Stable Preterm infants can have better Neurobehavioral state after 5 days of AVTK (Audio, Visual, Tactile, Kinesthetic) Stimulation

 

Mrs. G. Kausalya1, G. Maheswari2, B. Rekha3

1M.Sc. Nursing II Year, Dhanvantri College of Nursing, Under the Tamilnadu Dr.MGR Medical university

Namakkal District.

2Professor, Dhanvantri College of Nursing, Under the Tamilnadu Dr.MGR Medical University, Namakkal District.

3Professor, Dhanvantri College of Nursing, Under the Tamilnadu Dr.MGR Medical University, Namakkal District.

*Corresponding Author E-mail: mahipraneeth@gmail.com

 

ABSTRACT:

The immature brain, lungs, gastrointestinal tract and skin of preterm infants are particularly susceptible to injury and abnormal development and function, often leading to long-term neurological and health problems. The present study was aimed to evaluate the effectiveness of AVTK (Audio, Visual, Tactile and Kinesthetic) stimulation on neurobehavioral state among preterm. Quasi experimental - one group pre and posttest with control group design was used in this study. Purposive sampling technique was used for selecting 30 samples. The tools used for the study were demographic, clinical variables and modified Morgan’s Neonatal Neurobehavioral Examination Tool. The intervention was given for the duration of 30 minutes, twice a day for 5 days.  Results showed that there were significant differences between control and experimental group. The unpaired t’ test value showed statistical significance (t= 3.76). In relation to the demographic variable there were no significant association with post test scores in control and experimental group. AVTK was quiet significantly effective in enhancing the neurobehavioral state among preterm.

 

KEYWORDS: Audio, visual, tactile, kinesthetic, preterm, neurobehavioral, preterm.

 

 


INTRODUCTION:

The neonatal period – the first 28 days of life – carries the highest risk of mortality per day than any other period during the childhood. The daily risk of mortality in the first 4 weeks of life is 30 fold higher than the post neonatal period, that is, from 1 month to 59 months of age. India contributes to one fifth of global live births and more than a quarter of neonatal deaths.

 

 

 

Nearly, 0.75 million neonates died in India in 2013, the highest for any country in the world. The current Neonatal Mortality Rate is 28 per 1000 live births (WHO, 2014)

 

Neurobehavioral parameters means having to do with the way the brain affects emotion, behavior and learning. Neurobehavioral parameters in neonates include attention, mobility, response to visual and auditory stimuli, social and environmental adaptation. Neurological behavior includes evidence of alertness, visual interest, following responses to sounds, normal tone and strength in the extremities, normal control of head and neck (White et al., 2010).

 

 

The systematic literature review was organized on supplemental sensory motor stimulation. The impact of systematic sensory motor stimulation had beneficial effect on behavioral organization among preterm infant. Vestibular, tactile and kinesthetic, auditory, and oral stimulation were most effective interventions on behavioral parameters in extra uterine life. Comparing to single sensory motor stimulation, the sequential multimodal treatment model was most effective among preterm infants (Dieter and Emory, 2007).

 

RESEARCH METHODOLOGY:

“Quantitative Evaluative research approach” was selected for the present study. The research design was “Quasi experimental - one group pre and post test with control group design” to assess the effectiveness of AVTK simulation on neurobehavioral state among preterm admitted in NICU, Government Head Quarters Hospital, Erode.

 

In this present study, the independent variable was AVTK stimulation and the dependent variable refers to neurobehavioral state among preterm. The total sample size selected for this was 30 preterm out of which 15 preterm from control group and 15 preterm from experimental group through purposive sampling technique

 

The Inclusion criteria were, the preterm with gestational age 35 weeks and above at birth, both genders, APGAR score above 5 at 5 minutes after birth, who were vitally stable, who were on breast feeding, who were present during the period of data collection, whose parents were willing to participate in the study and the preterm with congenital anomalies, medical and surgical illness including icterus neonatrum, immuno compromised infants were excluded from the study.

 

Implementation of AVTK:

It refers to the combination 4 types of sensory motor stimulation given to preterm newborn admitted in NICU. It consists of auditory stimulation, visual stimulation, tactile stimulation and kinesthetic stimulation as a therapeutic intervention, with the total duration of 30 minutes, twice a day for 5 days.

 

RESULTS:

Frequency and percentage distribution of control group pre test and post test Score of level of Neurobehavioral state among preterm depicts that in pre test most (93)% of them had alert state. However 7% of preterm had dull state and no one had active state. In post test 100 % of them had alert state and no one had dull and active state. It shows that there was significant difference between pretest and post test scores. This difference seems happened due to the progressive development over period when in routine care environment. The experimental group results depicted that, in pre test most (93)% of them had alert state. However 7% of preterm had dull state and no one had active state. In post test only 13 % of them had alert state and 87% of preterm had active state. It shows that there was significant difference between pretest and post test scores. The results depicted that the AVTK was most effective on neurobehavioral state among preterm.

 

Table 1. Paired ‘t’ test value in control and experimental group

                                                                                                       N= 30

Groups

Paired ‘t’

value

Table value

Level of significance

Control group

5.298

2.15

P<0.05 significant

Experimental group

14.87

2.15

P<0.05 significant

 

The paired’ value in experimental group was 14.87, when it compared to table value (2.15) is high. It can be concluded there was significant difference between pretest and post test scores. The results depicted that the AVTK was most effective on neurobehavioral state among preterm

 

Table 2. Unpaired ‘t’ test value pretest and post test scores of control and experimental group.                                                 N=30

Neurobehavioral state of Preterm

Unpaired ‘t’ value

Table value

Level of significant

Pretest

0.11

1.701

P>0.05

Post test

3.76

1.701

P<0.05

 

Unpaired ‘t’ test was calculated to analysis the effectiveness of AVTK on neurobehavioral state among control and experimental group preterm post. The Unpaired ‘t’ test value for pretest was 0.11, when it compared to table value (1.701) is less. It reveals that there was no significant difference in pretest between control group and experimental group, whereas unpaired ‘t’ test values in post test was 3.76, when it compared to table value (1.701) is high. It reveals that there was significant difference in post test scores of neurobehavioral state between control group and experimental group. It depicts that AVTK was most effective in enhancing the neurobehavioral state among preterm

 

DISCUSSION:

An estimated 15 million babies are born too early every year. That is more than 1 in 10 babies. Approximately 1 million children die each year due to complications of preterm birth. Many survivors face a lifetime of disability, including learning disabilities and visual and hearing problems. Globally, prematurity is the leading cause of death in children under the age of 5 years. And in almost all countries with reliable data, preterm birth rates are increasing. Inequalities in survival rates around the world are stark. In low-income settings, half of the babies born at or below 32 weeks (2 months early) die due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. In high-income countries, almost all of these babies survive. Suboptimal use of technology in middle-income settings is causing an increased burden of disability among preterm babies who survive the neonatal period. AVTK is the combination 4 types of sensory motor stimulation given to preterm newborn admitted in NICU. It consists of auditory stimulation, visual stimulation; tactile stimulation and kinesthetic stimulation as a therapeutic intervention, with the total duration of 30 minutes, twice a day for 5 days bring changes in neurobehavioral parameters and weight among newborns which provides an alternative to conventional methods of care. The present study was conducted to assess the effectiveness of AVTK (Auditory, Visual, Tactile and Kinesthetic) simulation on neurobehavioral state among preterm admitted in NICU, Government Head Quarters Hospital, Erode. In control group paired’ value was 5.298, when it compared to table value (2.15) is high. The overall mean percentage of pretest was 52.5% and in post test it was 58.89%, showing a difference of 6.4 %. Whereas in experimental group, the paired’ value was 14.87, when it compared to table value (2.15) is high and pretest scores was 51 % and post test scores was 89.6%, revealing a difference of 38.2 %. The Unpaired’ test value for pretest was 0.11, when it compared to table value (1.701), it is less. The unpaired ‘t’ test values in post test was 3.76, when it compared to table value (1.701), it is high. This study results showed that, the AVTK stimulation was most effective on neurobehavioural state of newborn.

 

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Received on 07.02.2019          Modified on 28.03.2019

Accepted on 21.04.2019     © A&V Publications all right reserved

Int. J. Nur. Edu. and Research. 2019; 7(3):315-317.  

DOI: 10.5958/2454-2660.2019.00071.1