University of Shendi

Faculty of Postgraduate Studies

and scientific research

Assessment of Nurses Knowledge Regarding

Care of Preterm Babies

A Thesis submitted for Partial fulfillment of the requirement ofMaster

Degree in Pediatric Nursing

By:
Asma Rhamtalla Abdallah

Supervisor:
Dr. Ahlam Mohammed HagIbrahem
Associate professor of pediatric Shendi University

2019

1
 ‫اآلية‬

‫قال تعالـى ‪:‬‬

‫َ ََ ُ‬ ‫ُّ َ ُ‬ ‫ُ‬ ‫له ّوِن تُ َ‬ ‫َ ََ ُ‬ ‫َُ ذ‬
‫اب ث ذه وِن ج ۡطف ٖة ث ذه و ِۡن عنق ٖة ث ذه‬
‫ٖ‬ ‫ر‬ ‫ق‬‫ن‬‫خ‬ ‫ِي‬ ‫ٱَّل‬ ‫" هو‬
‫ذ‬ ‫ُ‬ ‫َ‬ ‫ُۡ ُ ُ ۡ ۡ ا ُ ذ َۡ ُ ُ ْٓ َ ُ ذ ُ ۡ ُ ذ َ ُ ُ ْ ُ ُ ا‬
‫ُيرِجله ِطفٗل ثه ِلِ بنغوا أشدكه ثه ِلِ كونوا شيوخا ۚ ووِنله ون‬
‫َ ۡ ُ َ َ ۡ ُ ُ ٓ ْ َ َ ا ُّ َ اّ َ َ َ ذ ُ ۡ َ ۡ ُ َ‬ ‫ذ‬
‫ُح َت َو َّٰف وِن قبل ُۖوِلِ بنغوا أجٗل وسّم ومعنله تعقِنون ‪" ٦٧‬‬
‫صدق اهلل العظيم‬
‫)‬ ‫سورة غـــــافـــر اآليــــة (‬

‫‪I‬‬
 ‫اإله ـ ـ ـ ـ ـ ــداء‬
‫إىل التى علمتين الصرب والرضى‬

‫أمــــــــــــي‬

‫اىل روح والـــدي العسيس‬

‫إىل روحك الطاهرة اليت ترقد على شآبيب الرمحة واملغفرة علي وعد ان‬

‫نلتقيك يف اعلى عليني مع النبني والصديقني والشوداء والصاحلني بادن اهلل‬

‫إىل روح زوجي ‪:‬‬

‫وليد أمحد شعد حممد عثمان‬

‫إىل إبنيت الصغرية وأملي يف احلياة‬

‫فــــوزيــــة‬

‫إىل من هم شندي وعضدي يف احلياة‬

‫إخــــواني وأخــــواتي‬

‫إىل صديقيت العسيسة‬

‫صفاء شراج الدين‬

‫‪II‬‬
 Acknowledgement
Firstly, with great appreciation I would like to

thank shendi University, faculty of graduate

studies and scientific research and faculty of

nursing science.

I would like to express special thanks to my

supervisor Dr. Ahlam Mohammed Haj Ibrahim, for

her continuous guidance, close supervision and

sustained advice during this study.

Immense gratitude goes to ELmakNimir

University Hospital, for offering me permission

to carry out this study, great thanks to all the

team working in the hospital.

III
 ABSTRACT
Premature is a live born infant delivered before 37 weeks from
the first day of last menstrual period .It accounts for the largest
number of admissions to f (NICU) . Premature infants can develop a
range of problems because their organs are not mature enough. the
proper nursing care of premature baby should be established by good
nursing performances. The descriptive study was aimed to assess
nurse's knowledge about premature baby in f (NICU) at Elmak
Nimir University Hospital at 2016.
Total coverage 50 nurses who were available during study period
in NICU and pediatric word. The study focused mainly on frequent
.Data was collected by questionnaire within statistic data analysis by
computer using spss program. Based on the study result ,the study
showed that percentage of nurses knowledge regarding care of
premature baby equal (53.9%). and the percentage of nurses .the
study show possative relation between the answers and educational
level and years of exeprince .The study recommended that
continuous education program for staff development availability of
equipment to improve nurses practice and recruitment of qualified
nurse .

IV
 ‫ملخص البحث‬
‫الطفل اخلديج ٍو الطفل املولود قبل شبع وثالثني اشبوع مً اول يوو‬
‫الخر دورة حيضية ويعد مً اكرب عدد حاالت دخول العياية املكجفة‬
‫للنواليد‪.‬‬
‫االطفال اخلدج يتعرضوٌ لعدد مً املشاكل وزلك الٌ اعضائَه‬
‫منوءٍا غري كايف ‪.‬‬
‫العياية التنريضية الصخيخة جيب اٌ تتأشض على االداء التنريضي‬
‫اجليد وٍدفت الدراشة الوصفية اىل التكييه املعريف للننرضات وفكا للعياية‬
‫التنريضية للطفل اخلديج يف وحدة العياية املكجفة للنواليد يف مصتشفى‬
‫املك منر اجلامعي بشيدي‬
‫التػطية الكاملة ‪ 05‬ممرضُ مً قصه حديجي الوالدة واالطفال السيً‬
‫وجدو اثياء فرتة الدراشة‪.‬مجعت البياىات بواشطُ االشتبياٌ والتخليل‬
‫االحصائي بواشطُ الكنبيوتر‪ .‬اوضخت الدراشة اٌ متوشط ىصبُ املعرفُ‬
‫عيد املنرضات وفكا لرعاية الطفل اخلديج تصاوي ‪ .0,35‬وخلصت الدراشة‬
‫الي عدو كفاية معرفة املنرضات وفكا للرعايُ التنريضيُ للطفل اخلديج‬
‫‪.‬كنا وجدت عالقة اجيابية بني معرفة املنرضات لرعاية الطفل اخلديج‬
‫واملصتوي التعليني يف عدد مً االجابات واوصت الدراشُ بالربامج التطويريُ‬
‫املصتنرة لالصطاف ‪ ،‬زيادة وتوفري املعدات لتخصني ادائَه ‪ ،‬زيادة تعيني‬
‫املنرضات املؤٍالت ‪.‬‬

‫‪V‬‬
 List of Content
Subject Page No

‫اآلية‬ I
Dedication II
Acknowledgement III
Abstract English IV
Abstract Arabic V
List of Content VI
List of tables VII
List of figures IX
Chapter one
1.1. Introductions 1
1.2. Justifications 3
1.3. Objectives 4
Chapter two
2. Literature review 5
Chapter three
3. Materials and methods 21
Chapter four
4. Results 23
Chapter five
5.1. Discussion 41
5.2. Conclusion 45
5.3. Recommendation 46
References & Appendix
References 47
Questionnaire 50

VI
 List of Table
No of Title of Table Page no
table
1 Age of study group 23
2 Previous work in NICU 25
3 Duration of work in NICU 25
4 Nurses knowledge About Definition of premature baby 26
5 Relationship between Education level * definition of premature 26
baby is
6 Nurses knowledge about Characteristics of premature baby 27
7 Relationship between Education level & Characteristic of 27
premature baby is
8 Nurses knowledge about The commonest problems of premature 28
baby
9 Relationship between Years of experience & Commonest 28
problem of premature baby is
10 Nurses knowledge about Definition of apnea 29
11 Nurses knowledge about causes of apnea 29
12 Relationship between Education level & Causes of apnea 30
13 Nurses knowledge about -management of apnea 30
14 Nurses knowledge about the normal body temperature of 31
premature baby when taken axillary
15 Nurses knowledge about method of heat loss: 31
16 Nurses knowledge about method to maintain body temperatures 32
17 Nurses knowledge about blood glucose level in case of 32
hypoglycimia:
18 Nurses knowledge about Treatment of hypoglycemia 33
19 Assessment of premature before the first drink it is necessary to 33

VII
No of Title of Table Page no
table
20 Nurses knowledge about preferred type of feeding to premature: 34
21 Nurses knowledge about premature baby can feed by bottle if: 34
22 Evidence to preterm cannot tolerate feeding can be 35
23 Relationship between Years of experience & Evidence preterm 35
cannot tolerate oral feeding can be
24 Nurses knowledge about Type of fluids require in first day: 36
25 Nurses knowledge about Type of electrolyte added at 2nd days 36
26 Nurses knowledge about Rote of administration of vit k to 37
premature baby
27 Table Nurses knowledge about quantity administration of 37
vitamin k to preterm
28 Relationship between Education level & Rote of administration 38
of vit k to premature
29 What is the teaching provide to mother before discharge 38
30 Average knowledge of nurses. 39
31 Problems faces the nurse during her work. 40

VIII
 List of Figure

No of Title of Figure Page no

figure
`1 Gender 23
2 Age of study group 24
3 Educational level 24

IX
Chapter One
Introduction
Rationale
Objective

X
 1-1 Introduction
Preterm baby also known as preterm birth is the birth of baby fewer
than 37 weeks of gestation. (1).
Preterm birth is a global problem. It occurs in high, low, and
middle-income countries. About 15 million babies are born preterm each
year; that is more than 1 in 10 babies worldwide. 60% of them are born in
sub-Saharan Africa and South Asia (2)
Prematurity is now the leading cause of death within the first month
of life and the second leading cause of all infant deaths. The etiology of
half of all preterm births is unknown. Preterm births take an enormous
financial toll, estimated to be in the billions of dollars. They also take an
emotional toll on those involved. Changes in perinatal care practices,
including regional care, have reduced newborn mortality rates.
Transporting high-risk pregnant women to a tertiary center for birth
rather than transferring the neonate after birth is associated with a reduction
in neonatal mortality and morbidity. (3)
( Despite increasing survival rates, preterm infants continue to be at
high risk for neurodevelopmental disorders such as cerebral palsy or mental
retardation, intraventricular hemorrhage, congenital anomalies,
neurosensory impairment, behavioral problems, and chronic lung disease.
Making sure that all pregnant women receive quality prenatal care
throughout pregnancy is a major method for preventing preterm births. (3)
Neonatal nurses may work in Level I, II or III nurseries, their duties
differ according to the condition of the infants. Level I nurseries are less
common than they once were, as many babies share a room with their
mothers, they are for healthy newborns who need minimal care such as
feeding, baths or changing diapers. Level II nurseries provide an
intermediate level of care -- babies in these nurseries may need oxygen,
intravenous fluids or specialized feedings. Level III nurseries are for very
1
sick infants. Nurse in these nurseries may manage ventilators, take care of
babies who have had major surgeries or provide other technically complex
care .Each institution establishes practice skills for neonatal nurses, but
most expect the nurse to be able perform math calculations. An infant often
needs a fraction of the dose of medication management of intravenous
lines, cardiopulmonary resuscitation and the use of specialized equipment
such as ventilators and incubators. A neonatal nurse must be technically
proficient with skills such as starting intravenous lines or using feeding
tubes on very tiny infants.(4).
Nursing infants is very different from nursing adults. Infants cannot
communicate verbally when in pain, their bodies respond differently to
medications and treatments and they must be protected from potential
dangers. In addition, the neonatal nurse must educate and support the
infant’s parents, who may be stressed or frightened. A neonatal nurse
should have excellent interpersonal skills, with the ability to establish
rapport and provide compassion and empathy to parents. She must also
understand and be vigilant to prevent harm from risks that specifically
affect newborns, such as temperature changes or excess oxygen .(4)

2
 1-2 Justification

o The prevalence of premature babies exists universally in all

population.
o Low birth weight with high mortality and morbidity, continuous to
be a major public health problem in the world. This serious problem
leads to increase in mortality and morbidity rate among this group of
newborns.
o Nurse's good knowledge and practice regarding care of premature
babies reduces their mortality and improves their outcome.

3
 1-3 Objectives
General objective:
Assessment of nurses' knowledge regarding premature babies in
Elmak Nimer university hospital.

Special objectives:
 To assess nurse knowledge about preterm neonates
 To assess nurses knowledge about major problems of preterm
neonates
 To identify important problems that faces nurses giving care in
NICU in Elmak Nimer university hospital.
 To identify nurses knowledge about mother health education
regarding special care at home.

4
Chapter Two
Literature Review

5
 2.Literaturereview
2.1. Definition and characteristics:
2.1.1. Definition
"Term" refers to the length of pregnancy. "Full-term" is the length of
a complete pregnancy ( 37 to 41 weeks). ―Pre-term‖ means ―before term‖,
that is a pregnancy less than 37 weeks (5).
2.1.2.Characteristics of the preterm newborn:
Compared with the term infant, the preterm infant is tiny, scrawny,
and red. The extremities are thin, with little muscle or subcutaneous fat.
The head and abdomen are disproportionately large, and the skin is thin,
relatively translucent, and usually wrinkled. Veins of the abdomen and
scalp are more visible. Lanugo is plentiful over the extremities, back, and
shoulders. The ears have soft, minimal cartilage and thus are extremely
pliable. The soft bones of the skull tend to flatten on the sides, and the ribs
yield with each labored breath. Testes are undescended in the male; the
labia and clitoris are prominent in the female. The soles of the feet and the
palms of the hands have few creases. Many of the typical newborn reflexes
are weak. (6)
2-2. Etiology and risk factors
The defining physiological mechanism that triggers the onset of
preterm labor is largely unknown but may include deciduas hemorrhage
(abruption), mechanical factors (uterine over distention or cervical
incompetence), hormonal changes (perhaps mediated by fetal or maternal
stress) and bacterial infections (However, a number of risk factors have
been associated with preterm labor (7).

5
2-3: Morbidity and mortality
As a result of high-tech neonatal intensive care, advanced
technology, and improved medications, the morbidity of babies born after
34 to 35 weeks has decreased and the definition of viability has changed
dramatically throughout the past several decades. The limits of viability
keep moving downward in gestation time, and this factor contributes to the
increasing numbers of preterm births. With appropriate medical care,
neonatal survival dramatically improves as gestational age increases, with
more than 50% of neonates surviving at 25 weeks’ gestation, and more than
90% at 28 to 29 weeks’ gestation. Short-term neonatal morbidities
associated with preterm birth are numerous and include respiratory distress
syndrome, intraventricular hemorrhage, periventricular leukemia lacia,
necrotizing enteocolitis, bronchopulmonary dysplasia, sepsis, and patent
ductusarteriosus. Long term morbidities include cerebral palsy, mental
retardation, and retinopathy of prematurity. The risk of these morbidities is
directly related to the infant’s gestational age and birth weight. (7)
2-4. Risk factors associated with preterm labor and birth:
• History of preterm birth, Uterine or cervical anomalie., Multiple
gestation, Hypertension, Diabetes, Obesitym, Clotting disorders, Infection,
especially urinary tract infections, Fetal anomalies, Premature rupture of
membranes.
Vaginal bleeding, especially in the second trimester or in more than one
trimester, Late or no prenatal care. Illicit drug use, Smoking, Alcohol.,
Diethylstilbestrol (DES) expo sure, Domestic violence, Non-Hispanic black
race, Age <17 years or >35 years, Low socioeconomic status., Long
working hours with long periods of standing, Periodontal disease. (8)

6
2-5. Preterm survival
Preterm babies have a better chance of surviving if they are cared for
in a F. If there is a risk that baby may be born early, arrangements may be
made for the mother to be transferred to deliver at a hospital that offers this
specialized care for the mother and baby.
As each baby is unique, the outcomes for each baby will be different.
The outcome for baby will depend on many things such as:
• Age - the number of weeks of the pregnancy.
• Weight at birth.
• Maturity - how far your baby’s body systems have developed.
• Health - whether your baby is sick or has abnormalities.
A few babies are so small, immature or sick that we cannot keep
them alive, despite all the care and treatment that is available. (5).
2-6.Teaching to prevent preterm labor:
• Avoid traveling for long distances in cars, trains, planes, or buses.
• Avoid lifting heavy objects, such as laundry, groceries, or a young child.
• Avoid performing hard, physical work, such as yard work, moving of
furniture, or construction.
• Visit a dentist in early pregnancy to evaluate and treat periodontal disease.
• Enroll in a smoking cessation program if you are unable to quit on your
own.
• Curtail sexual activity until after 37 weeks if experiencing preterm labor
symptoms.
• Consume a well-balanced nutritional diet to gain appropriate weight.
• Avoid the use of substances such as marijuana, cocaine, and heroin.
• Identify factors and areas of stress in your life, and use stress management
techniques to reduce them.
• If you are experiencing intimate partner violence, seek resources to
modify the situation. (9)
7
2-7. Signs and symptoms of preterm labor
• Uterine contractions, cramping, or low back pain
• Feeling of pelvic pressure or fullness
• Increase in vaginal discharge
• Nausea, vomiting, and diarrhea
• Leaking of fluid from vagina.(9)
2-8 Action to be done if it is occurs:
• Stop what you are doing and rest for 1 hour.
• Empty your bladder.
• Lie down on your side.
• Drink two to three glasses of water.
• Feel your abdomen and make note of the hardness of the contraction. Call
your health care provider and describe the contraction as
• Mild if it feels like the tip of the nose
• Moderate if it feels like the tip of the chin
• Strong if it feels like your forehead (9)
2-9 Common health problems:
Preterm babies are not fully developed. They may not be mature
enough to control body temperature, breathe on their own or feed by
sucking. They are at greater risk for health problems such as:
Breathing problems, Temperature problems, Feeding problems, Bleeding
into the brain, Jaundice, Infectio(5)

8
2-9-1 Common short- term complication(health problems)
A-Breathing problems.
A premature baby may have trouble breathing due to an immature
respiratory system. If the baby's lungs lack surfactant — a substance that
allows the lungs to expand — he or she may develop respiratory distress
syndrome because the lungs can't expand and contract normally.
Preemies may also develop chronic lung disease known as
bronchopulmonary dysplasia. In addition, some preemies experience
prolonged pauses in their breathing, known as apnea. ()
-Respiratory Distress Syndrome or RDS:
The part of the brain that controls breathing is not fully developed
until about 36 weeks gestation. This can cause pauses in breathing called
apnea. baby breathing will be closely monitored. Apnea usually goes away
as the baby matures, but some babies need treatment with medication. (9)
- Pneumothorax:
Pneumothorax is condition develops when a small air sac in the lung
ruptures and air escapes from the lung into a space between the lung and
the chest wall. If a large amount of air accumulates, the lungs cannot
expand adequately. The pneumothorax can be drained by inserting a
small needle into the chest. If the pneumothorax re-accumulates after
being drained with a needle, a chest tube can be inserted between the ribs.
The chest tube is connected to a suction device and continuously
removes any air that has accumulated until the small hole in the lung
heals(8).
- Broncho pulmonary dysplasia (BPD):
BPD 1s a chronic lung disease caused by injury to the lungs, it
occurs in about 25 to 30% of babies who are born before 28 weeks and
weigh less than 1.000 grams (2.2 pounds). Broncho pulmonary dysplasia is
most common in very premature babies born between 24 and 26 weeks (10).

9
- Apnea of Prematurity:
Apnea is a "pause in breathing of longer than 10 to 15 seconds, often
associated with bradycardia, cyanosis, or both. It is occurs in almost 100%
of babies who are born before 28 weeks gestation. It is much less common
in older premature babies, especially those born at 34 weeks or later. Apnea
usually does not happen immediately after birth; it occurs more commonly
at one to two days of age and sometimes is not evident until after a baby
has been weaned from a ventilator.(10)
B-Heart problems.
The most common heart problems premature babies experience are
patent ductusarteriosus (PDA) and low blood pressure (hypotension). PDA
is a persistent opening between two major blood vessels. While this heart
defect often closes on its own, left untreated it can cause too much blood to
flow through the heart and cause heart failure as well as other
complications. Low blood pressure may require adjustments in intravenous
fluids, medicines and sometimes blood transfusions (11).
C-Brain problems.
The earlier a baby is born, the greater the risk of bleeding in the
brain, known as an intraventricular hemorrhage. Most hemorrhages are
mild and resolve with little short-term impact. But some babies may have
larger brain bleeding which causes permanent brain injury (9).
Larger brain bleeds may lead to fluid accumulation in the brain
(hydrocephalus) over a number of weeks. Some babies who develop
hydrocephalus will require an operation to relieve the fluid accumulatio n.
(11)
D-Temperature control problems.
Premature babies can lose body heat rapidly; they don't have the
stored body fat of a full-term infant and they can't generate enough heat to

10
counteract what's lost through the surface of their bodies. If body
temperature dips too low, hypothermia can result.
Hypothermia in a preemie can lead to breathing problems and low
blood sugar levels. In addition, a preemie may use up all of the energy
gained from feedings just to stay warm, not to grow bigger. That's why
smaller preemies require additional heat from a warmer or an incubator
until they're larger and able to maintain body temperature without assista nce
(11).
Preterm babies have difficulty controlling their body temperature. The
part of the brain that controls body temperature is not fully developed and
these babies have very little body fat to keep them warm. As a result,
preterm babies can lose heat very quickly and it takes a long time to warm
them up again (5)
E-Gastrointestinal problems.
Preemies are more likely to have immature gastrointestinal systems,
leaving them predisposed to complications such as necrotizing enter colitis
(NEC). This potentially serious condition, in which the cells lining the
bowel wall are injured, can occur in premature babies after they start
feeding. Premature babies who receive only breast milk have a much lower
risk of developing NEC. (12)
F-Blood problems.
Preemies are at risk of blood problems such as anemia and infant
jaundice. Anemia is a common condition in which the body doesn't have
enough red blood cells. While all newborns experience a slow drop in red
blood cell count during the first months of life, the decrease may be greater
in preemies, especially if your baby has a lot of blood taken for lab tests.
Infant jaundice is a yellow discoloration in a newborn baby's skin and eyes
that occurs because the baby's blood contains an excess of a yellow-colored
pigment from the liver or red blood cells (bilirubin) (12).

11
G-Metabolism problems.
Premature babies often have problems with their metabolism. Some
preemies may develop an abnormally low level of blood sugar
(hypoglycemia). This can happen because preemies typically have smaller
stores of glycogen (stored glucose) than do full-term babies and because
preemies' immature livers have trouble converting stored glycogen into
glucose.(12)
H-Immune system problems.
An underdeveloped immune system, common in premature babies,
can lead to infection. Infection in a premature baby can quickly spread to
the bloodstream causing sepsis, a life-threatening complication. (12)
2-9-2 Long-term complications:
In the long term, premature birth may have thesecomplications:
A-Cerebral palsy. Cerebral palsy is a disorder of movement, muscle tone
or posture that can be caused by infection, inadequate blood flow or injury
to a preemie's developing brain either during pregnancy or while the baby
is still young and immature(1).
B-Impaired cognitive skills. Premature babies are more likely to lag
behind their full-term counterparts on various developmental milestones.
Upon school age, a child who was born prematurely might be more likely
to have learning disabilities.(12)
C-Vision problems. Premature infants may develop retinopathy of
prematurity, a disease that occurs when blood vessels swell and overgrow
in the light-sensitive layer of nerves at the back of the eye (retina).
Sometimes the abnormal retinal vessels gradually scar the retina, pulling it
out of position. When the retina is pulled away from the back of the eye, it's
called retinal detachment, a condition that, if undetected, can impair vision
and cause blindness (12)

12
D- Retinopathy of prematurity (ROP):
Retinopathy of prematurity is damage to the retina, perhaps caused by
an imbalance in the blood’s oxygen level or extreme prematurity, it
can treat by examination a pediatric ophthalmologist. If progression of
ROP is observed, surgery by a pediatric ophthalmologist may be required
to prevent blindness. (12)
E-Hearing problems. Premature babies are at increased risk of some
degree of hearing loss. All babies will have their hearings checked before
going home.(7)
F-Dental problems. Preemies who have been critically ill are at increased
risk of developing dental problems, such as delayed tooth eruption, tooth
discoloration and improperly aligned teeth. (12).
G-Behavioral and psychological problems. Children who experienced
premature birth may be more likely than full-term infants to have certain
behavioral or psychological problems, such as attention- deficit/
hyperactivity disorder (ADHD). However, more recent research suggests
that — at least for late preterm babies — the risk of ADHD may be the
same as it is for children who were born at full term. (12)
H-Chronic health issues. Premature babies are more likely to have chronic
health issues — some of which may require hospital care — than are full-
term infants. Infections, asthma and feeding problems are more likely to
develop or persist. Premature infants are also at increased risk of sudden
infant death syndrome (12)
I-Feeding problems:
Babies born before 30 weeks gestation need help with feeding. They
are not mature enough to suck and swallow well or may not tolerate
breastmilk or formula.
 Depending on their age and condition, there are many ways to help
preterm babies get the nutrition they need such as:

13
  giving nutrition through a vein in a special intravenous solution
called total parenteral nutrition
 feeding breast milk or formula through a soft plastic tube put through
the baby’s nose into the stomach, called gavage feeding
 adding extra vitamins and minerals
 giving a special formula made for preterm babies, if breast milk
 is not available
 As preterm babies mature and their condition improves, they can try
breastfeeding around 32 to 33 weeks gestation. (5)
J-Jaundice:
Preterm babies have a greater chance of getting jaundice. Jaundice is a
buildup of bilirubin in the bloodstream. Bilirubin is formed as red blood
cells break down. As the baby's body breaks down red blood cells that are
no longer needed, the bilirubin is released into the blood. The bilirubin
must be removed from the blood by the liver. If there is a lot of bilirubin in
the blood, or the baby's liver is not mature enough to remove the bilirubin,
the baby becomes jaundiced. If the bilirubin level becomes very high, it can
damage the baby’s brain.
 To tell if there is jaundice, the amount of bilirubin is measured in a
small sample of blood. Jaundice can be seen by a yellow color of the
baby's skin and the white part of the eyes.
 Sometimes jaundice gets better without any treatment. However, if
the bilirubin level gets too high, the baby may need phototherapy.
This treatment involves shining a special set of lights on the baby's
skin while protecting the baby’s eyes. The lights help to break down
the bilirubin. (5)

14
K-Infections:
The immune system, which is needed to fight against infections, is
not fully developed in preterm babies. Therefore, the babies can get
infections easily. Preterm babies may develop one or more infections while
in the Neonatal Nursery. Most of these infections respond to treatment with
antibiotics. Occasionally the infection is so serious that the baby may not
survive. (5)
2-10 Special care of premature:
2.10.1.Thermal care:
Simple methods to maintain a baby’s temperature after birth include
drying and wrapping, increased environmental temperature, covering the
baby’s head (e.g., with a knitted cap), skin-to-skin contact with the mother
and covering both with a blanket (McCall et al., 2005) (WHO, 1997a).
Delaying the first bath is promoted, but there is a lack of evidence as to
how long to delay, especially if the bath can be warm and in a warm room.
Kangaroo Mother Care (KMC) has proven mortality effect for babies
<2,000g techniques include warming pads or warm cots, radiant heaters or
incubators and these also require additional nursing skills and careful
monitoring .
Sleeping bags lack evidence for comparison with skin to- skin care
or of large-scale implementation. There are several trials suggesting benefit
for plastic wrappings but, to date, these have been tested only for extremely
(13)
premature babies
2.10.2.Feeding support:
Breast milk is the best food for premature babies. The composition
of breast milk produced by mothers who give birth prematurely is
different from the composition of breast milk produced by mothers who
gave birth at term and this difference lasted for about 4weeks. Often there
is a failure of breastfeeding in mothers who gave birth prematurely. This is
15
caused by maternal stress, no guilt, lack of confidence, not knowing
expressing milk in premature babies sucking and swallowing reflex does
not exist or less, to suck less energy, less gastric volume, frequent reflux,
slow peristalsis. the nurses has important role in teach red mother who gave
birth prematurely can successfully .In premature infants, reflexes suck,
swallow and cough is not perfect, the capacity of the stomach is still
small, the power of digestive enzymes, especially lipase still lacking
besides protein needs 3-5 grams / day and high-calorie (110 cal / kg /
day), so that the weight bodies as well as possible increases. This
amount is higher than the required term infants.
Provision of drinking starts when the baby was 3 hours so the baby
does not suffer from hypoglycemia and hyperbilirubinemia. Before
administering the first drink to be done imbibing gastric fluid. It is
necessary to determine the presence or absence of esophageal atresia and
prevents vomiting. Inhalation of gastric fluid was also performed
prior to each subsequent drink. In general, infants with a birth weight of
2000 grams or more can breastfeed. Infants with birth weight less than
1500 grams less able to suck milk or milk bottles. The amount of fluid
administered for the first time is 1-5 ml / h and the amount can be added bit
by bit every 12 hours. The amount of fluid given was 60 mg kg / day, and
every day was increased to 200mg / kg / day at the end of the second week
(13)
.
2.10.3. Infection prevention:
Clean birth practices reduce maternal and neonatal mortality and
morbidity from infection-related causes, including tetanus (Premature
babies have a higher risk of bacterial sepsis. Hand cleansing is especially
critical in neonatal care units. However basic hygienic practices such as
hand washing and maintaining a clean environment are well known but
poorly done. Unnecessary separa3ion from the mother or sharing of
16
incubators should be have avoided as these practices increase spread of
infections.
For the poorest families giving birth at home, the use of clean birth kits and
improved practices have been shown to reduce mortality. (13).

2.10.4.Kangaroo mother care:

KMC was developed in the 1970s by a Colombian pediatrician,
Edgar Rey, who sought a solution to incubator shortages, high infection
rates and abandonment among preterm births in his hospital
The premature baby is put in early, prolonged and continuous direct
skin-to-skin contact with her mother or another family member to provide
stable warmth and to encourage frequent and exclusive breastfeeding. A
systematic review and metaanalysis of several randomized control trials
found that KMC is associated with a 51% reduction in neonatal mortality
for stable babies weighing <2,000g if started in the first week, compared to
incubator care. (13)
2.10.5. Neonatal resuscitation:
Between 5 to 10% of all newborns and a greater percentage of
premature babies require assistance to begin breathing at birth (Wall et al.,
2009). Basic resuscitation through use of a bag-and-mask or mouth-to-
mask (tube and mask) will save four out of every five babies who need
resuscitation; more complex procedures, such as endotracheal intubation,
are required only for a minority of babies who do not breathe at birth and
who are also likely to need ongoing ventilation. Recent randomized control
trials support the fact that in most cases assisted ventilation with room air is
equivalent to using oxygen, and unnecessary oxygen has additional risks
(Saugstad et al., 2006). Expert opinion suggests that basic resuscitation for
preterm births reduces preterm mortality by about 10% in addition to
immediate assessment and stimulation (Lee et al., 2011). An education
program entitled Helping Babies Breathe has been developed by the
17
American Academy of Pediatrics and partners for promotion of basic
neonatal resuscitation at lower levels of the health system in low-resource
settings and is currently being scaled up in over 30 low-income countries
and promises potential improvements for premature babies. (13)
2.10.6. Care of babies with jaundice:
Premature babies are at increased risk of jaundice as well as
infection, and these may occur together compounding risks for death and
disability (Mwaniki et al., 2012). Since severe jaundice often peaks around
day 3, the baby may be at home by then. Implementation of a systematic
pre discharge check of women and their babies would be an opportunity to
prevent complications or increase care seeking, advising mothers on
common problems, basic home care and when to refer their baby to a
professional.
Babies with Respiratory distress Syndrome for premature babies
with RDS, methods for administering oxygen include nasal prongs, or nasal
catheters. Safe oxygen management is crucial and any baby on continuous
oxygen therapy should be monitored with a pulse oximeter .
The basis of neonatal care of very premature babies since the 1990s
was assisted ventilation. However, reducing severity of RDS due to greater
use of antenatal corticosteroids and increasing concerns about lung damage
prompted a shift to less intensive respiratory support, notably CPAP
commonly using nasal prongs to deliver pressurized, humidified, warmed
gas (air and/or oxygen) to reduce lung and alveoli collapse.
This model of lower intensity may be feasible for wider use in
middle-income countries and for some low-income countries that have
referral settings with stronger systems support such as high-staffing, 24-
hour laboratories. (13)

18
2-11. Nursing care of premature baby:
2-11-1Nursing care of premature in incubator:
1. Change humidifier water daily with distilled water.
2. Keep infant in incubator after pre worming incubator for 15
minutes.
3. Don’t place any clothes on baby except diaper.
4. Check temperature of newborn every hour.
5. Give care for baby by introducing hand through portal holes.
6. Do not drag ,move and pull incubator when baby in side. (14).
2-11-2 Nursing care of premature with gastric lavage:
1. Perform hand washing.
2. Measure the tube placing from tip of the nose to ear lobe & then up
to xiphoid.
3. Lubricate the tube with little lubrication jelly.
4. Check the correct position of the tube in the stomach.
5. Withdraw injection air from the stomach and aspirated the gastric
content.
6. Fix the tube with adhesive tip.
7. Waste material dispose as per hospital policy. (14)
2-11-3 Nursing care of premature baby under photo therapy:
1. Check the lights of phototherapy unit before use and place it in
proper place no loose electrical connection should be there.
2. Clean the glass surface of phototherapy unit.
3. The eyes and genitalia should be covered while phototherapy is in
use.
4. Eye patch should be removing 4hours.
5. Eye shield should not be tight or too loose.
6. Monitor infant temperature frequently.
(14)
7. Fluid balance must be carefully monitored.
19
2-11-4 Nursing care of premature for prevention of infection:
1. Held separation between infants infected with infants not
exposed to infection.
2. Wash hands before and after holding the baby.
3. Cleaning the crib as soon as no longer in use (maximum of a baby
wearing a bed for 1 week and then cleaned with an antiseptic
solution).
4. Cleaning the room at certain times.
5. Each baby has his own equipment.
6. Every officer in the baby ward must wear clothing that has been
provided.
7. Officers who have a communicable disease are prohibited caring for
the baby.
8. Baby's skin and the umbilical cord should be cleaned as well as
possible.
9. The visitors can only see the baby from behind the glass. (14).
2-11-5 Parents teaching and support:
1. Teaching mother’s about breastfeeding.
2. Teaching and help mother’s about kangaroo position.
3. Condition explained to the parents to reduce their anxiety.
4. Explain environmental hygiene ,follow-up plan and immunization.
(15)
5. Teaching mother's about any problem.

20
Chapter Three
Material and Method

21
 3. Materials and Methods

3.1. Study design:

This is a descriptive hospital based study.
3.2.Study area and sitting:
The study was conducted in Elmek Nimer university hospital in
Shendi. Shendi is located in the north of Sudan, about 173km to the north
of the Khartoum. The town is considered as center of Gaalein tribe as well
as other tribes like Shygia, Hssania, and others.
The major professions are farming, trading, working in factories and
craft .there are several general centers for different service also there is
Shendi university with it is different faculties (faculty of medicine and
health sciences, education, arts, economics, low social development and
faculty of sciences and technology. Shendi has 3hospitals,Shendi teaching
hospital, El-mak Nimer university hospital and military hospital.
All of them have different departments which provide good services
for town population, there are also many health centers.
NICU in elmak nimer consist of one room it consist of
2incubatersand 10 beds and one hiter and 6phototherapy.the staff consist of
15nurses through 2 months in the morning and afternoon night shift .
Pediatric ward consist of 4 words :gastrointestinal word and general
ward ,respiratory word, neonatal word and the staff consist of 30 nurse
through 2month morning and afternoon night shift
3.3. Study population:
Qualified nurses who were working in Elmak Nimer university hospital in
NICU and pediatric ward
3.4 .Sample size:
Total coverage of 50 nurses working in Elmak Nimer Hospital. In nursery and
pediatric word

21
3.5. Inclusion criteria:
- Qualified nurses
- Nurses working in Elmak Nimer Hospital in nursery and pediatric word
3-6 Exclusion criteria:
-Refusal of nurses
3-7 Data collection tool:
Data was collected by questionnaire which, consist of two parts:
 part one: socio-demographic data of nurses:
(genderage educational level-years of experiences- duration of work in NIC
 part two : nurses knowledge of premature baby:
Knowledge of nurses(definition of preterm and characters-common
problem –apnea –hypothermia-hypoglycemia -feeding of preterm –and
knowledge about vit k …etc)
3.8. Data collection technique:
The researcher provided questionnaire to the nurses included in
the study and waiting them until filling it. Each nurse was given enough
time for completing the questionnaire.
3-9. Data analysis and presentation:
The data has been analyzed by using computer software by SPSS
program. The results were presented in form of tables and figure.Chi 2test
was used for 95% confidence level of significance
3-10.Ethical consideration:
Official letter from faculty of post graduate studies was taken to
manager of Elmak Nimir university hospital and was taken to permission to
carry out this research in their hospital ,then The goal of research has been
explain to responder and inform about the right and confidentiality .

22
Chapter Four
Results

23
 4. Results
4.1. Socio demographic Data

Figure 1: Gender
The study showed that the majority (96%) of study sample were females
and just (4% ) were males

Table 1: Age of study groups:

Age Frequency Percent %
20-30 years 38 76
31-35years 7 14
36-40 years 5 10
More than 40 years 0 0
Total 50 100%

Table 1 showed the majority of studied group (76%) their age between
(20-30) years and no one has age more than 40 years

23
Figure 2 : Educational level

It was shown that (82%) their academic qualification was bachelor degree
and 18% was post graduate.

Figure 3: Years of experience

Figure 3 Clarified that more than half 60% had experience between (1-5)
years and 8% more than 10 years.

24
Table 2: Previous work in NICU:
Previous work Frequency Percent %
Yes 27 54
No 23 46
Total 50 100%

Table 2 showed that 27nurses (54%) previously worked in NICU and

23nurses 46%not previously worked in NICU.

Table 3 : Duration of work in NICU:

Years Frequency Percent %
Less than 1 year 21 77.8
1-3 years 3 11
4-7 years 2 7
7-10 years 1 4
More than 10 years 0 0
Total 27 100%

Table 3 showed that about three quarters of them (77.8 %) worked for less
than one year and no one worked more than ten years

25
4- Nurses knowledge:
Table 4: Nurses knowledge about definition of premature baby
Definition Frequency Percent %
Baby born alive before 37 weeks of 32 64
pregnancy.
Births of a baby after the developing organs 0 0
are mature enough.
Baby born before 34 weeks 15 30
Baby not complete develop 3 6
Total 50 100%

Table 4 clarified that (64%) define premature baby correctly and 6% of

nurses she said baby not complete developed.

Table 5 :Relation between Educational level and definition of

premature baby

Definition of premature baby

Baby born Baby born Baby not
Educational level before 37 before 34 complete Total
week of week of developmen
pregnancy pregnancy t
No F No F No F No F
Bachelor degree 27 54% 12 24% 2 4% 41 82%

Post graduate 5 10% 3 6% 1 2% 9 18%

Total 32 64% 15 30% 3 6% 50 100%

P.V = 0.026

26
Table 6: Nurses knowledge about characteristics of premature baby
Character of preterm Frequency Percent %
Labia majora not covered labia minora 5 10
Soft flat ears with little cartilage 2 4
Small scorotum and few felled 1 2
Excessive of lanugo hair 4 8
All the above 38 76
Total 50 100%

Table 6 showed (76%) of nurses were knowledgeable about character of

premature baby and 2% she said baby small scrotum and few felled

Table 7:Relations between educational level & characteristic of preterm

baby
Characteristic of premature baby is
Educational level true false Total
No F No F No F
Bachelor degree 30 60% 11 22% 41 82%
Post graduate 8 16% 1 2% 9 18%
Total 38 76% 12 24% 50 100%

P.V= 0.073

27
Table 8: Nurses knowledge about the commonest problems of
premature baby

Commonest Problem Frequency Percent %

Hypothermia 5 10
Respiratory distress 10 20
Jaundice 4 8
Anemia 6 12
infection 5 10
All above 20 40
Total 50 100%

The study showed that (10%) of nurses belief that the commonest problem
is hypothermia and just (40%) respond correctly
Table 9: Relation between years of experience &commonest problem
of preterm baby
Commonest problem of
Years of premature baby is Total
Experience Correct Incorrect
No F No F No F
>1 years 2 4% 6 12% 8 16%
1-5 years 13 26% 17 34% 30 60%
6-10 years 2 4% 6 12% 8 16%
More than 2 4% 2 4% 4 8%
10 years
Total 19 38% 31 62% 50 100%

P.V =0 .034

28
Table 10: Nurses knowledge about definition of apnea
Knowledge about definition Frequency Percent %
Irregular breathing 11 22
pause in breathing more than 30 sec 21 42
pause in breathing of longer than 5 sec 11 22
Pause in breathing of longer than 10 to 15 7 14
seconds.
Total 50 100%

Only (14%) know definition of apnea( pause of breathing of longer than

10-15 second )and 42% of nurses responded by pause in breathing longer
than 5sec.
Table 11: Nurses knowledge about causes of apnea
Causes of apnea Frequency Percent %
Hypoxemia 8 16
Infection 3 6
Anemia 1 2
Immature respiratory system 10 20
All the above 28 56
Total 50 100%

The study showed that more than half (56%) of sample know causes of
apnea and 20% responded by immature respiratory system.

29
Table 12: Relation between educational level & causes of apnea
Causes of apnea Total
Educational level True False
No F No F No F
Bachelor degree 12 42% 20 40% 41 82%
Post graduate 7 14% 2 4% 9 18%
Total 28 56% 22 44% 50 100%

P.V = 0.09

Table 13: Nurses knowledge about - management of apnea

Apnea management Frequency Percent %
Neonatal resuscitation 2 4
Nasal Oxygen mask 5 10
CPAP Ventilation 0 0
All the above 43 86
Total 50 100%

In this table (86%) of nurse answered correctly about management of apnea

(all the above) and 4% she choosed neonatal resuscitation

30
Table 14: Nurses knowledge about the normal body temperature of
premature baby when taken axillary

Normal body temperature Frequency Percent %

36.5 – 37.5cْ 17 34

35.5 – 36 cْ 20 40

36.5 – 37 cْ 5 10

34.5 – 35 cْ 8 16

Total 50 100%

In This table clarified that (34%) of nurses answered correctly about

normal body tempreture (36.5-37.5) and (40%) responded by a temperature
of(35.5-36)

Table 15: Nurses knowledge about method of heat loss:

Method of heat loss Frequency Percent %

He rest in more flexed attitude 10 20

Has more subcutaneous fat tissue. 1 2

Don't has the stored body fat 17 34

All the above 22 44

Total 50 100%

The study showed that 34% of nurses answered correctly by not having
store body fat) 44% of nurses choosed all the answered

31
Table 16: Nurses knowledge about method to maintain body
temperatures:

Method to maintain body temperature Frequency Percent %

Dry the baby 4 8

Kangaroo mother position 0 0

Increase environmental temperatures 3 6

Incubator heater 1 2

All the above 42 84

Total 50 100%

In this table study showed that 84% of nurses answered correctly (all the
above) and only 2% responded by incubator heater
Table 17: Nurses knowledge about blood glucose level in case of
hypoglycemia:

Blood glucose level Frequency Percent %

Random blood glucose less than 10 7 14

mg/dl
RBG less than 50 mg/dl 27 54

RBG less than 40 mg/dl 16 32

Total 50 100%

The study showed that more than half (54%) of nurses answered correctly
and 32% responded by a blood glucose of less than 40 mg/dl

32
Table 18: Nurses knowledge about treatment of hypoglycemia:

Treatment of hypoglycemia Frequency Percent %

Boules dose D10% body w.5 then 20 40

maintenance dose D10% body w.80
D5% boules body w.5 then maintenance 6 12
dose D10% body w.60
Maintenance dose D5% body w.60 3 6

Answer a & c 21 42

Total 50 100%

In this table it was shown that 40% of nurses attained the right answer and
42%of nurse were choose answer a and c

Table 19: Assessment of premature before the first drink it is

necessary to
Assessment Frequency Percent %

Determine presence or absence of edema 11 22

Determine the presence or absence of 13 26

umbilical cord bleeding
Determine the presence or absence of 15 30
esophageal atresia
Determine the presence of congenital heart 11 22
disease
Total 50 100%

In this table about third 30% of nurses were knowing the necessity of
assessment before first drink and 22% responded by determining
congenital heart disease

33
Table 20: Nurses knowledge about preferred type of feeding to
premature:
Preferred feeding Frequency Percent %

Formula feeding 3 6

Mother milk 10 20

Iv fluids 7 14

B and c answer 30 60

Total 50 100%

The Study showed that just 20%of nurses attained to right answer which is
breast milk and 60%of nurse answered by mother milk and iv fluids

Table 21: Nurses knowledge about feeding by bottle

Bottle feeding Frequency Percent %

was demonstrated co-ordinate sucking- 27 54

swallowing reflex
stay in NICU more than 2 week 15 30

weight less than 80 gm. 8 16

Total 50 100%

Table 21 showed that 54% of nurses responded correctly and 30%

believed on staying in NICU less than 2weeks

34
Table 22: Evidence that preterm cannot tolerate feeding

Evidence of intolerance Frequency Percent %

Vomiting 5 10

Abdominal distention 5 10

Find residual milk 3 6

All the above 37 74

Total 50 100%

Table 22 showed that 74%of nurses answered correctly (all the above and
6% responded by finding residual milk

Table 23 : Relation between years of experience &evidence that

preterm cannot tolerate oral feed

Evidence of feeding
Years of experience intolerance Total
correct Incorrect
No F No F No F
>1 years 6 12% 2 4% 8 16%
1-5 years 20 40% 10 20% 30 60%
6-10 years 7 14% 1 2% 8 16%
More than 10 years 4 8% 0 0% 4 8%
Total 37 74% 13 26% 50 100%

P.V =0.014

35
Table 24: Nurses knowledge about type of fluids required in first day:
Type of fluids required Frequency Percent %

D10% body weight x80 31 62

D5% body weightx80 10 20

NACL body weight x20 . 5 10

DNS body wightx60 4 8

Total 50 100%

Table 24 showed that62% was attained to right answer which is D10%

body weightx.80) and 8% by DNS body w x60)

Table 25: Nurses knowledge about type of electrolyte added on the 2nd days:

Electrolyte Frequency Percent %

K 10 20

Ca 1 2

Na 7 14

Answer a and b 32 64

Total 50 100%

It was shown in table 25 that 64% of nurses responded about type of

electrolyte added at 2nd day by k and ca and 20% by k

36
Table 26: Nurses knowledge about route of administration of vit k
Route of administration Frequency Percent %

IM 25 00

IV 7 14

S/C 18 36

ID 0 0

Total 50 100%

Table 26 showed that half of them were answered correctly about route
of administration of vit k and the other half answered incorrectly.

Table 27: Nurses knowledge about dose of vitamin K

Dose Frequency Percent %

Img IM 27 05

10 unit IV 14 28

1 Mg subcutaneous 9 18

1 Mg ID 0 0

Total 50 100%

The study show more than half of nurse attend to right answer and 28%
had said( 10 unit iv.

37
Table 28: Relation between Educational level &Route of
administration of vit k .
Rot of administration of vit k to
premature
Education IM IV S/C Total
level No F No F No F No F
Bachelor degree 21 42% 6 12% 14 28% 41 82%
Post graduate 4 8% 1 2% 4 8% 9 18%
Total 25 50% 7 14% 18 36% 50 100%

P.V =0 .839

Table 29: Teaching provided to the mothers before discharge

Teaching Frequency Percent

%
Teach the mother about breast feeding 4 8
Teach the mother about kangaroo mother position 0 0
Teach the mother about environmental hygine plan 1 2
immunization
Teach about any problem 1 2
All the above 44 88
Total 50 100%

The study show 88% of nurse known what is the teaching provide to
mother before discharge and 2% she said teach the mother about any
problem.

38
Table 30: Average knowledge of nurses.
Assessment of knowledge Right Wrong
No Fr No Fr
% %
1. Definition of premature baby 32 64 18 36
2. Characteristics of premature baby 38 76 12 24
3. The commonest problems of premature baby 20 20 40 80
4. Definition of apnea 7 14 43 86
5. Causes of apnea 28 56 22 44
6. Management of apnea 43 86 7 14
7. The normal body temperature of premature baby 17 34 33 66
8. Premature baby can lose body heat rapidly because 17 34 33 66
9. Which is following method to maintain body temperatures 42 44 8 16
10. Hypoglycemia can occur in preterm if 27 54 23 46
11. Treatment of hypoglycemia 20 40 30 60
12. Assessment of premature before the first drink it is necessary 15 30 35 70
13. Preferred type of feeding to premature 10 20 40 80
14. mature baby can feed by bottle IF 27 54 23 46
15. Evidence to preterm cannot tolerate feeding can be 37 74 13 26
16. Type of fluids require in first day 31 62 19 38
17. Type of electrolyte added at 2nd days 32 64 18 36
18. Route of administration of vit k to premature baby 25 50 25 50
19. Quantity administration of vitamin k to preterm 27 54 23 46
20. Teaching provided to mother before discharge 44 88 6 12
Total 52.9 47.1
Average knowledge 52.9%

39
Table 31: Problems facing the nurse during her work.
Problems Frequency Percent %
Low number of staff 32 23

No trained staff 27 19

Low remuneration & motivation 25 17

No facilities and equipment’s 24 16

High number of visitors to NICU 30 21

All the above 6 4

Total __ 100%

Table31 clarified 23% of nurses checked the low number of staff and 21%
of nurse are suffering from high number of visitors and 19% were said no
trained staff and 16% said no facilities and equipment’s and 17% checked
no remuneration and motivation.

40
Chapter Five
Discussion
Conclusion
Recommendations

41
 5-1 Discussion

Premature refers to a baby born before 37 weeks of pregnancy have

(3)
been completed, the study was done to assess nurses knowledge about
preterm baby in elmak nimer university hospital in period from octoper to
September 2016
Socio demographic characteristics
The study revealed that majority of them (96%) nurses were females
and the majority of them (76%) their ages range between 20-30years.
Regarding level of education it was observed that (82%) of nurses had
bachelor degree and only (18%) of them had post graduate level of
education. The years of experiences in (60%) of them were 1-5 years, only
half (54%) worked previously in NICU and majority (77.8%) worked for
less than one year in NICU. This may be reflected in deficient knowledge
and practice regarding preterm newborns.
Assessment of nurses knowledge
It was found that (64%) of nurses define premature baby correctly.
Similar study was done by Babiker ZA in Alribat University, 2015(16). She
found better knowledge as (92%) of nurses defined premature baby
correctly.There was statistical relationship between nurses level of
education and their knowledge (p vaue 0.026).Corresponding results were
attained by Essass(17) ,About (76%) of nurses knew the characteristics of
premature baby. Compared to the result found by Abdelgader WI and
Abdurrahman II(18) ,who found that (92%) of nurses know these
characteristics.There was significant correlation between level of education
and their knowledge pv=(0.073)
Common problems of preterm include breathing problems,
( 3 )
temperature problems,, feeding problems, jaundice and infection .
Nurses knowledge regarding these factors is deficient only (40%) of nurses
41
knowthese problems. There was significant relationship between years of
experiences and their knowledge p value 0.034.
Regarding nurse’s knowledge about apnea (14%) of nurses
responded correctly to questions about definition of apnea in premature
baby. Better knowledge was found regarding its causes (56%). Apnea is
defined as a pause in breathing of longer than10 to 15 seconds (8). Majority
(86%) of nurses knew the management of apnea of premature baby .There
was significant association between level of education and their knowledge
about apnea and it's management ( P value =0.09)
The study showed that (76%) nurses had insufficient knowledge
regarding normal body temperature and causes of body temperature loss in
premature baby. The part of the brain that controls body temperature is not
fully developed and these babies have very little body fat to keep them
warm. As a result, preterm babies can lose heat very quickly and it takes a
(8)
long time to warm them up again. In contrast to what found by Daffalla
EI elgazira in 2015(19), his study showed that (80-85%) of studied nurses
responded correctly about causes of decreased body temperature (19).
Nurses had better knowledge regarding methods of maintaining body
temperature, (84 %) know these methods .Statistically significant
relationship between answer and knowledge value (0.04). This agreed with
Daffala EI her study showed that (77-80%) of studied group answered
correctly about maintaining body temperature of preterm baby (18)
Hypoglycemia is one of the common problems of preterm babies.
Hypoglycemia if mild between 40-50mg/dl, moderate 20/30mg/dl and
severe 20mg/dl( 21). The study showed that only (54%) of nurses knew the
(21)
blood glucose level of hypoglycemia which is less than 50 mg/dl , and
40% of nurses responded correctly about treatment of hypoglycemia.
Before administering the first drink, it is necessary to determine the
presence or absence of esophageal atresia and prevent vomiting .(11 ), About
42
(30%)of nurses know the importance of premature assessment before the
first drink. Similar result attained by babeker ZA (16),she found (46%) of
nurses know necessary assessment of preterm before first drink. Only
(20%) of nurses knew the preferred type of feeding to preterm. About half
of them (54%) know that baby can feed by bottle if he was demonstrated
(11 )
co- ordinate sucking and swallowing reflex .Compared to what reported
by babeker ZA(14)as (90%) of nurses responded correctly.
Studied nurses had adequate knowledge about evidence of feeding
intolerance, (74%)of them responded correctly. There was statistically
significant relationship between level of education and their knowledge
about these evidences. (p value =0.07) and also their experience affects
their knowledge. pvalue (0.014)
Regarding the knowledge about type of fluid in the first day and
electrolytes to be added, studied nurses had similar knowledge (62%) and
(64%) respectively.
Vitamin K is recommended to be given to pre term babies. Only half
of nurses knew the route of administration of vitamin K and (54%) knew its
dose. In Ethiopia, kidanomarian A reported similar deficient knowledge (20)
.Nurses who know the dose of vitamin K were (41.8%) and there was no
significant association between knowledge and level of education, p value
(0.839).
Almost (88%) of nurse know what is the teaching provided to
mothers before discharge which include teaching mothers about
breastfeeding, kangaroo position, environmental hygiene and
immunization.(13 )
The overall knowledge regarding all studied items was average about
53.9% there was inadequate nurse’s knowledge regarding care of premature
baby.

43
 It is important to know the problems facing the nurses during their
work to be solved and hence improve their work. Important problem facing
them werelow number of staff (23%), absence of training staff (19%), low
offer (17%), diminished facilities and equipment, (21%) of nurse suffer
from high number of family visitors to NICU and (4%) of nurse suffered
from all mentioned problems.
The study showed that there is statistically significant relationship
between the level of education and their knowledge regarding definition
and characarisic of preterm baby, definition and management of apnea,
methods of maintaining body temperature and evidence of feeding
intolerance .Also years of experiences affects statistically their knowledge
regarding common problems of preterm and evidence of feeding
intolerance .This agrees with Francesca IO results(22 )

44
 5.2 Conclusions
Based on the study results, it was concluded that:-
o Majority of studied sample were females (96%) and (76%) of them their
age between (20-30) mostly
o Their level of education was bachelor degree in (82%) followed by post
graduate (18%)
o More than half (60%) of nurses had short duration of experiences
between 1-5 years.
o Nurse knowledge about definition and character of preterm was good
o Almost nurses had adequate knowledge about management of apnea
(86%) ,but they had inadequate knowledge about definition and causes
of apnea
o Most of them (84%) know the methods of maintaining body temperature
but they had poor knowledge about normal body temperature
o Almost (88%) of nurse know about the teaching provided to mothers
before discharge
o Nurse Knowledge was in adequate regarding feeding of preterm
o Percentage of nurses knowledge regarding care of premature baby equal
53,9.SO there was inadequate nurse’s knowledge regarding care of
premature baby.
o The study showed that there is statistically significant relationship
between the level of education and their knowledge regarding definition
and characarisic of preterm baby, definition and management of apnea,
methods of maintaining body tempreture and evidence of feeding
intolerance.
o Also years of experiences correlates positively with their knowledge
about commons problems of preterm and evidence of feeding
intolerance.

45
 5.3 Recommendations
Based on the study result ,it is recommended that:
o Continuous education program for staff development.
o Provision of necessary equipments to improve nurses practice.
o Recruitment of qualified nurses
o Improvement of policy of hospital specially to decrease number of
visitors to provide high quality nursing care
o Doing other researches to discover points of weakness to be treated and
forces point support it to improve nurses knowledge and provide high
quality ideal services to the babies. Hence to decrease morbidity and
mortality rates.

46
 References
& Appendices

47
 Reference

1. Wiki-https://en.mwikipedia abcdefg(preterm labeor and birth)

national inititutes of health 3 november 20014
2. WHO /MCN/httm///file///c/user//what is preterm baby -12 am= 10.12
2018
3. Klossner, N. Jayne. Hatfield. Nancy T. Introductory maternity&
Pediatric nursing. 2nd ed. Lippincott Williams & Wilkins. China;
2010 Wolters Kluwer Health.p.704-713
4. www.our-every day life-com/roles/responsibility-neonatal nurse ht
ml date 20-8-2016
5. www. © Hamilton Health Sciences, 2003 PDf 4877 -
09/2007WPC\PtEd\CH\Info Parents Less30WeeksGest-
lw.docdt/September 20016
6. Klossner, N. Jayne. Hatfield. Nancy T. Maternity& Pediatric
nursing. Lippincott Williams & Wilkins. China; 2009Wolters
Kluwer Health.p.456
7. Susan l ward and Shelton M Hisley Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, and Families 2009 -p-
352
8. Nicki.lpotts.Barba. lmandleco- Bediatric and nursing carefor children
and their families /third edition/Page 217-219
9. Ricci, S Scott. And Kyle.T.Maternity and pediatric nursing care
2009-p 552-568
10.Kimberly G. Lee, (1998). Shelov, Stephen P.; Hannemann, Robert
E., eds. Caring for Your Baby and Young Child: Birth to Age 5.
Illustrations by Wendy Wray and Alex Gray (Revised ed.). New
York, NY: Bantam. ISBN 0-553-37962-3. OCLC 90- 47015

47
11.Petrou S,Hendoerson j,(2008)Bracewell M,Hockley C, Wolke D, .
M arlow N , Pushing the boundaries of viability:the economic
imbac 0f extreme preterm birth .Early Hum Dev .2006:82:77-
84(PubMet)
12.Baby Magazine, 20018 http://www.academicjournals.org/SRE
13.Ministry of health of KSA, (2011), Available line at
http://www.efcni.comJoy E Lawn, Ruth Davidge, Vinod Paul,
Severin von Xylander, Joseph de Graft Johnson, Anthony Costello,
Mary Kinney, Joel Segre, Liz Molyneux
14.Raman Kalia , (2012) , Pediatric nursing procedures 1st edition :
jaypee Brothers
15.Parul Datta , (2009) , Pediatric nursing 2end edition : jaypee
Brothers.
16.BabikerZA―assessment of nurse knowledge about preterm baby‖
elribatunivricity -2014-12 md -10-12. 20018
17.-Issa,SSKadimJawad AL Madwah, HajerSalim Al Mosawi,
―Evaluation of Nurse's Knowledge in Management of Premature
Baby in Neonatal Units.‖ American Journal of Nursing Research,
vol. 6, no. 5 (2018): 291-295. doi: 10.12691/ajnr-6-5-1
18.Abdelgader WI and Abderhman II volissupp ( 1-9) assessment nurse
knowledge about preterm baby) soba university month October-
December 20016 avilableattwww.paper.puplication org
19.DafaallaEI ―assessment nurse knowledge about preterm baby ―
university of elgzira – wad-madani 2015.
20.KidanomariamAb,Tinsa F ,GebreegGm,‖knowledge and practice of
essential neoborn care publication‖ available at
https//www.reserchgate.net at 2018 .

48
21.Anudeepa, Sharma, Ajuandavis, andprems,shekhawat additional
article information Transal pediatric 2017 -335-348
Doi:10.21037/tp/hypoglycemia/10.6.2018-pmcid:pmc5682372
22.Francesca I. Onyejuruwa Florida Atlantic University ―IMPACT OF
AN Educational Intervention On Nurses’ Knowledge And Caring
Behavior For Late Preterm Infants‖ May 2014.

49
 Appendices

Republic Of Sudan
Ministry of Higher Education and Scientific Research
University of Shendi
Faculty of Graduate Studies and scientific research

Questionnaire
Assessment of nurses knowledge regarding care of preterm
neonates
Put circle arrowed the correct answer:
1.Gender
a. Male ( ) b. Female ( )
2. Nurses age:
a. 25 – 30 years ( )
b. b. 31 – 35 years ( )
c. 36 – 40 years ( )
d. >40years ( )
3. Educational level:
a.Diploma degree ( )
b. bachelor degree ( )
b.post graduate ( )
4. Years of experience:
a. less than 1 y ( )
b. b.1 – 5years ( )
c. 6 – 10years ( )
d. d. >10years ( )
5. Previous work in NICU:

50
 a. Yes ( ) b. No ( )
6.Duration of work in NICU :
a. less than one year ( )
b. 1-3 years ( )
c. 4-7 years ( )
d. 7-10 years ( )
7. Definition of preterm baby is:
a. Baby born alive before 37 weeks of pregnancy. ( )
b. Birth of a baby after the developing organs are mature enough. ( )
c. Baby born before 34 weeks. ( )
d. Baby not completely developed ( )
8.Characteristics of premature baby are:
a.Small head relative to rest of body ( )
b.labia majora not covering labia minora ( )
c.Soft flat ears, with little cartilage. ( )
d. All the above ( )
9. The common problem of premature baby is:
a.Hypothermia ( )
b.Respiratory distress ( )
c.Jaundice ( )
d.Anemia ( )
e.Infection ( )
10. Definition of apnea is:
a.Irregular breathing ( )
b.Pause in breathing more than 30 sec ( )
c.Pause in breathing of longer than 5 sec ( )
d.Pause in breathing of longer than 10 to 15 seconds. ( )
11. Causes of apnea include:
a. Hypoxemia ( )
51
 b. Infection ( )
c. Anemia ( )
d. Immature respiratory system ( )
e. All the above ( )
12- Management of apnea:
a.Neonatal resuscitation ( )
b.Nasal oxygen mask ( )
c.CPAP ventilation ( )
d.All the above ( )
13. The normal body temperature of premature baby is :
a.36.5 C – 37.3 C ( )
b.35.5 C – 36 C ( )
c.36.5 C – 37 C ( )
d. 34.5 C – 35 C ( )
14. Premature baby can lose body heat rapidly because:
a.He/She rest in more flexed attitude. ( )
b. He/She has more subcutaneous fat tissue. ( )
c. He/She don't has the stored body fat ( )
d. All the above ( )
15. Which of the following methods is used to maintain body
temperatures:
a. Dry the baby ( )
b. Kangaroo mother position ( )
c. Increase environmental temperature ( )
d. Incubatorheater ( )
e. All the above ( )
16.Blood glucose level in hypoglycemia :
a. Less than 10 mg/dl ( )
b. Less than 50 mg/dl ( )
c. Less than 40 mg/dl ( )

52
17. Treatment of hypoglycemia:
a.Bolus dose D10% body weightx5 then maintenance dose D10%
body wx80 ( )
b.D5% bolus body weight x5 then maintenance dose D10% body
wx60 ( )
c.Maintance dose D5% body weight x60 ( )
d.Answer a & c ( )
18.Assessment of premature before the first drink it is necessary to:
a. Determine presence or absence of edema ( )
b.Determine the presence or absence of umbilical cord bleeding ( )
c.Determine the presence or absence of esophageal atresia ( )
d. Determine the presence of congenital heart disease ( )
19. Preferred type of feeding to premature:
a.Formula feeding ( )
b.Mother milk ( )
c.Intra-venous fluids ( )
d.B and c answer ( )
20. Premature baby can feed by bottle if:
a.He was demonstrated co-ordinate sucking- swallowing reflex. ( )
b.He stayed in NICU more than 2 weeks. ( )
c.His weight less than 80 gm . ( )
21.Evidence that preterm did not tolerate feeding can be:
a.Vomiting ( )
b.Abdominal distention ( )
c.Finding of residual milk ( )
d.All the above ( )
22. Type and amount of fluids in the first day:
a.D10% body weight x80 ( )
b. D5% body weight x 80 ( )
53
 c.Normal saline body weight x20 ( )
d..Dextrose with normal saline body weight x60 ( )
23. Type of electrolyte added on the 2nd day:
a.K ( )
b.Ca ( )
c. Na ( )
d. answer a & b ( )
24. Route of administration of vit k to premature baby is:
a.IM ( )
b.IV ( )
c.S/C ( )
d.ID ( )
25. Quantity administration of vitamin k to preterm:
a. 1mg IM ( )
b. 10 unit IV ( )
c.1 mg S/C ( )
d. 1mg ID ( )
26. Teaching provided to the mother before discharge :
a.Teaching the mother about breastfeeding ( )
b.Teaching the mother about kangaroo position ( )
c.Explaining environmental hygiene-follow-up plan and
immunization ( )
d.Teaching the mother about any problem ( )
27. Important problems facing the nurses during their work :
a.Deficient number of staff ( )
b.No training staff ( )
c. low remuneration & motivation ( )
d.no facilities and equipment ( )
e.High number of visitors to NICU ( )
f.All the above ( )
54