong to primipara and significant percent (36%) belongs to multipara. It was consistent with study done by Harigopal S, Satish HP, Taktak AFG, that majority (76%) of parity of mothers belong to primipara.⁹

4. Distribution of weight of mothers depicts that half (50%) had <50kg, followed by 37% had 51-60kg and 10% had 61-70kg of body weight. It was in line with Subhedar N, Primhak RA, who also observed that highest percentage (48%) of mothers had <50kg weight.¹⁰

5. Distribution of height of mothers depicts majority 57% from 150-175cm and remaining 43% were from >150cm. It was supported by the values obtained by Morgan that higher in heights of mothers 60% from 150-175cm reported.¹¹

6. Distribution of mothers according to their family shows that majority (70%) were from nuclear family and (28%) were from joint family. It depicts the current family system in India. It was well documented by Saugstad OD, Aune D that highest percentage of mothers 68% were from nuclear family.¹²

7. Distribution of religion of mothers higher 80% belong to hindu, 10% belong to Christian, 8% belong to Muslim. It was supported by Hari Krishna who also observed 78% of the mothers belong Hindu religion.¹³

8. Distribution of socio-economic status of mothers higher 83% belongs to upper middle class, 10% belongs to lower middle class and remaining 7% belongs to upper class. It was supported by Fouzas S, Priftis KN, Anthracopoulos MB, who also observed that 85% of the mother belongs to upper middle class.¹⁴

9. Distribution of education of mother’s majority 62% belongs to secondary, 18% belong to primary, 15% belong to higher secondary. Rabi Y, Yee W, Chen SY, Singhal N also observed that majority 60% of mothers had education up to secondary school.¹⁵

10. Distribution of occupation of mother’s majority 66% belong to home maker, 12% belong to daily wages, 10% belong to private employee and 7% belong to agriculture. Røsvik A, Øymar K, Kvaløy JT, Berget M, also noted in the study that 65% were home maker.¹⁶

11. Distribution of residence of mothers higher 95% belong to rural area and remaining only 5% belong to semi urban area. Ramji, S, Rasaily, R., Mishra, P, Narang, A, Jayam, S Kapoor, A, observed that majority 80% belong to rural area.¹⁷

b. Baseline data of neonates:

1. Distribution of gender of neonates, majority 72% were baby boy and remaining 38% belong to baby girl. Saugstad, O.D, Rootwelt, T, Aalen, O also observed in their study that majority 70% neonates were male.¹⁸

2. Distribution of weight of neonates, majority 27% belong to >2.5kg, 27% belong to <2.5kg and 6% belong to 2.5kg. It was well supported byVento, M, Asensi, M, Sastre, J, Lloret, A, Garcia-Sala, F, Vina, J, who observed that significant percent 30% belongs to >2.5 kg weight.¹⁹

3. Distribution of length of neonates, most 97% had to 48-52cm and remaining 3% belong to <48cm.It was supported by Baldwin HS, Dees E, that 90% of the neonates had height in between 48-52cm.²⁰

4. Distribution of head circumference of neonates higher 95% belong to 33-35cm and remaining 5% belong to <33cm. It was supported by Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J, Hazinski MF, who also observed that 90% of the neonates had height about 33-35cm.²¹

5. Distribution of chest circumference of neonate’s majority 88% belong to 30-33cm and remaining 12% belong to <30cm. It was supported by Perlman JM, Risser R, who also noted that majority 80% neonates had 30-33cm chest circumference²²

6. Distribution of midarm circumference of neonate’s majority 85% belongs to 8-10cm and remaining 15% belong to <8cm. Bancalari E, Claure N, found that majority 80% of the neonates had mid arm circumference belong to 8-10cm.²³

2. Description of maternal antenatal status of mothers of neonates:

1. Distribution of danger signs among mother during pregnancy, (70%) them had abdominal pain, (18%) of them had headache and remaining (12%) them had pedal edema.

2. Distribution of abdominal girth among mother during pregnancy, depicts that higher 95% belongs to 70-80cm and remaining 5% belongs to 81-90cm.

3. Distribution of lie of mothers depicts that higher 98% belonged to longitudinal lie and remaining 2% belonged to transverse lie.

4. Distribution of position of mothers depicts that higher 58% belonged to left occiputo anterior and remaining 42% belonged to right occiputo anterior.

5. Distribution of amniotic fluid index of mothers depicts that higher 83% belonged to 10-15 AFI and remaining 17% belonged to 7-10 AFI.

6. Distribution of placental location of mothers depicts that 62% belonged to anterior, 32% belonged to posterior and 6% belong to marginal.

7. 3.Description of maternal parameters of mothers of neonates

8. Distribution of vital signs of mothers i.e. A total of 64% mothers had normal temperature, 23% mothers had hypothermia (<970F) and remaining 13% mothers had hyperthermia (>1000F). Respiration depicts majority 89% mothers had normal respiration pattern (16-22 b/m), 8% mothers had bradypnea (<16 b/m) and remaining 3% mothers had (>22 b/m). Pulse depicts majority 86% mothers had normal heart rate (60-100 b/m), 13% mothers had tachycardia ( >60 b/m) and remaining 1% mothers had bradycardia (<60 b/m). Blood pressure depicts majority 87% mothers had normal blood pressure 120-80 mm/Hg, 12% mothers had hypertension >140-90 mm/Hg and remaining 1% mothers had hypotension <90-60 mm/Hg. It was well supported by Hamed Said Habib who also observed the mean respiratory rate, heart rate, and mean blood pressure at birth were 18-22 b/m, (80-100 b/m), and 130/70 mm/Hg respectively.²⁴

9. Distribution of duration of labour of mothers depicts majority of 50% mothers had normal labour in primigravida, 45% of mothers had normal labour in multipara and remaining 5% of mothers had lower segment caesarean section. It was supported by Sucheta Tiwari, Soumya Tiwari, Sushma Nangia, Arvind Saili who also observed that 36% mothers had normal labour.²⁴

10. Type of delivery of mothers, majority 93% belonged to Full term normal delivery with episiotomy, 5% belonged to lower segment caesarean section and remaining 2% belonged to normal labour.

11. Distribution of placental weight of mothers depicts majority 88% of mothers belong to 450-550grams and 12% mothers belong to 300-450grams.

12. Distribution of placental abnormality of mothers depicts 100% mothers had no placental abnormality.

13. Distribution of fetal heart rate of mothers depicts majority 98% mothers had normal fetal heart rate and only 2% mothers belong to <140 BPM.

14. Distribution of hemoglobin levels of mother’s total 75% mothers were anemic and remaining 25% mothers had normal hemoglobin level. It was supported by Sucheta Tiwari, Soumya Tiwari, Sushma Nangiaa, Arvind Saili who also observed that 44.2% of the mothers were anaemic and 53% mothers had normal haemoglobin.72

15. Distribution of plasma glucose random of mothers 82% had normal plasma glucose random range, 16% belonged to <74mg/dl and remaining 2% belonged to >140mg/dl.

16. Distribution of cord clamping of mothers among that majority 98% mothers’ cord were clamped at 1-3 minute and remaining 2% mothers’ cord were clamped above 3 minute.

17. Length of cord of mothers majority 92% cord length was normal, 5% mothers cord length belonged to >50cm and remaining 3% mothers cord length belonged to <50cm

18. Abnormalities of mothers 95% had normal cord, 3% cord belonged to true knot and remaining 2% cord belonged to false knot.

4. Description of neonatal parameters:

B) Early outcome parameter:

1. At 01-minute SPO2 monitoring of neonates 43% had normal SPO2, 42% had decreased SPO2 (<60%) and 15% had increased SPO2 (>65%)

2. At 05 minute of SPO2 monitoring of neonates 58% had normal SPO2, 32% had decreased SPO2(<80%) and remaining 10% had increased SPO2(>85%). It was supported by Mariani G, Dik PB, Ezquer A, Aguirre A, Esteban ML, Perez C, Fernandez Jonusas S, Fustiñana C.et al, who also observed that at 5 minutes, the mean pre-ductal SpO2 level was 89%, and the mean post-ductal SpO2 level was 81%.²⁵

3. At 10 minute of SPO2 monitoring of neonates 43% had normal SPO2, 40% had decreased SPO2(<85%) and remaining 10% had increased SPO2(>95%)

4. It was supported by Melissa C Morgan, Beth Maina, Mary Waiyego, Catherine Mutinda, Jalemba Aluvaala, Michuki Maina, Mike English et al who also observed that Mean preductal SpO2 was 93%–94% across all GA and birthweight groups. Mean post ductal SpO2 was 93%–94% for all GA groups, 93% for birth weights ≥2.5 kg and 95% for <2.5 kg.²⁶

5. Cry of neonate’s majority 65% cried immediately after birth, 22% cried after back massage and remaining 13% cried after ticking.

6. Suction of neonates depicts majority 87% were suctioned by oral route and remaining 13% were suctioned by nasal route.

7. Vital parameters of neonates i.e. A total of 45% had normal temperature, 50% had hypothermia (<980F) and remaining 5% had hyperthermia (>1000F). Respiration depicts majority 65% had normal respiration pattern (40-60 b/m), 33% had bradypnea (<40 b/m) and remaining 3% had (>60 b/m). Pulse depicts majority 47% had normal heart rate (120-160 b/m) and 53% had tachycardia (<120 b/m).

8. APGAR scoring of neonates majority 82% neonates APGAR score was normal and remaining 18% neonates AGAR score was 4-6 mild depression. It was supported by Wadah M. Khriesat, Zouhair O. Amarin, Manal Kassab, Mooayad Shkour, Mohammad AL Maghyreh et al who also observed that at 1 min, median (range) 7 (7-8), Apgar at 5 min, median (range) 8 (8-9) and the Apgar at 10 min, median (range) 10 (10-10).75

C) Late outcome parameter:

I) Specific assessment:

Distribution of transitional assessment of neonates i.e. Urine majority 78% neonates had normal urine pattern, 18% neonates passed urine after 48 hours and 4% neonates not passed urine after 48 hours too. i.e. Stool majority 98% passes stool before 48 hours and remaining 2% neonates not passed stool.

II) Neurological assessment:

CONCLUSION:

The major conclusion drawn from this study is that, at 01 minute SPO2 monitoring of neonates 43% had normal SPO2, 42% had decreased SPO2 (<60%) and 15% had increased SPO2 (>65%). At 05 minute of SPO2 monitoring of neonates 58% had normal SPO2, 32% had decreased SPO2(<80%) and remaining 10% had increased SPO2(>85%). At 10 minute of SPO2 monitoring of neonates 43% had normal SPO2, 40% had decreased SPO2(<85%) and remaining 10% had increased SPO2(>95%) For 05 minute the reliability is 0.58 this indicates the correlation between pre and post ductal saturation with APGAR is moderately correlated. For 01 minute the reliability is 0.29 this indicates the correlation between pre and post ductal saturation with APGAR is not correlated. For 10 minute the reliability is 0.15 this indicates the correlation between pre and post ductal saturation with APGAR is not correlated

ACKNOWLEDGEMENT:

The authors are thankful to Dr Vijay L Kelkar, Chancellor and honorable Dr Rajendra Vikhe Patil, Pro chancellor, Pravara Institute of Medical Sciences, Deemed University, Loni (Bk) for providing me an opportunity to undergo this course in PIMS (DU), College of Nursing, Loni (Bk) and grateful to the study participants for providing the necessary information which was required to fulfil the objective.

CONFLICT OF INTEREST:

None.

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Received on 22.09.2020 Modified on 04.01.2021

Int. J. of Advances in Nur. Management. 2021; 9(2):138-144.

DOI: 10.5958/2454-2652.2021.00033.0