RAJIV GANDHI UNVERSITY OF HELATH SCIENCE,BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FORDISSERTATION

1. NAME OF THE CANDIDATE AND ADDRESS

: V. VIJAYAKUMARI1ST YEAR M.SC NURSING,

INDIAN COLLEGE OF NURSING, TILAK NAGAR, BYPASS ROAD, CANTONMENT,

BELLARY – 583104

2. NAME OF THE INSTITUTION : INDIAN COLLEGE OF NURSING, TILAKNAGAR, BYPASS ROAD,

CANTONMENT,

BELLARY – 583104

3. COURSE OF STUDY AND SUBJECT

: DEGREE OF MASTER OF NURSING ,

OBSTETRICS AND GYNAECOLOGICAL NURSING

4. DATE OF ADMISSION TO COURSE

: 15-05-2010

5. TITLE OF THE TOPIC : A STUDY TO ASSESS THE

EFFECTIVENESS OF THE

STRUCTURED TEACHING

PROGRAMME REGARDING SKILLS

AND PRACTICES OF NEWBORN

RESUSCITATION IN MANAGEMENT

OF BIRTH ASPHYXIA AMONG III

YEAR GNM STUDENTS IN SELECTED

NURSING SCHOOLS ,AT BELARY,

KARNATAKA.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUTION:

It was Barcraft who said, “Breathing is living” Most infants begin to

breathe spontaneously with in a few seconds of a birth as a result of exposure to

the external environment. Although the majority of babies gasp and establish

respiration with in 60 seconds of birth, some do not failure to initiate and sustain

respiration at birth, necessitates prompt and effective intervention1. Asphyxia

neonatorum is respiratory failure in the new born, a condition caused by the

inadequate intake of oxygen before, during or just after birth.2

Asphyxia neonatorum, also called birth or newborn asphyxia, is defined as

a failure to start regular respiration with in a minute of birth. Asphyxia

neonatorum is a neonatal emergency as it may lead to hypoxia (lowering of

oxygen supply to the brain and tissues) and possible brain damage or death if not

correctly managed.3Birth asphyxia is clinically defined as failure to initiate and

maintain spontaneous respiration following birth, there is a hyper ventilation,

anaerobic glycolysis, and lactic acidosis.4

Asphyxia neonatorum has been defined by World Health Organization: as

a combination of hypercapnia, hypoxia and acidosis. Some clinicians prefer the

term “Apnoea neonatorum”.Recently the term has been changed to “Depressed

Infant”1. Apgar score: A five part scoring system to assess newborn at one minute

and five minutes after birth regarding heart rate, respiratory effort, muscle tone,

reflex irritability, and colour. The total Apgar score is 10 (No depression: 7-10,

Mild depression: 4-6, Severe depression: 0-3)5.

National Neonatology Forum of India has suggested that birth asphyxia

should be diagnosed when the baby has gasping and inadequate breathing or no

breathing at 1 minute. It corresponds to 1 minute Apgar score of 3 or less6.

Perinatal Asphyxia is the medical condition resulting from deprivation of

oxygen (hypoxia) to a newborn infant long enough to cause apparent harm7. It is

manifested by low Apgar score and metabolic acidosis. It is often develop as a

continuation of ante partum and intrapartum problems.

The treatment for asphyxia neonatorum is resuscitation of the newborn. All

medical delivery rooms have adequate should an infant not breathe well at

delivery. Between 1970 and 2000, neonatal resuscitation has evolved from

disparate teaching methods to organized programs. The most widely used

procedure is the Neonatal Resuscitation Program (NRP), supported by the

American Academy of Pediatrics (AAP) ad the American Heart Association

(AHA).

If stimulation fails to initiate regular respiration in the newborn2, all

resuscitation arrangements and essentials to be kept ready. At least one health

personnel should be skilled in neonatal resuscitation, who should present at

delivery room. Heat source should be kept ready for use5.

Other treatment measures include, giving the extra amount of oxygen

before delivery. Extra-Corporeal Membrane Oxygenation (ECMO), medications

support the baby’s breathing. ECMO is a technique similar to a heat – lung bypass

machine, which assists the infant heart and lung function with use of external

pump and oxygenaton.2

6.1 NEED FOR STUDY:

Birth asphyxia is a serious clinical problem world wide. Each year

approximately four million babies are born asphyxiated which results in one

million deaths and an equal number of serious neurological squeal, such as

cerebral palsy, mental retardation, and epilepsy8. It is estimated 23% of the

neonatal deaths are due to birth asphyxia, 99% of these deaths occur in low and

middle income countries. The management of initial apnoea in resource rich

countries has focused on the basic resuscitation, Using bag mask ventilation,

oxygen, and subsequent ventilation9. In Tunisia, prenatal mortality remains public

health problem, currently estimated at 28/1000, including 15/1000 of still birth

rate and 10-15 % of early neonatal mortality rate10.

According to National Center for Health Statistics (NCHS) in 2002, infant

mortality caused by birth asphyxia neonatorum amounted to 14.4 deaths per

100.000 live births in United States, representing the tenth leading cause of infant

mortality. World wide, more than one million babies die annually from

complications of birth asphyxia. According to World Health Organization,

Asphyxia neonatorum is one of the leading causes of newborn death in developing

countries in which 4-9 million cases of newborn asphyxia occur each year,

accounting for about 20% of infant mortality rate.11

A comparative study was conducted among 64 term asphyxiated

neonates and 90 term non–asphyxiated born at Queen Mary’s hospital in Luck

now. Neonatal mortality increased as the 5 minute Apgar score decreased (5.6%

for controls (= 0-7) 6.3% for 6, 20% for 5, 25% for 4, 63.3% for 0-3. It was

significantly higher for the 10 minute Apgar score groups (16.7% for 6, 33.3% for

5, 40% for 4 and 77.8% for 0-3) .Their neonatal mortality rates were 66.6% and

33.3% respectively. None of the asymptomatic new born with 5 minute apgar

scores of 4-6 died. These findings suggest that a multidisciplinary effort to

improve the life of neonates12.

In India preinatal asphyxia is one of the common cause of neonatal

mortality, data from national perinatal data base suggests that perinatal asphyxia

contributes to almost 20% of neonatal deaths13.

The World Health Organization estimates that globally between four and

nine million newborn suffer from birth asphyxia each year, of those estimated 1.2

million dies and almost same number develop severe consequences. The WHO lso

estimates that globally 29% of neonatal deaths are caused by birth asphyxia in

addition a sizable proportion of still births are caused by asphyxia14.

A cross sectional study was conducted among 182 infants to determine the

base line incidence of birth asphyxia in neonatal intensive care unit in university of

Zambia, in USA. Among 182 infants 42 (23%) had a clinical diagnosis of birth

asphyxia. Of 42 infants with birth asphyxia, 13 (31%) had an abnormal neurologic

examination during the clinic visit: in contrast, 13 of 141 infants without birth

asphyxia (9%) had an abnormal examination. Birth asphyxia survivors account for

almost a quarter of NICU survivors in developing countries. Studies are necessary

to determine the percent of birth asphyxia survivors who have disabilities.15

The most widely used curriculum is the Neonatal resuscitation programme

which is supported by American academy of Pediatrics (AAP), and American

Heart Association (AHA). In this era of evidenced based medicine the most recent

neonatal resuscitation programme guidelines were developed to provide

recommendation based on the best currently available sciences.

The current medical nursing literature reflects the prevalence of birth

asphyxia among neonates. Based on literature and investigator experience the

investigator feels that it is important to create awareness among III Yr General

Nursing and Midwifery students to prevent mortality rate and morbidity rate. So

the knowledge of the students may be applied in early recognition of birth

asphyxia in selecting for early resuscitation. Hence the investigator planned to

impart the knowledge by conducting structured teaching programme to III Year

General Nursing and Midwifery students.

6.2 REVIEW OF LITERATURE:

Review of literature is a key step in research process. Review of literature

refers to an extensive, exhaustive and systematic examination of the publications

relevant to the research projects.16

A study was conducted to determine the effect of training in newborn care

and resuscitation on seven day (early) neonatal mortality rate for very low birth

weight infants. The study was designed among the local instructor trained birth

attendant’s rates from 96 rural communities in six developing countries, to test the

impact of ENC (Emergency Newborn Care) and NRP (Neonatal Resuscitation

Programme) training data on infants of 500-1499g were collected by using a

controlled study design. A cluster-randomized controlled trial design was used to

test the impact of NRP. A total of 1096 VLBW (500-1499) infants were enrolled,

and 98.5% of live born infants were monitored to seven days. Neither ENC nor

NRP of birth attendants decreased 7-days neonatal, still birth or perinatal mortality

rates for very low birth weight infants (VLBW) born at home or at first level

facilities.17

A study was conducted to systematically review the evidence for

neonatal resuscitation, content, training, equipment, and key programme for

resource contained setting. Each year approximately 10 million babies don’t breath

immediately at birth, of which about six million require basic neonatal

resuscitation. Evidence from severe observational studies shows that facility based

basic neonatal resuscitation may avert 30% of intrapartum related neonatal deaths.

very few babies require advanced resuscitation and these newborns may not

survive without ongoing ventilation, of 60 million non facility births, must do not

have access to resuscitation. The study concludes that: the basic resuscitation

would substantially reduces intrapartum related neonatal deaths; it is a priority to

ensure that all birth attendants are competent in resuscitation.18

An evaluative study was conducted to evaluate the neonatal resuscitation

of infants born with severe asphyxia in Sweden. All case records of 472 claims for

financial compensation due to suspected medical practice in conjunction with

child birth in Sweden. Inclusive criteria were gestational age >or=33, neonatal

asphyxia, Apgar score <7 at 5min. it was accessed that 117 infants suffered from

cerebral palsy and early death due to severe asphyxia. Median Apgar score at 5min

was 3, indicating that needed immediate and extensive resuscitation. There was

insufficient adherence to guidelines concerning neonatal resuscitation, including

delayed initiation of resuscitation in 19 infants, lack of satisfactory ventilation in

79 infants and ultimate interruption of resuscitation in 38 infants. The study

concluded that: compliance with guidelines for resuscitation of severely

asphyxiated newborn may be improved, especially concerning ventilation and

prompt paging for skilled personnel in case of imment asphyxia.19

A study was conducted to identify the risk factors for birth asphyxia

mortality in rural population in southern Nepal. A total of 23,662 new born infants

were enrolled between September 2002 to January 2006, birth asphyxia (9.7/1000

live births) accounted for 30% neonatal mortality. Low socio-economic status is

highly associated with asphyxia, and leading to mortality needed to be elicited.

The interaction between maternal infections and prematurity may be an

impartment target for future community based interventions to reduce global

impact of birth asphyxia on neonatal mortality.20

A retrospective study was conducted among 66 new born’s who are born

in hospital at Trakya region of Turkey, during last three years and were diagnosed

as perinatal asphyxia and were referred to our National unit. Among 66, 35 in

group-1, 18 in group-2, 13 in group-3. The number of cases who had not been

resuscitated was 10 in the pertaining period and 3 in trained period and 1 in post

training period which decreased significantly. The 1st min Apgar score in three

groups were as follows: 2.08+/-1.2, 2.2+/-1.1, 3.7+/-1.4. the fifth minute Apgar

score also increased from 5.43+/- 1.5 to 6.5+/- 1.9. the number of patients with

stage-1 and 2 HIE decreased more in group-3 (n=11 in stage-1HIE, n=17 in stage-

2 HIE ) after NRP course the number of patients with perinatal asphyxia and

duration of hospitalization decreased significantly where as the first minute Apgar

scores increased significantly.21

A study was conducted to determine the risk factors for birth asphyxia in

neonates with help formulate effective management protocol in the development

of pediatrics, Hyderabad, from April 2005-2006 April. 125 newborns (75 males,

15 females) admitted to the neonatal care unit, who are delivered with delayed cry

or low Apgar score (<7) were included. Out of 125 newborns 28% were diagnosed

as suffering with moderate or severe encephalopathy. Ante partum risk factors

include, non-attendants for antenatal care (64%), multiple births (4.8%), vaginal

bleeding was strongly associated with asphyxia in 34.44% neonates. Lack of

neonatal care, poor nutritional status, ante partum hemorrhage, was associated

with higher incidence of asphyxia. A significant reduction in the neonatal

mortality rate among asphyxiated neonates, by aggressive resuscitation

management.22

A study was conducted to evaluate the effect of home based intervention on

birth asphyxia and to compare the effectiveness of two types of workers and three

methods of resuscitation in homodelivery, in Gadchiroli in India. Birth asphyxia in

home deliveries was managed differently during different phases. Trained

traditional birth attendants used mouth to mouth respiration (1993-95), village

health workers they used tube mask (1996-99) bag mask (1999-2003), during the

intervention years, 5033 home deliveries occurred. The incidence of birth asphyxia

decreased by 60%, from 14% in the observational year to 6% in the intervention

year. The incidence of severe birth asphyxia did not change significantly but Case

Fatality (CF) in neonates is decreased by 47.5%, from 39 to 20% and Asphyxia

Specific Mortality Rate (ASMR) by 65%, from 11 to 4%, mouth to mouth

resuscitation reduced the ASMR by 12%, tube mask reduced the CF by 27% and

ASMR by 67%. The bag mask showed an additional decrease in case fatality of

39% .Conclusion of the study was home based intervention delivered by a team of

TBA and semi skilled village health worker reduced the asphyxiated related

neonatal mortality by 65%.23

A retrospective study was conducted to determine the incidence of

neonates with anoxic ischemic shock related to asphyxia, among 3,301 infants.

This study was performed over a two years period in three pediatric MICU

(Medical Intensive Care Unit) from the France area. Among these 3,301 infants

237 neonates (124 boys and 113 girls) with anoxic ischemic encephalopathy

related to asphyxia were selected. Among 237 neonates, 83% of neonates had an

apgar score at 1 minute <3. 88% at 5 minute of life and 34% of these had an apgar

score of 10 minute > 5.24

A comparative study was conducted among 431 asphyxiated babies, 210

in the room air and 221 in 100% oxygen group were enrolled .To compare the

short term efficiency of room air versus 100% oxygen for resuscitation of

asphyxic newborns at birth . Both groups were comparable at 1 minute (94 bpm

and 88 bpm ) 5 minutes (131 bpm ad 131 bpm) and 10 minute (8 versus 8), in the

room air and oxygen groups respectively, were found to be comparable. Median

time to first breath (1.5 versus 1.5 minute) was similar in the room air and oxygen

group. Median duration of resuscitation (2.0 versus 3 minute) was significantly

shorter in the room air group. There was also no statistically significant difference

in the overall and asphyxia related mortality in the two treatment groups (12.4%

and 10.0% in room air versus 18.1% and 13.6% in oxygen group). The study

concluded that: room air appears as good as 100% oxygen for resuscitation of

asphyxic new born babies at birth.25

A study was conducted to determine the mortality rate among hospital born

neonate with birth asphyxia. 150 neonates with birth asphyxia were prospectively

studied. The neonatal mortality of 24.7% (35/150) among asphyxiated neonates

compared to that of non-asphyxiated newborns<0.0001). The mortality rate in

preterm asphyxiated neonates was 47.8%. The relative risk factors of mortality

increased progressively with increased birth weight. The study concluded that: a

significant reduction in mortality among asphyxiated neonates will require

aggressive management by resuscitation efforts.26

6.3 STATEMENT OF THE PROBLEM:

“A study to evaluate the effectiveness of the structured teaching programme

regarding skills and practices of Newborn Resuscitation in management of Birth

asphyxia among III year GNM students in Selected Nursing Schools, at Bellary,

Karnataka.”

6.4 OBJECTIVES OF THE STUDY:

1. To assess the pre-intervention knowledge of III year GNM students regarding

newborn resuscitation in management of Birth asphyxia by pre-test knowledge

scores.

2. To develop and conduct structured teaching programme regarding newborn

resuscitation in management of birth asphyxia.

3. To assess the post interventions knowledge of III Year GNM students regarding

newborn resuscitation in management of birth asphyxia by post-test knowledge

scores.

4. To determine the effectiveness of structured teaching programme by comparing

the pre-test and post-test knowledge scores of III year GNM students.

5. To determine the association between the socio-demographic variables and

knowledge level of III year GNM students regarding newborn resuscitation in

management of birth asphyxia.

6.5 RESEARCH HYPOTHESIS:

H1. There will be significant difference between pre-test and post-test of

knowledge score on newborn resuscitation in management of birth asphyxia

among III year GNM students at 0.05 levels

H2.There will be a significant association between knowledge scores

among III Year GNM students with selected demographic variables.

6.6 VARIABLES UNDER STUDY:

INDEPENDENT VARIABLES

Structured teaching programme on newborn resuscitation in management of

birth asphyxia.

DEPENDENT VARIABLES

Knowledge among III Year GNM students regarding newborn

resuscitation in management of birth asphyxia.

ATTRIBUTE VARIABLE

Age, sex, education, religion, etc.

6.7 OPERATIONAL DEFINITION:

1) Assess: In this study, it refers to the III Year GNM students responses to before

and after structured teaching programme regarding newborn resuscitation in

management of birth asphyxia.

2) Effectiveness: In this study, it refers to the extent to which the structured

teaching programme has achieved the desired effect in improving the knowledge

of III year General Nursing and Midwifery students before and after structured

teaching programme regarding Newborn Resuscitation in management of Birth

asphyxia.

3) Structured teaching programme: In this study, it refers to the systematically

organized teaching design for a group of III Year GNM students that enhances the

knowledge regarding Newborn Resuscitation in management of Birth asphyxia.

4) Knowledge: In this study, it refers to correct response from III Year GNM

students during interview schedule regarding Newborn Resuscitation in

management of Birth asphyxia.

5) Practice: it refers to a job or activity. This involves a lot of skill or training.

6) Neonate: In this study, it refers to infant at any time during the first 28 days of

life. The word is particularly applied to infant just born or in the first week of life.

7) Newborn resuscitation: Resuscitation is a series of action to establish normal

breathing, heart rate, colour, tone, and activity, in newborn with depressed vital

signs (LOW APGAR).

8) Birth asphyxia: respiratory failure in the newborn caused by inadequate

oxygen supply during birth

6.8 ASSUMPTIONS:

The III Year GNM students may not have adequate knowledge regarding

newborn resuscitation in management of birth asphyxia.

Teaching strategy regarding newborn resuscitation in management of birth

asphyxia may have to improve the knowledge among III Year GNM

students.

6.9 DELIMITATIONS:

Study is delimited to III Year GNM students who are willing to participate

in the study, at Selected Nursing Schools, at Bellary.

The study is limited to those who are III Year GNM students.

The study is limited to III Year GNM students studying in selected Nursing

Schools.

7 . MATERIALS AND METHODS:

7.1. SOURCE OF DATA:

The data will be collected from III Year GNM students in Selected Nursing

Schools, at Bellary.

7.2 METHOD OF COLLECTION OF DATA:

7.2.1 RESEARCH DESIGN:

The research design chosen for the study is pre –experimental “One group

pre test and post test design”.

7.2.2 RESEARCH APPROACH:

An evaluative research approach

7.2.3 RESEARCH SETTING:

Study will be conducted in selected Nursing schools, at Bellary.

7.2.4 POPULATATION:

The population included in the present study is the III Year GNM students.

7.2.5 SAMPLE SIZE:

The total sample size consists of 60 III Year GNM students in selected

Nursing Schools, Bellary.

7.2.6 SAMPLING TECHNIQUE:

Non–probability, purposive sampling technique will be used

7.2.7 DURATION OF THE STUDY:

4 – 6 weeks.

7.2.8 SAMPLING CRITERIA:

Inclusion Criteria

III year GNM students from selected Nursing Schools, Bellary.

III Year GNM students who are willing to participate in the study

III Year GNM students who are available during the period of data

collection.

Exclusion Criteria

III Year GNM students who are not available at the time of data

collection.

III Year GNM students who aren’t willing to participate in the study.

7.2.9 DATA COLLECTION TOOLS:

Structural interview schedule will be conducted into two parts

Part-1: Demographic data such as age, sex, education, religion, etc.

Part-2: Knowledge questionnaire regarding Newborn Resuscitation in

management of Birth asphyxia.

7.2.10 COLLECTION OF DATA:

The investigator herself collects the data from the III Year GNM

students from Selected Nursing Schools.

Structural interview schedule is used to assess the knowledge by

taking pre-test on Newborn Resuscitation in management of Birth

asphyxia.

Conduct structured teaching programme for III Year GNM students

from selected Nursing Schools.

Same structured interview schedule for the pre test will be used for

post- test to assess the effectiveness structured teaching programme

7.2.11 DATA ANALYSIS METHODS:

The investigator will use descriptive and inferential statistics

Paired‘t’ test will be used to test the significant difference in the

knowledge scores between pre- test and post- test score.

Chi–Square test is used to determine the knowledge scores with

demographic variables.

It is presented in the form of table, diagrams and graphs based

findings

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER

HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE, BRIEFLY.

YES, the study requires administration of structured interview

Schedule and structural teaching programme to III Yr General

Nursing and Midwifery students at Selected Nursing Schools,

Bellary.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION IN CASE OF 7.3?

YES, informed consent will be obtained from the institution

authorities.

Subject privacy, confidentially and anonymity will be guarded.

Scientific objectivity of the study will be maintained with honesty

and impartiality.

8. LIST OF REFERENCES:

1. J. Viswanath, A.B Desai. “The text book of paediatrics”. 3 rd edition. Newdelhi.

Orient Longman publication. 2005. p.no 181-183

2. Wisewell T.E. “Neonatal resuscitation”. Respiratory care 48. no:3. march 2003.

p.no:288-294.

3. Cheung P.Y, C.M Robertson. “Predicting the outcome of term neonate with

intrapartum asphyxia”. Acta pediatrics 89. no:3. march 2000. P.no: 262-264.

4. D.C Dutta. “The text book of Obstetrics”. 6 th edition. Calcutta. India. P.no:

469-471.

5. Annama Jacob. “The comprehensive text book of Midwifery”. 1st edition. New

Delhi. Jaypee publication. 2005. p.no: 662.

6. Parul Dutta. “The text book of Paediatrics” 1 st edition. Newdelhi. 2007. p.no:

80-82.

7. Barkkovich and Truwit “. “Brain damage from perinatal asphyxia”. 1087.

8. Laviton A, Nelson K.B. “Problems with definition and classification of

newborn encephalopathy”. Pediatr-neurul. 1992. p.no: 85-90.

9. Sarah Harris, Peter Fleming. “WHO Guidelines for management of apnoea in

birth asphyxia” U.K.

http//www.who.net/child.adolescent health

10. Ben Hamida NouailiE, Chaouachis. Department of neonatology. January.

2010.

11. Dave Woods. “Neonatal resuscitation”. International association for maternal

and neonatal health. October. 2004.

www.gfner.ch/medical education En/PGC RH 2004/Neonatal

asphyxia.htm

12. Misra P.K. Srivasthav .N, Malik G.K. “A study conducted on relation to

Apgar score in term neonates.” Lucknow.

13. Agarwal . r. Decorari A.K, Paul V.K. Department of Paediatrics. New Delhi.

India. December. 2001.

14. Wiggleworth J.S,“Monitoring prenatal mortality”. A pathophysiological

classification of prenatal death.p.no: 1345-1351.

15. Halloron DR, Moclure E, Chakrabharthy H. A cross incidence of birth

asphyxia. Saint Louis university. March. 2009.

16. B.T Basavanthappa. “Nursing Research”. New delhi. Jaypee publications.

2005. p.no: 49

17. Carlo WA, Goudar SS, Jehan I. “A study on mortality rate for low birth weight

infants in developing countries .despite training”. USA October.2010.

18. Wall SN, Lee AC, Niermeyer S, “A study on Neonatal resuscitation in low in

19. Berglund S, Normen M, Grunewad C. “A study on Neonatal resuscitation of

severe asphyxia”. Stockholm. Sweden. June. 2008.

sophie.berglund@sodersukhuset.se

20. Ann CC Lee, Luke C, Mullany. “A prospective community based cohort study

on birth asphyxia”. Katmandu. Nepal.. January 2007.

21. Duran R, Aladag N, Sut N. “A Retrospective study on Neonatal resuscitation

programme”. Trakya University of school medicine. Turkey. June. 2007.

ridvan duran @yahoo.com.

22. Rehana Majeed, Yasmeen Memon, Ferrukh majeed. “A prospective study on

birth asphyxia” Isra University, Hyderabad. 2007 .

23. Bang AT, Bang R, Baitule SB, “A study on management of birth asphyxia in

home deliveries”. Gadchiroli. India March. 2005.

search @satyam.net.in.

24. Lode N, Choukrio, Casadevall, Lagrue A.“A Retrospective study on Newborn

asphyxia at term during delivery”. Paris. February .2003..

noelle.lode@rbd.ap-hop-paries.fr

25. Ramji S, Rasaily R, Mishra PK . “A comparative study on efficiency of room

air versus 100% oxygen for resuscitation”. Moulana Azad Medical College, New

Delhi. India. .June . 2003.

26. Paul VK, Singh M, Sundaram KR. “A study on mortality among hospital born

neonate with birth asphyxia”. Newdelhi. India. March. 1997.

9. SIGNATURE OF THE STUDENT :

10. REMARKS OF THE GUIDE : The research topic

Selected for the study is

relevant and forwarded for the

needful action.

11. NAME AND DESIGNATION OF :

11.1 GUIDE NAME AND ADDRESS : Smt.Mercyrani.A

M.Sc. Nursing

Obstetrics and Gynaecological

Nursing

Indian College of Nursing,

Bellary.

11.2 SIGNATURE OF GUIDE :

11.3 CO – GUIDE (IF ANY) : Miss.Surbala

11.4 SIGNATURE :

11.5 HEAD OF THE DEPARTMENT :

NAME: Smt.Mercyrani.A

ADDRESS M.Sc. Nursing

Obstetrics and

Gynaecological Nursing

Indian College of Nursing

Bellary .

11.6. SIGNATURE OF H.O.D :

12. REMARKS OF THE CHAIRMAN: The research topic

AND PRINCIPAL selected by the

candidate is relevant

as it focuses on

knowledge

regarding

newborn

resuscitation in management of

birth asphyxia which in turn

will reduce the newborn’s

mortality and morbidity rate of

the nation.

12.1 SIGNATURE OF PRINCIPAL :