64 Indian Journal of Public Health Research & Development, April-June 2022, Vol. 13, No.

An Experimental Study to Assess the Effectiveness of Nesting

on Physiological Parameters and Posture of Preterm Babies in
A Selected Hospital, New Delhi

Karamjeet Kaur1, A. Malar Selvi2, Sherly Thomas2

1
M.Sc. Nursing Student, Holy Family College of Nursing, New Delhi, 2Associate Professor, Holy Family College of
Nursing, New Delhi

Abstract
Preterm babies are physically immature and physiologically unstable. They cannot tolerate
environmental stimuli. Due to immaturity, they often lack adequate muscle tone and are at the risk
of developing an abnormal posture. Nesting helps maintain position, promote comfort and provide
physiological, behavioural and postural stability to premature babies. The objectives of the study were:
1. To assess the effectiveness of Nesting on physiological parameters and posture of preterm babies. 2.
To compare the effectiveness of Nesting on physiological parameters and posture of preterm babies in
both experimental and control group. 3. To find out the association between the physiological parameters
with the selected variables of preterm babies. 4. To find out the association between the posture with the
selected variables of preterm babies.

The study was done at the Neonatal Intensive Care Unit of Kasturba Hospital and Hindu Rao Hospital,
Delhi. A total of 60 samples were randomly assigned into 2 groups (30in the experimental and 30
in the control group) through probability sampling technique (simple random sampling) using a chit
method. A structured interview schedule, record sheet to assess the physiological parameters and Infant
Positioning Assessment Tool were used to collect the data. Nesting was administered after a pre-test
to the experimental group for 9 hours for consecutive 6 days, and routine care was given to the control
group. Post-tests of physiological parameters were observed on the first day at the 3rd, 6thand 9th hour
and post-tests of posture were assessed on the 2nd, 4thand 6th day of both the groups. The findings
reveal that the calculated ‘t’ values of physiological parameters (Heart rate) were 2.261 in post-test 3
and found significant at p≤0.05. In the respiratory rate, the calculated ‘t’ value was 2, 2.079 in post-test
and found significant at p≤0.05. In oxygen saturation, the calculated ‘t’ value was 2, 3.28 in post-test
and found significant at p≤0.05. In posture, the calculated ‘t’ values were 3.644 in post-test 1, 9.917
in post-test 2 and 13.467 in post-test 3. The values were found to be significant in all the post-tests
at p≤0.05. Thus, the study concluded that Nesting effectively stabilises the physiological parameters
(Heart rate, Respiratory rate and Oxygen Saturation) and improves the preterm babies’ posture, and it
can be implemented as a useful measure.
Keywords: effectiveness, nesting, posture and
Corresponding Author: preterm babies.
Karamjeet Kaur,
M.Sc. Nursing student, Holy Family College of Introduction
Nursing, New Delhi, Background of Study
Email ID: karamjeetkaur6812@gmail.com
Preterm babies have poor muscle tone leading
 Indian Journal of Public Health Research & Development, April-June 2022, Vol. 13, No. 2
to abnormal tone and consequent delay in motor
development. The flexed posture reduces the surface
area exposed to the environment, minimising heat loss
which prevents enormous weight loss. It also affects
neuro-behavioural development. Stable physiological
parameters such as heart rate, respiratory rate and
oxygen saturation are the indicators of good health and
reflect the maturation of the central nervous system1.
Good posture can help to improve the circulation and
digestion, enhance sleep and preventcramping. It
also enhances the quality of life and muscle control,
physiological functioning and reduces stress. Many
factors may combine to cause early birth. The causes
of preterm babies are associated with maternal factors
– malnutrition, hypertension, multiple pregnancies,
polyhydramnios, placenta previaor diabetes, with
behavioural and environmental factors – smoking,
alcohol, domestic violence, stress, lack of social
support. Foetal factors associated with prematurity
area chromosomal abnormality, fetoplacental unit
dysfunction, congenital anomalies and unknown
factors. Due to immaturity, they often lack adequate
muscle tone and are at the risk of developing an
abnormal posture. A posture or alignment of various
body parts in relation to one another as midline head
position, neck slightly flexed forward, hands flexed
and able to touch the face, rounded shoulders, hips,
knees, ankle and feet aligned and softly flexed.
Nesting is one of the methods that help maintain
position, promote comfort and provide physiological,
behavioural and postural stability to the premature
babies.
Need of Study
A new born has so many adjustment problems
soon after the delivery. When they were in the
mother’s womb, the temperature is maintained, and
the flexed position provides much comfort to the
baby. After delivery, there is an alteration in the
posture and physiological parameters. Preterm babies
65
have poor muscle tone, and they lay with their arms
and legs extended. Extended posture for a long time
may lead to abnormal tone and consequent delay in
motor development. In India, 6.4 lakh neonatal deaths
occur per year – theneonatal mortality rate of 24
deaths per 1,000 live births in India (2019). India is
the only major country to have higher mortality for
girls than boys. Kerala, Goa and Delhi have neonatal
mortality rates of 10 per 1,000 live births and Bihar
and Uttarakhand stands at 44 per 1,000 live births1.
Review of Literature
Gill Sandeep Kaur (2011)2 conducted the
study to assess and evaluate the effect of Nesting on
physiological parameters (temperature, respiratory
rate, oxygen saturation) and comfort behaviour
of preterm infants admitted in NICU at Ambala.
The sample was 30 preterm babies included for the
experimental and control group. The findings of the
study revealed that there was a 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
behaviour of preterm infants (‘t’(29) = 22.48, 22.03).
The results showed that Nesting was effective in
significantly raising and stabilising the temperature of
preterm infants and lowering and stabilising the mean
respiratory rate and mean heart rate of preterm infants.
Mony K. (2013)3 conducted a study on the effect
of Nesting on sleep patterns among preterm infants
admitted in the NICU. Samples were babies born
before the completion of 37 weeks of gestation. 21
samples were randomly assigned to two groups of nest
and routine procedure. Sleep status was evaluated by
using the neonatal sleep Assessment Scale. Duration
of Total Sleep Time per cycle (TST) and duration
of each stage, such as quiet sleep and active sleep
indeterminate sleep, were recorded and analysed
using a paired t-test. The result was that the total
duration of sleep time showed that the mean value of
66 Indian Journal of Public Health Research & Development, April-June 2022, Vol. 13, No. 2
the entire course of sleep is significantly higher (113
min) among infants with Nesting than routine care
(86 min). The study concludes that Nesting increases
the sleep and duration of quiet sleep and aids in
maintaining physiological parameters.
K. Prasanna (2015)4 conducted a quasi-
experimental study on the effectiveness of Nesting
on posture and motor performance among newborn
babies. The sample size was 60 newborn babies, and
purposive sampling was used for the selection of
subjects. Questionnaire to obtain socio-demographic
data of baby and mother and modified observational
checklist Albert’s Test of Infant Posture and Motor
Assessment scale to assess the posture and movement
of newborn babies. As a result, the post-test score
mean was 18.8 with S.D. of 5.77, whereas in the
control group, the post-test score mean was 13.5
with SD of 6.19. The calculated t-test value was 3.5,
which exceeded the table value of 2.75 (p≤0.01). So,
the study concluded that Nesting was an effective
intervention in maintaining good posture and motor
performance among newborns.
Problem Statement
An experimental study to assess the effectiveness
of Nesting on physiological parameters and posture
of preterm babies in a selected Hospital, New Delhi.
Objectives
1. To assess the effectiveness of Nesting on
physiological parameters and posture of preterm
babies.
2. To compare the effectiveness of Nesting
on physiological parameters and posture of preterm
babies in both experimental and control group.
3. To find out the association between the
physiological parameters with the selected variables
of preterm babies.
4. To find out the association between the
posture with the selected variables of preterm babies
Conceptual Framework
The conceptual work adopted for the study was
modified by Weidenbach’s helping art of clinical
nursing theory.
Methodology
Research design: It was a true experimental
research design,consistingofphysiological parameter
record,structured interview schedule, physiological
parameters and Infant Positioning Assessment
Setting: The present study was conducted in
neonatal intensive care units in Kasturba Hospital and
Hindu Rao Hospital, New Delhi.
Sample size: 60 preterm babies (30 in the
experimental group and 30 in the control group) were
selected.
Population: preterm babies admitted in neonatal
intensive care unit in the selected hospital.
Sampling technique: theprobability sampling
technique (simple random sampling).
Tool: It consists of three sections:
Section 1 – Subject data to collect the demographic
characteristics and clinical health data of mothers and
preterm babies.
Section 2 – Record sheet to check the physiological
parameters, watch, stethoscope and pulse oximeter.
Section 3– Infant positioning assessment tool.
Validity: The tool was established by consultation
with expertsto calculate inter-rater observer reliability.
The tool was found reliable with inter-rate reliability
of 80%.
Pilot study: It was conducted on six preterm
 Indian Journal of Public Health Research & Development, April-June 2022, Vol. 13, No. 2
babies in September to ascertain the feasibility of the
study.
Data collection: A structured interview schedule,
record sheet to assess the physiological parameters
and Infant Positioning Assessment Tool were used
to collect the data. On the first day before giving
Nesting, the pre-test was done for the experimental
and controlgroup using the respective tool for
physiological parameters (Heart rate, respiratory
rate and oxygen saturation) and infant positioning
assessment tool for assessing the posture of preterm
babies and record on the record sheet. Nesting was
done for the subject in the experimental group for 9
hours in 6 consecutive days. Post-test assessment of
physiological parameters done on 1st day at 3rd, 6th
and 9th hour and post-test assessment of posture was
assessed with infant positioning assessment tool on
2nd, 4th and 6th day and recorded it.
Result
Section - I: Description of Demographic Data
(a): Assessment of demographic profile of the
mothers of preterm babies in both experimental and
control groups.
Out of 30 samplesin the experimental group,
the majority of 24 (80.0%) samples had a vaginal
delivery, 5 (16.7 %) samples had caesarean section
delivery, and 1 (3.3%) sample had assisted delivery.
The majority of 24 (80.0%) samples did not have any
complications, but 4 (13.3%) samples had pregnancy-
induced hypertension (PIH), and 2 (6.7%) samples
had diabetes mellites. None of the samples had any
maternal unhealthy habits - 30 (100.0%) samples.
A majority of 28 (93.3%) samples did not have
any previous information on Nesting, and 2 (6.7%)
samples knew about nesting.
Out of 30 samples in the control group, two-
thirds of the total samples - 20 (66.4%) samples
67
had a vaginal delivery, 10 (33.3%) samples had a
caesarean section with no assisted mode of delivery.A
majority of 27 (90.0%) samples did not have any
complications, but 2 (6.7%) samples had pregnancy-
induced hypertension (PIH), and 1 (3.3%) sample had
diabetes mellites. A majority of 29 (96.7%) samples
did not have any maternal unhealthy habit, and 1
(3.3%) sample had a history of smoking and alcohol.
A majority of 28 (93.3%) samples did not have any
previous information onnesting, and 2 (6.7%) samples
knew about nesting.
(b): Assessment of the demographic profile of
the preterm babies in both experimental and control
groups
Out of 30 samples in the experimental group,
half of the total samples –15 (50.0%) samples
were between 32-34 weeks of gestation, 12 (40%)
samples were between 30-31 weeks of gestation,
and 3 (10.0%) samples were between 28-29 weeks
of gestation. A majority of 29 (96.7%) samples had
the vertex as apresentation for the preterm, 1 (3.3%)
sample had the breech presentation for the preterm.In
terms of age, 27 (90.0%) samples were at 8-12 days,
and 3 (10.0%) sampleswere at 17-21 days. Almosthalf
of the total samples – 14 (46.7%) had birth weight
between 1-1.5kg, 14 (46.7%) sampleshad birth weight
between 1.5-2kg, and 2 (6.7%) samples had birth
weight between 2-2.4kg. Almost two-thirds of the
total samples - 19 (63.3%) samples were male preterm
babies, and 11 (36.7%) sampleswere female preterm
babies. A majorityof 25 (83.3%) samples were fed
with EBM, 4 (13.3%) samples were on breastfeeding,
and 1 (3.3%) sample was having fed with formula
feeding.
Out of 30 samples in the control group,a majority
of 23 (76.7%) samples were between 32-34 weeks of
gestation, 4 (13.3%) samples between 30-31 weeks of
gestation and 3 (10.0%) samples were between 28-29
weeks of gestation. Five-sixths of the total samples -
68 Indian Journal of Public Health Research & Development, April-June 2022, Vol. 13, No. 2

25 (83.3%) samples had the vertex presentation for
the preterm, 5 (16.7%) samples had the breech as a
presentation for the preterm, and none of the samples
had any other presentation. All the samples - 30
(100%) were at the age of 8-12 days. Almost one-third
of the total samples -10 (33.3%) samples had birth
weight between 1-1.5kg, 10 (33.3%) samples had birth
weight between 1.5-2kg, and 11 (36.7%) samples had
birth weight between 2-2.4kg. The number of samples
was equal in terms of gender, 15 (50.0%) samples,i.e.
half of the total samples were male preterm babies and
another half, 15 (50.0%) samples were female preterm
babies. Almost two-thirds of the total samples, 21
(70.0%) samples, were fed with EBM, 9 (13.3%)
samples were on breastfeeding, and none of them had
formula feeding.
Section -II: Assessment of the Physiological
Parameters and Posture in the Experimental
Group and Control Group.

Table – 1: Comparison between pre-test and post-test of physiological parameters (heart rate) of
preterm babies in the experimental group
n = 30

Std. error t – value

Physiological Experimental Mean Standard p
Mean mean
parameter Group Difference deviation -value
difference Calculated Tabulated

Pre-test 140.66 - 8.15 - - - -

Heart Rate
Post-test 145.53 4.87 4.98 1.744 2.792* 2.05 0.002

Pre-test 49.8 - 6.81 - - - -

Respiratory
Rate
Post-test 46.5 3.3 3.65 1.312 2.339* 2.05 0.009

Pre-test 95.53 - 2.56 - - - -

Oxygen
Saturation
Post-test 97.06 1.53 1.70 0.561 2.727* 2.05 0.003

*significant at p(29) ≤0.05

The data represented in Table – 1 depicts that
the mean score of the post-test of the experimental
group was more than the mean pre-test score of the
experimental group. In the post-test, the calculated
‘t’ values were greater than the tabulated ‘t’ value
of 2.05 at the 0.05 level of significance. The results
indicate that Nesting effectively stabilised the heart
rate, respiratory rateand oxygen saturation of preterm
babies in the experimental groupwithin 9 hours
onwards.
 Indian Journal of Public Health Research & Development, April-June 2022, Vol. 13, No. 2 69

Table – 2: Comparison between pre-test and post-test of the posture of preterm babies in the
experimental group
n = 30

Std. error t – value

Experimental Mean Standard
Mean mean p -value
Group Difference deviation
difference Calculated Tabulated

Pre-test 7.7 - 1.54 - - - -

Post-test 11.03 3.33 0.80 0.318 10.487* 2.05 0.0001

*significant at p(29) ≤0.05

The data presented in Table – 2 depicts that the post-test mean score was greater than the pre-test score
of the experimental groups. The calculated ‘t’ value ofthe post-test was greater than the tabulated ‘t’ value of
2.05 at the 0.05 level of significance. The result indicates that Nesting was effective in improving the posture of
preterm babies in the experimental group after Nesting.

Table – 3:Mean, mean difference, standard deviation, standard error of mean difference and ‘t’ value
of post-test score of physiological parameters (Respiratory rate) of preterm babies
n1 + n2=60

PHYSIOLOGICAL PARAMETER (POST-TEST 9 HOURS)

‘t’ – value
Mean Standard Std. Error
Post-Test Group Mean p-value
Difference Deviation Difference
Calculated Tabulated

EXP 145.53 4.98

Heart
3.57 1.579 2.261* 2.001 0.011
Rate
CON 149.10 7.07

EXP 48.63 4.27

Respiratory
0.61 1.026 2.079* 2.001 0.042
Rate
CON 46.50 3.66

EXP 95.37 1.87

Oxygen
1.53 1.533 3.284* 2.001 0.0017
Saturation
CON 96.90 1.75

*significant at p(58)≤0.05
70 Indian Journal of Public Health Research & Development, April-June 2022, Vol. 13, No. 2

The data represented in Table – 3 depicts that
the mean post-test score of heart rate and respiratory
ratein the experimental group is higher than the mean
post-test score of the control group. The post-tests’
calculated ‘t’ values were greater than the tabulated
‘t’ value at the 0.05 level of significance.The result
indicates that Nesting effectively stabilised the heart
rate, respiratory rate and oxygen saturation of preterm
babies in an experimental group.

Table – 4: Mean, mean difference, standard deviation, standard error of mean difference and ‘t’value
of post-test score of the posture of preterm babies
n1 + n2= 60

POSTURE (score)

‘t’ – value
Mean Standard Std. Error
Post-Test Group Mean p-value
Difference Deviation Difference
Calculated Tabulated

EXP 8.80 0.664

Post-test 1 (At
0.6 0.165 3.644* 2.001 0.0001
2nd day)
CON 8.2 0.610

EXP 9.83 0.592

Post-test 2 (At
1.56 0.157 9.917* 2.001 0.0001
4th day)
CON 8.27 0.626

EXP 11.03 0.809

Post-test 3 (At
2.8 0.206 13.467* 2.001 0.0001
6th Day)
CON 8.26 0.784

*significant at p(58)≤0.05

The data represented in Table – 4 depicts that
the mean post-test posture score of the experimental
group is significantly higher than the mean post-test
score of the control group with the ‘t’ value of 2.001 at
the 0.05 level of significance. The result indicates that
Nesting effectively maintains the posture of preterm
babies in an experimental group.
Association between Pre-test Physiological
Parameters and Selected Demographic Variable:
There was no significant association between
physiological parameters of heart rate,respiratory
rate, oxygen saturation with the selected demographic
characteristics like mode of delivery, maternal
complication, unhealthy habits of the mother, the
period of gestation, age of preterm baby, birth weight.
Association between Pre-test Posture and
Selected Demographic Variable:
There was no significant association between
posture and selected demographic variables like mode
 Indian Journal of Public Health Research & Development, April-June 2022, Vol. 13, No. 2
of delivery, mother complication, mother habits, a
period of gestation age of preterm babies and birth
weight of preterm babies.
Discussion
The present study shows that Nesting effectively
stabilises the physiological parameters and improves
the posture of preterm babies compared to routine care.
Physiological parameters like heart rate, respiratory
rate, and oxygen saturation were stabilised, and
posture improved after Nesting. The above study
was consistent with the study finding of Nahed Saied
Mohamed5, who reported the effectiveness of Nesting
in stabilising the heart rate, respiratory rate and oxygen
saturation. Another study supported by K. Prasanna
and Radhika (June 2015)4 related to posture. This
result indicated that Nesting effectively stabilised the
physiological parameters and improved posture.
Conclusion
The following conclusions are drawn from
the study. The study’s finding proved that Nesting
effectively stabilised physiological parameters and
improved the posture in preterm babies admitted to
the neonatal intensive care unit. Nesting intervention
can be integrated with the nursing curriculum. The
sample size was small to draw generalisations, and
the time duration was limited.
Ethical Clearance: It was taken from the ethical
committee of Holy family hospital with Kasturba
Hospital and Hindu Rao Hospital. The final study
was conducted at the Neonatal Intensive Care Unit
of the hospital, and data collection was done in
71
December 2019 and January 2020. Eligible samples
were randomly assigned to the experimental and
control groups using the chit method’s simple random
sampling technique.
Source of Finding: Self
Conflict of Interest: Nil
References
1. UNICEF. United Nations Children’s Fund. Cited
2019. URL: https://www.unicef.org/
2. Gill S, Kumar Y, Sharin J. Effect of Nesting on
Preterm Infants Admitted in NICU. Journal of
Nursing Science & Practice. 2015 Jan;5(2):8–11.
Available from: https://www.researchgate.net/
publication/324477256
3. Mony K., Vindra Selvam V, Dr. Krishnakumar
Diwakar, and Dr. R.Vijaya Raghavan4 study
of Nesting on physiological parameters among
preterm infant admitted in NICU. International
journal of advanced research (IJAR) March
2018’6(4)’357_362.available on http//dx,doi.
org/10.21474/IJAR/6867.
4. Prasanna K, Radhika M. Effectiveness of Nesting
on Posture and Motor Performance Among
Newborn babies. IJSR - International Journal of
Scientific Research. 2015;4(6):467–70.
5. Nahed M. A study on the effect of Nesting on
physiological functioning and neurobehavioral
organisation of preterm infants. Life Science
Journal. 2016, 13(IS) Available from: https://
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