Assess the Effectiveness of Increased Breast feeding on Temperature Stability and Hydration among the Newborns with Hyperbilirubinemia Receiving Phototherapy at Pravara Rural Hospital.

Mrs Shelar Sangita¹, Lt. Col. V. Radha², Mr. Vaibhav Bhosale³

¹Pravara, Institute of Medical Sciences (DU), College of Nursing, Loni (Bk), Tal. Rahata, Ahmednagar Dist. Maharashtra

²Principal and Professor, College of Nursing, PIMS, Loni. BK

³Lecturer, College of Nursing, PIMS, Loni.BK

*Corresponding Author E-mail: sangita_bular@yahoo.com

ABSTRACT:

Background: Jaundice is one of the most common disease conditions in newborn babies seeking medical attention. Phototherapy is a choice of treatment from all modalities of the treatments for Jaundice which has side effects such as temperature instability, skin rashes and dehydration. Increased breastfeeding is the best way to minimize these side effects. The present study was carried out with the objective to determine the effectiveness of increased breast feeding on temperature stability and hydration level of newborns with hyperbilirubinemia receiving phototherapy and correlate them. Material and Method: A True experimental study pretest posttest design with control group approach was carried out at Pravara Rural Hospital. Total 60 Newborns with hyperbilirubinemia receiving phototherapy were enrolled in study and control group. The investigator encouraged mothers of newborns in study group to breastfeed newborns 10-12 times in 24hrs. Control group mothers were advice to breastfeed the newborns as per their daily routines. The post test was conducted after termination of phototherapy. The data was analyzed by using the descriptive and inferential statistic and coefficient correlation. Results: It was found that increased breast feeding is significantly improved the hydration level of newborns with hyperbilirubinemia in study group. Paired “t” test was calculated to analyze the difference in temperature stability, hydration between the newborn with hyperbilirubinemia in study and control group. There was relation between increased breastfeeding and various aspects of hydration, skin turgor and oral mucosa with significant statistical difference at 0.05 levels. It interprets that the temperature stability influences the hydration level of the newborns. Conclusion: The study outcome uncovered that increased breastfeeding was effective in improving hydration among the newborns with hyperbilirubinemia. Hence it is recommended that breastfeeding is the cost effective and beneficial way to improve hydration of newborns with hyperbilirubinemia rather than parentral therapy.

KEYWORDS: Increased breastfeeding, temperature stability, hydration, Newborns with hyperbilirubinemia, and phototherapy.

INTRODUCTION:

“A newborn baby has only three demands. They are warmth in the arms of its mother, food from her breast and security in the knowledge of mother’s presence. Breastfeeding satisfies all three.” Jaundice is the most common cause of morbidity in first week of life, occurring in 60% of term and 80% of preterm newborn. Jaundice is the main cause of readmission after discharge from birth hospitalization¹. Neonatal jaundice occurs in 25% to 50% of term newborns, and in a larger proportion of newborns, in the first two weeks of life². However, a few babies will develop very high levels of bilirubin, which can be harmful if not treated³. Neonatal Jaundice is seen within the first three days of birth in 80% of preterm babies and 60% of full-term infants’⁴.

MATERIALS AND METHODS:

True experimental study pretest posttest design with control group was selected for the present study The study subjects were randomly selected. To judge the similarity of two groups pretest or pre-measurement is made in the ‘before’ time period. The independent (Increased Breast feeding every 2 hourly for 15 to 20 minutes) variable was introduced in study group only, after which both the study and control group were measured in the ‘after period’. The study was conducted in pediatric wards of Pravara Rural Hospital, Loni (Bk) Maharashtra. Samples were randomly selected 60 newborns with hyperbilirubinemia for both groups i.e. study (30) and control (30) group.5 Study was approved by the Institutional Ethics/research committee of PIMS (DU), and protocol of the study was explained to the Mothers of Newborns and written informed consent was obtained before enrollment.

The pre-test profile on temperature and hydration level of newborns with hyperbilirubinemia were assessed and recorded accordingly. Increased breast feeding was given to the newborns with hyperbilirubinemia receiving phototherapy for study group. Control group newborns were given breastfeed as per their routine. After the intervention post-test was carried out to know effectiveness of increased breast feeding temperature and hydration level. The collected data were complied, tabulated and analyzed based on objectives/hypotheses with help descriptive by using (mean, SD and mean %) inferential (‘t’ test, co-efficient of correlation) statistical methods

RESULTS:

Profile of newborns with hyperbilirubinemia undergoing phototherapy:

In study and control group the majority (43% and 33% respectively) of Newborns had hyperbilirubinemia after 3 days of child birth which is similar to the physiological jaundice in Newborns. In relation to gender in study group majority (60%) were female babies whereas in control group (63%) was male.

In study group (27%) newborns had birth weight between 2.76 -3.00 kg. While in control group nearly one fourth (23%) of newborns had birth weight 3.1kg and above. In study group higher percentage (43%) and (70%) newborns had height between 47.1-49cms in study and control group respectively .In study group majority (83 %) were had bilirubin level between 5.1-10 mg/dl, However in control group most (93%) had bilirubin level between 10.1- 15 mg/dl.

Section II: Assessment of pretest temperature stability and hydration of newborns receiving phototherapy:

Percentage wise distribution of mean, SD, mean % of pretest temperature and hydration level in newborns show that the mean temperature score (98.5±0.24) which was (99.49 %) in study and control group respectively it indicates that the newborn babies had normal body temperature. In relation to hydration such as ‘baby weight’ shows that in both groups the average babies’ weight (2.6±0.39) which was (75%) of the total score indicates the newborn babies had normal weight range.

In relation to ‘skin Turgor’ study group newborn babies had mean score (1.32±0.24) which was (44%) indicates “some dehydration” whereas in control group the mean was (2.14±0.54 ) which was (71%) indicates “moderate dehydration.”

In relation to hydration area ‘oral mucosa’ the result revealed that both in study and control group the newborn babies (80%) had similar mean score (1.61±0.52) which indicates “wet oral mucosa.” In relation as ‘anterior fontanel’ findings shows that in study group the newborn babies “normal anterior fontanel” whereas in control group the babies had “bulged anterior fontanel”.

Section III: Effectiveness of breast feeding:

Table No –1. Assessment of mean, SD, Mean percentage of post test score of temperature stability and hydration of newborns with hyperbilirubinemia n=60

S N	Areas	Experimental group			Control group			Difference in Mean
S N	Areas	Mean	SD	Mean%	Mean	SD	Mean%
1	Temperature	98.5	0.33	99.09	98.98	0.38	99.17	0.48
2	Hydration
	a. Babies weight	2.71	0.35	77.85	2.65	0.39	75.30	0.06
	b. Skin Turgor	1.00	0.21	31	1.66	0.35	55.33	0.66
	c. Oral mucosa	2.00	0.43	96.56	1.1	0.27	55	0.9
	d. Anterior fontanel	1.86	0.43	62	1.43	0.36	47.66	0.43

The post test analysis shows that in study group majority (90%) of newborns with hyperbilirubinemia had normal body temperature and in control group only (40%) had normal body temperature and the remaining (60%) had body temperature above the normal level (i.e.99ºF and above) and (50%). The result indicates that the increased breast feeding effective in improving the temperature stability of newborns with hyperbilirubinemia receiving phototherapy. Also increased breast feeding was effective to improve skin turgor, oral mucosa, and anterior fontanel in all areas except weight of newborns. It might be related to normal physiological process/ changes in the initial phase of neonatal period.

Distribution of mean, SD, mean % of posttest temperature stability and hydration of newborn with hyperbilirubinemia undergoing phototherapy in study group shows that irrespective of age, gender and weight the newborns had normal temperature and normal hydration such as normal skin turgor, wet oral mucosa and normal anterior fontanel. It shows that the increased breast feeding maintained the temperature stability and enhanced the hydration level of the newborn with hyperbilirubinemia receiving phototherapy.

DISCUSSION:

Higher percentage (27%) had birth weight between 2.76 -3.00 kg in study group, however in control group nearly one fourth (23%) of newborns had birth weight 3.1kg and above respectively. These facts were congruent with the study by Abdullah Kumral, Hasan Ozkan, Nuray Duman, Didem Cemile Yesilirmak, Huray Islekel et al that in study and control group the average birth weight of newborn babies was 3008± 225 and 3168 ± 298 in respectively.⁶

In relation to bilirubin level of newborns with hyperbilirubinemia when phototherapy started, showed that in study group majority (83 %) were had bilirubin level between 5.1-10 mg/dl, However in control group most (93%) had bilirubin level between 10.1- 15 mg/dl. These findings were contradictory to the study by Gulcan H, Tiker F and Kilicdag H that in study and control group the preterm newborn babies had bilirubin level above 18.2 ±2.9 which was far above from the normal range.⁷

The result disclosed that the newborn babies in both group had normal body temperature, while in relation to hydration areas such as weight and oral mucosa were within the normal limits.⁸

The study results also highlights that the newborn babies who received increased breast feeding had mild dehydration while the newborn babies in control group had some dehydration. It shows the role of increased breast feeding in maintaining the hydration status of the newborn babies under phototherapy. This fact was well document in the study by Maisels MJ, Newman TB that the phototherapy increases the dehydration and temperature instability which can be overcome with cost effective method such as increased breastfeeding.⁹

The study results shows that the newborn babies who had increased breastfeeding have wet oral mucosa and normal anterior fontanel whereas the (control group) newborns had dry oral mucosa and depressed anterior fontanel. These findings further add to the evidence that the increased frequency of breast feeding had positive impact in maintaining the hydration level consistently at the normal level. These findings were consistent with a universally accepted fact that the increased breast feeding is the bioactive substances which have influence on the fluid and electrolytes balance there by it helps for maintaining normal hydration such as wet oral mucosa and normal anterior fontanel. Further the study makes clear that the newborns babied under phototherapy they did not have increased breast feeding exhibits the signs of dehydration. Thus it concludes that the increased breastfeeding is mandatory and also recommended for the well-being of newborn.

CONCLUSION:

Neonatal hyperbilirubinemia is one of the common abnormal physiological changes during the first week of life. Phototherapy is the most widely used form of treatment strategy, which may result with side effects such as dehydration, diarrhea, electrolyte imbalance and hyperthermia. Increased breast feeding is the best and cost-effective method to tackle these effects. The study result shows that the increased breastfeeding helps the newborn babies to maintain normal skin turgor, wet oral mucosa and normal anterior fontanel whereas the newborn babies who did not have increased breastfeeding had some dehydration, dry oral mucosa and depressed anterior fontanel. The conclusion drawn from the study was, the increased breastfeeding maintained the temperature stability and enhanced the hydration level of newborns with hyperbilirubinemia receiving phototherapy.

SOURCE OF FUNDING:

Self

CONFLICT OF INTEREST:

Nil

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Received on 31.10.2017 Modified on 10.12.2017

Int. J. Nur. Edu. and Research. 2018; 6(1): 122-125.

DOI: 10.5958/2454-2660.2018.00029.7