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.
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..
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 :