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Effect of Nesting on Preterm Infants Admitted in NICU

Article · January 2015

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 Journal of Nursing Science & Practice
ISSN: 2249-4758(online), ISSN: 2348-957X(print)
Volume 5, Issue 2
www.stmjournals.com

A Study to Assess and Evaluate the Effect of Nesting on

Physiological Parameters and Comfort Behavior of
Preterm Infants Admitted in NICU of Selected Hospitals
in Punjab and Haryana
Sandeep Kaur Gill, Yogesh Kumar*,Jyoti Sharin
Department of Nursing, M.M. College of Nursing, M.M. University Mullana-Ambala, Haryana, India

Abstract
Preterm infants are born with physiological handicaps. The sensory impact of the NICU has
been postulated to influence the physiological, neuro-development outcome of preterm infants
and the quality of life of these newborns. A study was conducted with the objectives to assess
and evaluate the physiological parameters (temperature, respiratory rate, heart rate and
oxygen saturation level) of preterm infants before and during ‘nesting’ and to assess and
evaluate the comfort behavior of preterm infants before and during ‘nesting’. Total 30
preterm infants were selected purposively and data was collected using physiological
parameter record sheet and modified comfort behavior scale. Temperature was assessed using
digital thermometer, respiratory rate by counting rise and fall in the chest, pulse oxymeter
was used to assess heart rate and oxygen saturation level. The findings of study revealed that
there was significant effect of ‘nesting’ at 60th and 120th min on temperature
(‘t’(29) = 7.86,11.2), respiratory rate((‘t’(29) = 6.43,5.03 ), heart rate ((t(29) = 6.61,2.47)
and comfort behavior of preterm infants (‘t’(29) = 22.48, 22.03). there was no significant
effect of ‘nesting’ on oxygen saturation level (‘t’ (29) = 0.80,1.08) of preterm infants.

Keywords: preterm infants, nesting, physiological parameters, comfort behavior

*Author for Correspondence E-mail: yogesh.dhakar@gmail.com

INTRODUCTION infants with the objectives to objectives to

Globally 12.9 million preterm are born every
year, representing 9.6% incidence of preterm
births. In India Incidence of preterm births is
estimated to be 11–14% [1].Preterm infants,
may spend months in the NICU, are exposed
to an environment very different from that in
utero. This environment may interfere with the
maturation and organization of preterm
infant’s central nervous system. Short-term
sequelae, such as changes in heart rate,
respiration rate, color, blood pressure and
saturation levels, are specifically related to
physiological instability and/or increased
stress levels. Incorrect body positioning results
in postural deformities, such as hip abduction
and external rotation, ankle eversion, retracted
and abducted shoulders, neck hyperextension
[2]. Developmental supportive Positioning
includes midline orientation, hand-to-mouth
activity and fetal flexor patterns. All these
principles are achieved through ‘nesting’ [3].
The present study was conducted on preterm
assess and evaluate the physiological
parameters (temperature, respiratory rate, heart
rate and oxygen saturation level) of preterm
infants before and during ‘nesting’ and to
assess and evaluate the comfort behavior of
preterm infants before and during ‘nesting.
MATERIALS AND METHODS
The present study was conducted in neonatal
intensive care units of selected hospitals in
Punjab and Haryana as mentioned Chandigarh
Child Care Centre, Kotkapura (Punjab) and
M.M.I.M.S.R&H, Mullana, Ambala
(Haryana). Thirty preterm infants were
selected by purposive sampling. The study was
carried out in the month of December 2010 to
February 2011.physiological parameter record
sheet and modified comfort behavior scale was
used. Physiological parameter record sheet
consist of two sections. Section one to assess
sample characteristics of preterm infants and
their mothers. Section two consists of record

JoNSP (2015) 8-11 © STM Journals 2015. All Rights Reserved Page 8
Effect of Nesting on Preterm Infants Admitted in NICU
sheet to record the physiological parameters
Temperature was monitored through digital
thermometer. Respiratory rate was calculated
through counting of rise and fall in chest
minute for full one minute. Heart rate and
oxygen saturation level was monitored through
pulse oxymeter. The modified comfort
behavior scale was used to assess the comfort
behavior of preterm infants. The validity of the
tool was established by consultation with
experts. In order to calculate interobserver
reliability for assessing physiological
parameters simple kappa formula was used.
The reliability coefficient for temperature,
heart rate and oxygen saturation, K = 1. The
reliability coefficient for respiratory rate was
K = 0.90. The linear weighted kappa formula
was used to calculate reliability coefficient for
modified comfort behavior scale and it came
to be K = 0.82.hence the tool was found to be
reliable. Ethical approval was obtained from
the institutional ethical committee for
conducting the study.
Pilot study was conducted which did not
indicate any major flaws in the feasibility and
design of the study. Final data collection was
done from the month of December 2010-
february 2011. Formal administration
permission was obtained from Director,
Chandigarh Children Child Care Centre,
Kotkapura (Punjab) and Principal,
M.M.I.M.S.R & H, Mullana, Ambala. Written
consent was taken from the parent/guardians
of the preterm infants.
The observations of heart rate, oxygen
saturation level, respiratory rate, comfort
behavior and temperature were made at 1st and
15th min and simultaneously documented.
After that nesting was done and maintained for
180 min for 25 infants and ‘nesting’ was
discontinued after 120th min for five infants on
breast feeding. Observations were again made
at 60th min, 120th min, and 180th min during
‘nesting’ and simultaneously documented for
25 preterm infants. Data was analyzed using
descriptive and inferential statistics.
RESULTS
The maximum numbers of subjects (50.0%)
were in age group of 8–14 days on the first
day of implementation of ‘nesting’. Maximum
number of them (60%) was male. Forty
JoNSP (2015) 8-11 © STM Journals 2015. All Rights Reserved
Sandeep et al.
percent of preterm infants had gestational age
between 34 and 37 weeks and 36.6% had
gestational age between 31–33weeks. Majority
of them (80.0%) had low birth weight between
1500–2499 g. Most of preterm infants (40.0%)
were on orogastric feeding. 86.6% of the
preterm infants were nursed in supine position
with head end elevated under radiant warmer
Findings further revealed that mean
temperature of preterm infants at 60th min
(98.440F) as well as at 120th min during
nesting (98.570 F) were apparently higher than
the mean temperature before nesting (98.110F)
it further showed that ‘t’ values calculated
between the mean temperature before nesting
and at 60th min during ‘nesting’
(‘t’(29) = 7.86) as well as at 120th min
(‘t’(29) = 11.2) were found to be statistically
significant at 0.05 level of significance.
The data also reveal that mean respiratory rate
at 60th min (39.70 breaths/minute) as well as at
120th min during nesting(40.19 breaths/min)
were apparently lower than the mean
respiratory rate before ‘nesting’(42.98
breaths/min). It further shows that the
computed ‘t’ values at 60th min (‘t’(29) = 6.43)
and 120th min during ‘nesting’ (‘t’(29) = 5.03)
were statistically significant at 0.05 level of
significance. Findings further reveal that mean
heart rate at 60th min (141.77 beats/min) as
well as 120th min during ‘nesting’ (143.72
beats/min) was apparently lower than the
mean heart rate before ‘nesting’(145.56
beats/min). Data further showed that the
computed ‘t’ value for heart rate at 60th min
(t(29) = 6.61) and 120th min during ‘nesting’ (t
(29) = 2.47) were statistically significant at
0.05 level of significance.
The data also reveal that mean oxygen
saturation level at 60th min (94.35%) as well as
at 120th min (94.37%) were apparently higher
than mean oxygen saturation level before
‘nesting’ (94.22%). It further showed that
calculated ‘t’ value at 60th min during ‘nesting’
(‘t’(29) = 0.80) and at 120th min during nesting
(‘t’(29)=1.08) were not significant at 0.05
level of significance. Findings further revealed
that there is a difference in temperature of
preterm infants at 180th min during ‘nesting’,
there was no significant difference in
respiratory rate, heart rate and oxygen
saturation level of preterm infants.
Page 9
Journal of Nursing Science & Practice
Volume 5, Issue 2
ISSN: 2249-4758(online), ISSN: 2348-957X(print)
Table 1: Frequency and Percentage Distribution of Subjects by Level of Comfort Behavior Before
and During ‘Nesting’
N Criteria
Highly comfortable (7–11 scores)
Before nesting 30
Moderately comfortable (12–16 scores)
During ‘Nesting’
Highly comfortable
At 60th min 30
Moderately comfortable
Highly comfortable
At 120th min 30
Moderately comfortable
Highly comfortable
At 180th min 25
Moderately comfortable
Not assessed
The data in the Table 1 reveal that before
nesting majority of preterm infants (96.7%)
were moderately comfortable. During nesting
at 60th and 120th min majority of preterm
infants (96.7%) were highly comfortable. At
180th min during nesting, most of preterm
infants i.e. 46.7% were highly comfortable.
The results also reveal that the mean score on
comfort behavior scale at 60th min (08.82) as
well as 120th min during ‘nesting’ (09.36) were
apparently lower than the mean scores on
comfort behavior scale before ‘nesting’
(13.78). It further showed that ‘t’ value
calculated between the mean score on comfort
behavior scale before nesting and 60th min
during ‘nesting’ (‘t’(29) = 22.48) as well as
120th min during ‘nesting’(‘t’(29) = 22.03) was
found to be statistically significant at 0.05
level of significance.
Results also showed that there is no
association between the comfort behavior of
preterm infants during nesting and gestational
age and birth weight.
DISCUSSION
The results of present study showed that
‘nesting’ is effective in significantly raising
and stabilizing the temperature of preterm
infants and nesting is also effective in
lowering and stabilizing the mean respiratory
rate and mean heart rate of preterm infants.
Findings further revealed that the ‘nesting’ has
no significant effect on mean oxygen
saturation level of preterm infants which are
partially consistent with the findings of the
JoNSP (2015) 8-11 © STM Journals 2015. All Rights Reserved
F %
01 03.3
29 96.7
29 96.7
01 03.3
29 96.7
01 03.3
14 46.7
11 36.7
05 16.6
study conducted by Patcharain Yotteim4 which
showed that supine with flexion position
resulted in increased skin temperature and
higher mean oxygen saturation level but no
effect on mean respiratory rate and mean heart
rate of preterm infants.
The findings of the present study indicated that
the comfort level of preterm infants
significantly improved when they lie under
‘nest’. These findings were consistent with the
results of the study conducted by Angie
Henessey, Carin Marre, Piet Becker [5] which
showed that developmentally supportive
positioning significantly decreases premature
infant’s stress level. These findings were also
consistent with the results of the study
conducted by Slevin which also showed that
‘nesting’ helps in reducing discomfort among
preterm infants.
REFERENCES
1. Beck Stacy et al. The worldwide incidence
of preterm birth: a systematic review of
maternal mortality and morbidity. Bulletin
of World Health Organization.2010 Jan;
88(1):1–80p.
2. Symington A, pinelli J. Developmental
care for promoting development and
morbidity in preterm infants. Evidence
based Nursing Journal. 2001; 4:75p.
3. Hennesy Angie, Maree carin, Berker Piet.
The Effect of Developmentally Supportive
Positioning on Preterm Infants stress level.
Journal of Neonatal Nursing 2007; 12(1).
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2004 [cited 2010 Jan]; 7(3): 36–42p. Physiological Parameters and Comfort
5. Angie Hennessy et al. The effect of Behavior of Preterm Infants Admitted
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JoNSP (2015) 8-11 © STM Journals 2015. All Rights Reserved Page 11

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