Effectiveness of kangaroo mother care (KMC) on level of physiological parameters among preterm infants at selected hospitals, Nagercoil, 2016

INTRODUCTION: Preterm infants are born too earlier in time they reach their full gestational age of 40 weeks, in which the preterm infant’s loss their time, to grow in their mother womb, leads to structural and physiological immaturity. As a consequences preterm infant looking very thin, red, smoothie, wrinkled, fragile skin and weight less appearance because of minimal deposition of subcutaneous fat. Preterm infants are vulnerable to many impediment and complications in the first few weeks of life due to immaturity of the body system. The structural and functional immaturity of neuro behavioral development of the preterm infants results dishevelment of nervous system, physiological function, stress and behavior. The adaptation of postnatal preterm infant’s in their extra uterine life, challenges to maintain the physiological parameters of the body temperature, heart rate, respiration, oxygen saturation, weight in their new environment and higher risk for potential complications. Thus, the preterm infants needs additional energy, stay with warm, support for feeding, free from infection and maintain the stable physiological parameters in their postnatal period of life. There are various measures are used to stabilize the preterm infants like radiant warmer, incubators, mummification, nesting, swaddling and KMC. Kangaroo Mother Care is a non-invasive, cost effective, therapeutic motherly based care and its promotes breast-feeding, maintain thermal stability, promotes physiological and behavioral effects and promotes weight gain, reduce the length of hospital stays also enhance the humanization, and bonding between the mother and the preterm infants. The investigator during her clinical experience identified that preterm infants are unable to maintain the physiological parameters within normal limits. They need assistance and supportive measures to maintain the normal physiological parameters. Many studies focused the effectiveness of KMC with 24 hours, 8hours, 4 hours, 2 hours and 1hour of duration. Due the maternal factors such as stress, anxiety in handling the preterm infants, pain due to birth process, co morbid illness of preterm infant has increased stay in NICU. So that the mothers of preterm infants unable to perform KMC for longer duration. Hence, research investigator wants to minimize time duration, reduce the constraints and assessed the effectiveness of Kangaroo Mother Care for 30 minutes for three consecutive days on level of physiological parameters among preterm infants. OBJECTIVES: 1. To assess and compare the pre and post test level of physiological parameters among preterm infants in study and control group. 2. To assess the effectiveness of KMC on level of physiological parameters among preterm infants. 3. To associate the selected demographic variables with the mean differed score of physiological parameters among preterm infants in study and control group. NULL HYPOTHESES: NH1: There is no significant difference between effectiveness of KMC on level of physiological parameters among preterm infants in study and control group at p<0.05 level. NH2: There is no significant association of selected demographic variables with mean differed score of physiological parameters among preterm infants in study and control group at p < 0.05level. METHODOLOGY: A quasi-experimental pre and posttest control group research design was adopted in order to assess the effectiveness Kangaroo Mother Care on level of physiological parameters among preterm infants. The independent variable of this study was Kangaroo Mother Care. The dependent variables were physiological parameters. The study was conducted in the NICU of Dr. Jayasekaran and Dr. Jayaharan hospitals, Nagercoil. The study population includes preterm infants between 26-36 weeks of gestation admitted in the NICU. The sample size consisted of 60 preterm infants (who fulfills the inclusion and exclusion criteria) selected by non-probability purposive sampling technique. The study included the preterm infants who where hemodynamically stable, birth weight more than 1500 grams and admitted in the NICU. The study excluded mothers of preterm infants who were affected with contagious disease and who was not willing to provide KMC. The tool consisted of two parts i.e., data collection tool and intervention tool. The data collection tool used in this study was structured interview schedule and medical record review for demographic data, WHO guidelines was used to assess the level of physiological parameters of the preterm infants. After preparation of articles, environment, preterm infant and mothers of preterm infants, the investigator wore cap and mask, performed hand hygiene and monitored the physiological parameters such as temperature heart rate, respiratory rate oxygen saturation and weight of the preterm infants was recorded. The investigator assisted the mother to perform KMC with the preterm infants for 30 minutes by placing the preterm infant between the mothers breast, in a perpendicular position such that the head is turned to one side in slightly extended position, flexed and abducted the arms, hip in a frog like position. The investigator placed the preterm abdomen at the level of mother’s epigastrium, asked the mother to hold the preterm infants and then the investigator supported both the mother and the preterm infant by autoclaved cotton sheet for 30 minutes for three consecutive days. After the intervention of KMC preterm infant placed in a comfortable position. The investigator checked and documented the physiological parameters after the procedure for three consecutive days. Preterm infants are allowed to perform their routine activities. RESULTS AND DISCUSSION: The findings of the study revealed that KMC for 30 minutes for three consecutive days among preterm infants between study and control group, there was no significant difference in pretest level physiological parameters among preterm infant between study and control group. The post test mean difference and calculated unpaired ‘t’ value founded after the intervention of KMC along with the hospital routine for physiological parameters such as temperature was 0.93,11.29 & heart rate was 9.96,13.48 & respiratory rate 8.26,14.85 & oxygen saturation 2.63,8.59 and weight was -12.43,-0.18 respectively. The calculated unpaired ‘t’ value shows there was statistically high significant difference in the post test level of physiological parameters among preterm infants between study and control group at p < 0.001 level. Thus, the null hypothesis NH1 stated earlier “There is no significant difference between pre and post test level of physiological parameters among preterm infants between study and control group at P < 0.05 level was rejected”. The study findings were analyzed by using of one way analysis of variance. The One way ANOVA ‘F’ test was used for association. In study group the calculated ‘F’ value indicated there was significant association of physiological parameters of temperature with gestational age, weight, drugs given during the study period, duration of hospital stay and frequency of feeding. The physiological parameters of respiratory rate associated with the variables of occupation of the mothers of preterm infants. The physiological parameters of oxygen saturation associated with the variables of gender and occupation and physiological parameters of weight associated with the variables of drugs given during the study period. In control group, the calculated ‘F’ value indicated there was significant association of the physiological parameters of temperature with the variables of weight, respiratory rate associated with the variables of gestational age, heart rate associated with the variables of drugs given during the study period and oxygen saturation associated with the variables of weight and frequency of feeding. Hence the null hypothesis NH2 stated earlier “There is no significant association of selected demographic variables with the mean differed score of physiological parameters among preterm infants in study and control group at P < 0.05 level” was rejected. CONCLUSION: The findings proved that the KMC for 30 minutes for three consecutive days was effectively improving the physiological parameters among preterm infants. Kangaroo Mother Care also improved the behavioral and psychological wellness of the preterm infants. The health care providers in their practice while caring for the preterm infants in the NICU, postnatal ward and home settings can utilize KMC. Hence, it can be used as a simple, cost effective, motherly based nursing measure for improving the physiological parameters of the preterm infants and it can used as a routine care of preterm infants. IMPLICATIONS: The nurse can adopt KMC as a safe, secure and comfortable daily nursing practice for all stable preterm infants as well as term infants at their clinical areas of practice. The nurse educator can incorporate the major study findings in the nursing curriculum at various levels to develop and well equip the staff nurses in the NICU’s in order to identify and improve the immaturity levels of preterm infants. The findings of the study can be disseminated to the nurses working in various institutions and student nurses through media and also can train their mothers as a part of preterm care to improving the physiological parameters home settings. The nurse administrator should take initiation in organizing CNE, conferences and workshop on various trends of KMC on level of physiological parameters in order to reduce the complication among preterm infants. The nurse researcher can generalize the study results by replicating the study with larger population