AN EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF

MUMMIFYING AND ROOMING-IN TO MAINTAIN THERMOREGULATION

AMONG NEONATES IMMEDIATELY AFTER BIRTH IN SELECTED HOSPITAL, AT
KATNI.

BY
MRS. SYLVIA R.MATHEW
(CHILD HEALTH NURSING)

ANUSHREE COLLEGE OF NURSING

RANI DURGAWATI VISHWAVIDYALAYA, JABALPUR, M.P

CHAPTER I
Neonatal week is observed every year with different themes because the journey towards healthy
nation begins here. A single yardstick that predicts the achievement of nation is neonate mortality
rate. On the light of high infant mortality rate in developing countries with special reference to
India [68/1000 live birth] the care for newborn is intensified. About 60% of neonatal death
contributes to infant mortality rate, 5dies in first 28 days of life.

keep me warm to help me survive the slogan once used for neonatal week an appeal from the
neonate is heart rendering in the event of high neonatal death [48/1000]sq.

Mother desire to be warm loving and close to their child. In 1967 Rubin found that women try
on and test their motherhood role by taking their own mothers or substitute mothers as role
model, support persons from sources of information and experiences. The mother and child
relationship progress from the pregnancy throughout the life of the child.

The infant mortality occurring during the first month of life must be addressed. About 2/3 of the
infant mortality occurs in the first week of life, and of these occurs in the first month of life.
The main cause of early neonatal deaths are hypothermia, asphyxia, birth trauma, infection,
prematurity and malformations. During the remainder of the first month, deaths are due to sepsis,
pneumonia, meningitis and diarrhea.

The highest neonatal mortality rates are in Asia and Africa, which account for 92 percent of all
the neonatal deaths in the world. Neonatal mortality rates are expressed as rates per 1000 live
births. The neonatal mortality rates in Latin America and Oceania are about half that in Africa
and Asia but about three times the rate in Europe and North America.

Instinct leads mother to keep their neonates warm and this instinct surely prevailed during
millennia that preceded recorded history;
1. Organized institutional program for the care of neonates did not appear until the last
quarter of 19th century. Tarnier in Paris and Budin, his intern and successor, were largely
responsible for the first protocols for in hospital global care of neonates.
2. Previously fondling asylum cares for unwanted neonates who were dropped off by the
parents.
3. Provision of warmth, breast milk and tender nurture by mothers, it followed that their
postnatal care should be continuation of the nurtutre that began in utero.
Temperature is normally regulated in the brain [primarily hypothalamus] with integrates
thermal input from skin surface, lower neural centres and deep threshold temperature for
each thermoregulatory response. Most of this thermo information is preprocessed in
spinal cord and brain stem although some mechanism shivering, vaso dilatation, cause an
increase in cardiac load stress.
Body core temperature

Heat
retention
Insulation
body fat
surface to
volume
ration shell
to core
shunting

Heat
production
shivering

Less
than
cold

Cold
challenge
Temperature
Wetness
Environmen
t

Table no. 1 body core temperature.

Hypothermia
=

Emotional attachment to the child begins during the prenatal period as women use
fantasizing and day dreaming to prepare themselves for motherhood Rubin [1975] and
Gaffney [1988]
Thermal protection is the series of measures taken at birth and during the first day of life
to ensure that the newborn baby doesnot become either too cold [hypothermia] or too hot
[hyperthermia] and maintains a normal body temperature of 36.5 37.5 degree Celsius
[97.7 99.5 degree Fahrenheit]
New born babies cool down or heat up much quicker than adults because they cannot
regulate body temperature as well. The smaller baby and the more premature the risk is
greater. The heat loss mechanism in newborn like evaporation, conduction, convection
and radiation.
The majority of the heat loss occurs during the first minutes after birth. In the first 10-20
minutes the newborn may lose by 2-4 degree C [3.6 7.2 degree F] and more loss in the
following hours. Preventing heat loss at the time of birth through four ways such as
drying, wrapping, skin-to-skin contact and breast feeding.
Bathing of the newborn baby soon after birth causes a drop in temperature and is not
necessary. If cultural tradition demands bathing it should not be carried out before six
hours after birth, and preferably the second or third day of life. When newborn is healthy
and its temperature is normal, bathing can be done quickly in a warm room using warm
water. The baby dried thoroughly and dressed [wrapped the baby]
Touch or the tactile sense is used to the newborn comfort. Mother and newborn seems to
enjoy sharing each others body warmth. A large amount of heat is produced and lost from
the body constantly. The nurse role is to maintain the warm chain from the time of birth.

WARM DELIVERY ROOM

Conduct Training And

Immediate Drying Of The Baby

Awareness Program

Warm transport

skin-to-skin contact

Warm resuscitation

post poned bathing and

[mummyfying]

weighing

Rooming in

FIG. NO : 1. WARM CHAIN

In the warm chain rooming in wrapping the baby {mummifying} were placed in an important
role. At first midwife and pediatric nurse role to maintain the warm delivery room and immediate
drying of the new born. The rooming in and wrapping the baby (mummifying) to maintain the
temperature of the new born to prevent hypothermia.
Newborn needs human touch to survive and it is an important part of their life development.
Rooming-in is a wonderful safe way for new parents to interact and nurture their baby. The
infant is calmed through the warmth of their parents skin and the sound of the parents breathing,
voice and heart beat.

Rooming in refers to hospital arrangement for maternity patients where in a mother and her
newborn are cared for together in the same room. In rooming in nurse remains responsible for
nursing care of both the mother and the baby.

In rooming in unit, the mother has an opportunity to bond her newborn and practice dressing and
wrapping her newborn. The staff may be responsible for meeting rooming in newborns needs and
for educating parents about newborn care.

The neonate is placed on cloth with shoulders at fold and feet toward the opposite corner, with
the infant right arm straight down against the body neonate right shoulder and chest and beneath
left side of the body. This procedure is called as mummifying, carried out to prevent heat loss
due to large surface area.

The method used to keep the baby warm will depend on its weight, gestational age and health as
well as on the availability of staff and equipment, warming devices such as radiant heaters,
heated water filled mattresses, should only be used in institutions that have a reliable electricity
supply, skilled personnel to care for babies. In warming devices staff should be skilled in
maintaining cleaning repair of the warming devices, and must have knowledge on spare parts are
available. But the rooming in and mummifying is inexpensive and more effective to regulate
newborn temperature.

Nurses play a vital role in maintaining thermoregulation in newborn. If thermoregulation is not

regulated, it results to hypothermia and death. The nurse should warm her hands, delay initial
bath until body temperature has stabilized, tub bath should be given and dried quickly.

NEED FOR THE STUDY

Future destiny of the child is always the work of the mother
-

Napoleon

The health care delivery system of most countries is complex interaction of many interest groups
{clients, physicians, nurses, etc} all competing for limited resources. In the past decade
efficiency drives perspectives which have dominated international health policy debates {Gilson,
1998} but as the decade draws to a close, there is a persistent high level of ill health and
inequalities in health and access to health care which indicates that equity in health care are still
inadequately addressed.

Since the declaration of health for all at alma ata in 1978, the health care systems of most
countries have generally improved for the better as evidenced by increase life expectancies,
lowered mortality rates, and higher standards of living.

At present most health information is disaggregated in the form of mortality and morbidity rates
according to age, race, or ethnicity, socio-economic status, urban or rural and sex, although the
latter category is seldom used in some countries. The relationship between the various indicators
provides the greater information on equity rather than each indicator taken separately, for
example Mocumbi {1997} uses a quadrant analysis to relate health needs with health care
provision to indicate efficiency and equity between need and supply of health care services.
Approximately 130 million infants born worldwide each year, is estimated that four million
infants die during 1st month of life. The vast majority of these neonatal deaths occur in poor
countries where standards of both maternal and newborn care are low. One of the Millennium
Development Goals is to reduce the number of childhood deaths under the age of five years by
two thirds from 95 per 1000 to 31 per 1000 by 2015. In South Africa, approximately 33% of
deaths of under-five-year olds, 44% of infants deaths {before one year}, and 87% of neonatal
deaths {in the first month} occur during the first seven days after birth.

The village health workers carried a survey on neonatal mortality rate from the year of 20002005 and observed 763 neonates in the first year, 685 in the second and 913 in the third year. The
change in the percent incidence of morbidities was i. infections, from 61.6 to 27.5 (-55% ; p
<0.001), ii. Care related morbidities (asphyxia, hypothermia,feeding problems) from 48.2 to
26.3 9 (-4.5% ; p<0.001); iii. Low birth weight from 41.9 to 35.2 (-16%; p<0.05); iv. Preterm
birth and congenital anomalies remain unchanged. The mean number of morbidities/100
neonates in the 3yrs.was 228,170 and 115 (a reduction of 46.9%; p<0.001).

In general, newborn needs a warmer environment than adults. In fact a naked newborn exposed
to a room temperature of 23 c (73.4 F) suffers the same heat loss as does a naked adult at 0c (32
F) hypothermia and hyperthermia are dangerous and may cause the death of the baby, but are
easily prevented by simple procedure of mummifying special equipment.

The newborn has universal self care deficits take priority in the first few hours; comprehensive
nursing care is the parents role and their dependent care deficits.

The idea of providing warmth for newborn was always with challenge. Treatment of core
temperature changes can be passive in mild cases or in advanced cases.

The human thermoregulatory system usually maintains body core temperature 0.2 to 37 degree
C. When human internal temperature deviates significantly, metabolic deteriorate and death may
result. Outcome studies have shown hypothermia (1deg.C-2DEG.C), moderate (27-32deg.C),
based on core temperature. Below 90deg.F or 32.2deg.C neonate looses shivers and cannot
rewarms spontaneously., such severe hypothermic is usually accidental environmental
exposure. Severe hypothermia may stimulate death in the caveat. no one is dead until they are
warm and dead.

Post natal hypothermia was prolonged, with axillaries core temperature only reaching 36deg.C
after mean of 6.4 hrs. (range 0.21, SD-4.6). There was persistent and increasing cold stress over
first 24 hours wit hcore skin temperature (axillary fore head) temperature gap exceeding 3
degrees C for more than half of first 24 hours. The severity and duration of thermal problems
was greater than expected even in hospital setting where some of the WHO recommendation had
already been implemented.

The temperature range in which basal metabolic rate of the baby is minimu, oxygen utilization is
least and baby thrives well is known as thermo neutral range of temperature or Neutral thermal
environment. For baby 2.5 3.5 kg

Age
0-6 hrs
6-12hrs
12-24hrs
24-36hrs
36-48hrs
48-72hrs

Range of temperature
32.0-33.8 d/C
31.4-33.8 d/C
31.0-33.7d/C
30.7-33.7d/C
30.5-33.3d/C
30.1-33.3d/C

Table no: 2. Age and Body Temperature.

Hypothermia is classified as accidental or intentional and primary or secondary. Primary or

accidental hypothermia is due to environmental exposure with no underlying medical condition
causing disruption of temperature regulation. And may happen from accidental exposure to cold
by immersion in cold water or by trauma from a serious accident. In the elderly, hypothermia
may develop over hours or days as a result of poor body heat regulation, inability to properly
sense the cold, or living in cold environment in the winter. Diseases of the endocrine glands also
may result in decrease heat production in the body.

Hypothermia results from an abnormally low body temperature which causes the circulatory,
respiratory and nervous system to slow down. Body temperature is a balance between how much
heat is produce and how much heat is lost with the brain acting as the thermostat, severe
hypothermia cause an irregular heart beat which can lead to the heart failure and possibly death,
over 700 deaths occur annually from hypothermia in united states.

Neonates with mild hypothermia have an excellent prognosis. However, morderate to severe
hypothermia can face serious complications and even death. Children are more likely to recover
from severe hypothermia than adults.

Nurses have the most important role to play prevention and proper guidance on how to take care
of new born. Neonatal nursing is fast emerging as specialized field to prepare competent nurses.
Nurses force in to area, our claim to march towards progress would sound unauthentic, if we fail
to bring down neonatal deaths- the bundle of joy that every aspirant, parents look forward to
cuddle in their arms should exceed joy and happiness, not pail of gloom.

CHAPTER II
This chapter deals with the objectives, hypotheses, operational definition, assumption, limitations
of the study, significance of the study and conceptual framework.

OBJECTIVES:
1. To assess the level of thermoregulation before mummifying and rooming in among
neonates in experimental and control group.
2. To evaluate the level of thermoregulation after mummifying and rooming in among
neonates in experimental and control group.
3. To compare the level of thermoregulation between experimental and control group.
4. To associate the level of thermoregulation with demographic variable in experimental and
control group.

HYPOTHESES:
H1 : The neonates with mummifying and rooming in will have lesser occurrence of hypothermia
than those neonate without it.
H2 : The neonates are more prone to hypothermia than the neonates with mummifying and
rooming in.

OPERATIONAL DEFINITIONS:
An operational definition of a concept is a specification of the operations that researcher must
perform in order to collect the required informations.
1. Assess :
An activity to appraise the outcome of mummifying and rooming in on temperature
2. Effectiveness :
It is significant maintenance in the level of thermoregulation among neonates regarding
mummifying and rooming in, is measured through modified temperature chart and
compare with experimental and control group. The scores will be interpreted as below
average (<50%) average (51-75%) and excellent (>76%)
3. Mummifying:

It is a shell of covering the neonate with the flannel cloth made in to a quilt to prevent
heat loss.
4. Rooming in:
The neonate is placed with the mother for body contact to maintain body temperature.
5. Thermoregulation:
Temperature maintainence takes place in neonatal by heat production and heat loss
mechanisms. It is measured through electronic axillary thermometer before, immediate
and after doing intervention. (mummifying and rooming in)
ASSUMPTIONS:

Speed of air enhances rapid heat loss

Multiple layers of cloth will trap air and retain heat.
Skin is a vital organ in heat regulation.
Neonates are prone to hypothermia due to environmental conditions.

DELIMITATIONS:

The study was limited to neonates immediately after birth in M.G.M Hospital &
research centre, Katni.
Sample size limited to 60 neonates due to availability of samples.
Prescribed data collection period is only 4 weeks.

SIGNIFICANCE OF THE STUDY:

The study implies the importance of mummifying and rooming in by maintaining temperature of
the neonates.

CONCEPTUAL FRAMEWORK:

Theory is a set of interrelated concepts that provide a systemic explanatory and predictive view
of phenomena can begin as an untested premise (hypothesis) that becomes a theory when tested
and supported or can progress in a more inductive manner.

Theory can be developed by using only conceptual approaches. Conceptual framework is

deliberately formed from experience and it conveys the human experiences of the concept.
Conceptual framework is created by considering all three sources of experiences related to the
concept ,the word, thing itself, and the associated feelings. The same word may be used to
represent more phenomenon.

The investigator adopted Ernestine Widen Bach need for help (1969) to the present study
because the pediatric nurse can use this theory model for the childbearing mothers.

Ernestine Widen Bach offers a prescriptive nursing theory based on clinical practice. Widen
Bach first published her ideas in 1964 in clinical nursing, A helping Art.

Widen Bach proposes a prescriptive theory for nursing, which is described as a conceiving of a
desired situation and the ways to attain it. Prescriptive theory directs action towards an explicit
goal. It consists of three factors, central purpose, prescription and realities a nurse develops a
prescription based on a central purpose and implements it according to the realities of the
situation.

The five realities identified by Widen Bach are agent, recipient, goal, means and framework.
The agent
The recipient
The goal
The means
The framework

- the nurse and the post natal mothers.

- the neonates.
- maintaining the normal temperature
- mummifying and rooming in
- postnatal ward and labour room of M.G.M Hospital &Research
Centre, Katni.

According to Widen Bach,, a nurses central purpose is based on a personal philosophy. The
three essential aspect of a nursing philosophy are a reverence for life, a respect for the dignity of
each person, and resolve to act dynamically in relation to ones beliefs.

Widen Bach also offers a conceptualization of nursing practice. It includes identification,

administration, and validation.

Identification
It determines patients need for help based on the existence of a need, whether the patient
realizes the need, what prevents the patients from meeting the need, and whether the patient
cannot meet the need alone. Postnatal mothers need for help assessed in the identification phase.
The postnatal primi and second gravidae mothers are need to maintain the temperature of the
neonates. Hence, they have lot of factors affecting like age, education, occupation, type of work,
family income, type of family, habitant, religion, social support, sex of the baby, gravidae, para,
abortion, still birth and gestational age of the baby and weight of the baby. Neonates are divided
in to two groups as experimental and control group.

Ministration
The nurse act according to the need, which is assessed in the identification phase. Then
mummifying and rooming in was provided to three days as pr before, 1 hour after procedure, 3
hours after procedure and 5 hours after procedure only for experimental group.

Validation
The investigator validated the intervention before and after the mummifying and rooming in,
assumed that the neonatal temperature will be maintained.

Summary
This chapter dealt with the objectives of the study, operational definitions, hypothesis,
assumptions, delimitation and significance of the study and conceptual framework.

CHAPTER III
REVIEW OF LITERATURE
Survey of literature provides valuable help in the development of knowledge of research project.
A review of literature is an essential aspect of scientific research. One of the major functions of
review of research literature is to ascertain what is already known in relation to the problem of
interest and this will help in developing of broad conceptual framework in to which a research
problem will fit.
Literature is a standard requisition of scientific research. It means reading and writing the
pertinent information of the attempt in research topic to understand better about the proposed
topic. It also support and explained why the proposed topic is taken for research, and avoid
unnecessary duplication to explore the feasibility and illuminate the way of new researcher.

The investigator to gain insight in to the selected problem did an extensive review of literature.
Review of literature is presented under the following heading.
1. GENERAL INFORMATION ABOUT THERMOREGULATION.
2. STUDIES RELATED TO HYPOTHERMIA.
3. EFFECT OF MUMMIFYING TO MAINTAIN THERMOREGULATION.
4. EFFECT OF ROOMING IN TO MAINTAIN THERMOREGULATION.

1.GENERAL INFORMATION ABOUT THERMOREGULATION:

A study done on importance of thermoregulation among 34 healthy mothers and infants at New
York. This study reveals that when internal temperature deviates significantly, metabolism
deteriorate, and death may result.

A study was conducted on maternal and new born outcome related to maternal warming with
sample of 62 neonates and mothers at Canada. Randomized control design is used. Neonates
were received either forced air warming blanket (intervention) or usual care warmed cotton
blankets (control). It reveals, with the exception of perceived thermal comfort, neonates in the
two groups were not significantly in terms of axillary temperature. Although mothers oral
temperature were within the normal range, the neonate in both groups showed significant decline
in body temperature to mild hypothermic range (control 36.7C 0.40C to 35.9 C 0.5 C p<

0.001 ; intervention 36.8 c 0.4c to 36.1c 0.4 c p<0.001). the study concludes that usual
treatment of supplying warmed cotton blankets remains the treatment of choice for this
population.

A cohort study was conducted on hygienic intervention on thermal stability of newborn in first
48 hrs. at Spain. A prospective study was done. The study reveals that Tc (core temperature) and
Tp (peripheral) decreased by mean of 1deg.C with respect to baseline temperature. A fall in
axillary temperature observed in 87.4 % of recordings and a fall to less than 36deg. C was
observed in 45.5%, axillary temperature at duration of almost 1 hr.

A study investigated on change in the body temperature of healthy term infant over the first 72
hours of life. All 2oo consecutive cases of neonates delivered at our hospital from march to aug.
2001 were included in this retrospective study. The result was, mean rectal temperature at birth
was 37.19 degrees C. the lowest average temperature was reached at 1 hour after delivery
(36.54degreesC) with a significant difference between natural delivery (36.48 degrees C)and
section (36.59 degrees C) (P<0.05). Temperature subsequently rose to 36.70 degrees C at 8 hours
and 36.78 degrees C at 15 hours (P<0.05). Hypothermia was seen I 51.8% and hypothermia in
42.5 % of the patients. On the 3 rd day after delivery, 96% of all temperatures were in the normal
range. A significant relation was found between hypothermia on both low birth weight (P<0.001)
and low gestational age (P<0.05)

A study on influence of head position on thermal stress in newborn at France. The study reveals
when head is uncovered, dry heat loss from mannequin as whole is lower (-0.35 to -0.40 W) in
the face to the side position than in the face straight up position as a result of decreased heat loss
from surface area of the face in contact with the mattress. It suggests that in heavily clothed
newborn whose head is covered by bonnet thermal stress depends on head position and maintain
thermoregulation.

A study conducted on thermoregulation in neonates. It is a critical physiological function that is

closely related to transition and survival of the infant. And understanding of transitional events
and physiological adaptation that neonates must make is essential to helping the nurse provide
and appropriate environment and help the infants maintain thermal stability. This article reviews
neonatal thermal regulation, heat loss and gain and the thermal response that is generated when
thermal stability is threatened.

2.STUDIES RELATED TO HYPOTHERMIA:

A study conducted to assess the incidence of hypothermia was high in both low birth weight
(LBW) and normal birth weight (NBW) infants. Acceptance of skin-to-skin care (STSC) was
nearly universal. No adverse events from STSC were reported. STSC was perceived to prevent
newborn hypothermia, enhance mothers capability to protect her baby from evil spirits, and
make the baby more content. The study concluded that STSC was highly acceptable in rural
India when introduced through appropriate cultural paradigms. STSC may be of benefit for all
newborns and for many mothers as well. New approaches are needed for introduction of STSC
may be of benefit for all the newborns and for all newborns and for many mothers as well. New
approaches are needed for introduction of STSC in the community compared to the hospital.

A study investigated on neonatal thermoregulation. Thermoregulation is the ability to balance

between heat production and heat loss in order to maintain body temperature within a certain
normal range. The provision of a thermo neutral environment is an essential component of the
immediate and longer term care of new born infants. Cold stress and hyperthermia may have
serious metabolic consequences for all newborns. In the preterm these consequences may be
devastating and may increase both morbidity and mortality rates. Health professionals have a
responsibility to be aware of and to ensure that the thermoregulatory needs of the infant are
upheld in order to provide them with the best start possible. Current medical literature lacks well
designed, prospective, randomized controlled trials for both diagnosis and intervention of
providing thermo neutral environment and systemic reviews report that none of the interventions
have serious adverse effects.

A study on neonatal hypothermia in Uganda: prevalence and risk factors. A cross sectional,
descriptive study of neonatal hypothermia was performed on 300 newborns consecutively
recruited day and night during 2months at a Ugandan per urban hospital. Parallel tympanic and
rectal temperature measurements were made at 10, 30, 60, and 90 min post partum. Rectal
temperatures taken at 10, 30, 60, and 90 min showed that 29, 82, 83 and 79% of the new borns,
respectively, were hypothermic. New borns observed to have no body contact with the mother
comprised 87% of hypothermic newborns, whereas this was the case in 75% of the nonhypothermic newborn (p=0.03). the mean birth weight was 3218 g. a persistent pattern of high
prevalence of neonatal hypothermia was confirmed and indicates that more vigorous efforts have

to be undertaken, also in a tropical setting to overcome problems of non-adherence to appropriate

methods for non thermo protection of the newborn.

A study done on hypothermia in Iranian newborns. Incidence, risk factors and related
complications. In 1952 neonates were selected randomly by using a multistage sampling
technique from February 2004 to February 2005. The obtained results showed that approximately
one third of the new borns became hypothermic immediately after birth. This study concludes,
there is an urgent need to train mothers and all levels of neonatal care staff to control this health
problem in our country.

A study conducted on the impact of new born bathing on the prevalence of neonatal hypothermia
in Uganda : a randomized, controlled trial at Sweden. Non-asphyxiated newborns after vaginal
delivery (n=249) in a Ugandan referral hospital were consecutively enrolled and randomized
either to bathing at 60 min post partum (n=126)Or no bathing (n=123). All mothers practiced
skin-to-skin care iof their newborns. Four rectal and tympanic registrations of newborn
temperatures were carried out in both groups directly after drying at birth, and at 60, 70 and 90
min post partum. Result were bathing of newborns in the first hour after delivery resulted in a
significantly increased prevalence of hypothermia, defined as temperature <36.5deg. C, at 70 and
at 90 min postpartum despite the use of warmed water and the application of the STS method.
There was no neonatal mortality. Aside from the bathing procedure, no back ground factor
potentially predisposing the newborn to hypothermia was identified.

A study done on neonatal hypothermia levels and risk factors for mortality in a tropical country.
Cross sectional descriptive study. Three hundred and thirteen consecutive newborn infants
admitted to the NNU for care. Results are prevalence of hypothermia on admission was 85%
with a mean axillary temperature of 34.3 degrees C (SD=1.6).median age on admission was 120
mins and there was a case fatality rate of 18.3%. the need for resuscitation, age at admission to
NNU, time of delivery, birth weight, sex and being born before arrival were not significantly
associated with being hypothermic. The only factors that were associated with mortality were
babies being born before arrival.

A study conducted to risk factors associated with neonatal hypothermia during cleaning of
newborn infants in labor rooms. The core temperature of 227 randomly selected normal term
infants immediately before and after cleaning in a labour room was measured with infrared
tympanic thermometer inserted in to their left ears. Their mean post cleaning body temperature

(36.6deg. C, SD= 1.0) was significantly lower than their mean pre cleaning body temperature
(37.1 deg .C, SD=1.0; p<0.001). logistic regression analysis showed that the risk factors
significantly associated with precleaning hypothermia (,36.5deg.C) were:
1. Not being placed under radiant warmer before cleaning p=0.03
2. Lower labour room temperature (p<0.001). logistic regression analysis also
showed that the risk factor significantly associated with post cleaning
hypothermia were lower pre-cleaning body temperature (p=0.001); and
longer duration of cleaning(p=0.002). it concludes that labour room
temperature to set at a higher level to maintain thermoregulation instead of
cleaning infants in the labour room should be discouraged.

3.EFFECT OF MUMMIFYING TO MAINTAIN THERMOREGULATION:

A study on warm blankets prevents hypothermia at birth in term infants at USA. Twenty seven
infants with similar baseline characteristics were assigned and placed in warm blanket (n=14)
immediately following delivery without drying and placement under a radiant warmer. Axillary
temperature was recorded on admission to the neonatal unit. The results show that the average
temperature in the warm blanket was significantly higher (35.9 0.13 vs. 34.90.24 deg. C,
(p=0.002). it concludes that warm blanket prevent heat loss and are a simple and effective
intervention in preventing hypothermia in the delivery room and early acidosis in infants.

A study conducted to systematically identify and synthesize investigation of the effectiveness of

occlusive skin wrap for reducing heat loss in infants born. The study findings suggest that
occlusive skin wrap prevents heat loss in infants. The meta-analysis lacked the power to provide
definitive results regarding the effect of wrap on mortality.
A study done on safety of neonatal skin cleansing in rural Nepal among 32-neonates at Nepal.
The study explains body temperature of new born decreased an average of 0.40 deg C (95% cl:
0.31-0.49 deg C, p<0.0001) in cleansing the baby after birth.

EFFECT OF ROOMIING IN TO MAINTAIN THERMOREGULATION:

A study done on mother and infant: early emotional ties. Recent behavioral and physiologic
observations of infants and mothers have shown them ready to begin interacting in the first
minutes of life. Included among these findings is the newborn infants ability to crawl toward the
breast to initiate suckling and mother-infant thermoregulation. The attachment felt between

mother and infant may be biochemical modulated through oxytocin; encouraging attachment
through early contact, suckling and rooming in has been shown to reduce abandonment.

A study has been done on bed sharing and infants thermal environment in home setting with the
sample of 40 infants at New Zealand. The study implies that the mean rectal temperature two
hours after sleep onset for bed share infants was 36.79 deg.C and cot sleeping infants was
36.75deg. C (difference 0.05deg C, 95% cl-0.03 to 0.14). The rate of change thereafter was
higher in the bed share group than in the cot share group (0.04deg C v 0.03deg C/h, difference
0.01,0.00,to 0.02).

A study was conducted on Night rooming in: who decides? An example of staff influence on
mothers attitude among 132 infants at Sweden. the study reveals that the mother who had not
roomed in with their babies were more likely to perceive fewer attitudes towards mother. The
staff believed their babies should stay in the nursery compared with those mothers who practiced
night rooming in (Z= -2.733, P=0.006). Mothers not rooming in with their babies scored
closeness to their babies as less important than those mothers who roomed in with their babies as
less important than those mothers who roomed in with their babies [z=(-3.780),p=0.0002]; they
also were more worried about their own and their sleep(z= -2.321, p=0.02).

A retrospective study was performed on rooming in thermal management for Newborns in

Australia. The study implies use of rooming in resulted in a higher temperature for neonates (z=
108.50 p<0.01).

A study conducted on guideline on co-sleeping and breast feeding. it states that parent child cosleeping provides physical protection for the infant against cold and extense the duration of
breast feeding thus improving the chances of survival of the slowly developing human infant.

A study conducted to find that rooming in was to help a parent feel connected. Eye contact led to
an experience of knowing infant. Full term neonates have placed on moms chest, kicking and
screaming then quieting to look in to mom dads face. So more attachment will form parents and
neonates. This study concluded that when baby got cold, the mothers body temperature would
increase to warm the baby up and to prevent hypothermia.

A study concluded that close contact (rooming in) seems to influence state organization and
motor system (neuro behavioral response)modulation of the new born infant shortly after
delivery. This study conducted 1-hour long observation starting at 4 hours postnatally : the
infants kept close in close contact (rooming in) slept longer , were mostly in a quiet sleep state,
exhibited more flexor movements and postures, showed less extensor movements.

A study conducted to compare that skin to skin care and traditional care. 140 infants were
selected and conducted a comparative study was find that rooming in had a significant positive
impact on the perceptual, cognitive and motor development and on the parenting process, and an
indirect effect by improving parental mood, perception and interactive behavior.

This study examines the policy of rooming in which is in most public maternity hospitals in
Australia. Rooming in is the practice where the baby is placed in a cot beside the mothers bed
and is cared for by the mother while she is in hospital. Rooming in may strengthen the mother
infant bond and lead to the early establishment of breastfeeding because the mother will have
close contact and involvement with her new born from birth. The policy should, therefore,
benefit most new mothers and their newborn infants.

A comparative study done on mothers touching newborns of rooming in versus minimal contact.
We compared the maternal behaviors of women who had extended an early contact (rooming in)
with their infants with those who had contact only during feedings. Thirty one young, unmarried,
predominantly black, lower socioeconomic mothers and their infants were observed in the
mothers hospital room for 15 mins after a morning feeding approximately 18 hours after
delivery. This study suggests that increased postpartum contact with infants leads not only to
more interaction, but also to more touching as well as touching in more intimate places (face ,
head), thus highlighting the value of rooming in arrangements for mothers and infants.

A study investigated on early mother infants contact and infants temperature stabilization.
Thirty healthy mother infant were divided in to 2groups, nineteen control infants were placed in
heated cribs and fifteen were given immediate and extended physical contact with the mothers.
The result indicates separating normal newborn from the mothers will have of fluctuation of
temperature.
Rooming in is the most favorable wellbeing of the mother infant relationship. Mothers with
children 0-24 months of age were randomly selected in to 2 groups of infants wit hnormal
deliveries before (210 infants) and after (160 infants) the rooming in system (1987 and 1990).

The findings were that separation time decreased significantly from 6.3 + or -3.2 hours in 1987
to 1.62 4.2 hours in 1990. Predominant breast feeding (0-4 months) prevalence at discharge
increased from 85% to 99%, which was significant increase at p 0.05- 92% initiated breast
feeding in 1987 while 99% initiated breast feeding in 1990 with rooming in predominant breast
feeding (0-4months) increased significantly from 33% in 1987 to 56% in 1990. Current breast
feeding at 24 months did not show a significant increase, i.e, 44% in 1987 vs 48% in 1990. The
rate of child desertion decreased significantly from 3.6/1000 live births in 1987 to .1/1000 live
births in 1990. Predominantly breast feeding was selected as the appropriate variable since
mothers regularly give infants some water after breast feeding.

CHAPTER IV
METHODOLOGY
INTRODUCTION:
Research methodology refers to controlled investigation of the ways of obtaining and analyzing
data. Research methods are the steps, procedures and strategies for gathering and analyzing the
data in a research investigation.

This chapter deals with the methodological approach to assess the effectiveness of mummifying
and rooming in on neonatal temperature among postnatal mothers admitted at M.G.M Hospital &
research centre, Katni

It includes description of research approach, research design, study setting and sampling
technique, development and description of the tool, data collection technique and plan for data
analysis.

RESEARCH APPROACH:
The research approach adopted for this study was an evaluative approach. Evaluative approach
helps to explain the effect of independent variables on the dependent variables. This approach is
considered most suitable for this study.

RESEARCH DESIGN:
The research design refers to the researchers overall plan for obtaining answers to the research
questions and for testing the research hypothesis. The research design spells out the strategies
that the researcher adopts to develop information that is accurate, object and interpretable.
For the present study the design was an experimental design, which includes manipulation,
control and randomization.

Table No. 3. SCHEMATIC REPRESENTATION OF THE RESEARCH DESIGN:

An experimental study with two group pre and post test.
E

01

1ST DAY
X
02 03

01

02

03

04

05

04

05

2ND DAY
X1 06 07
-

Key:
01 Pre assessment of temperature on first day.

06

07

08

09

08

09

3RD DAY
X2 010 011
-

01-

011

012
012

X, X1, X2 mummifying and rooming in was given on first day, second day , and third day.
02,03,04 Assessment of temperature after one hour , after three hours, and after five hours of
mummifying and rooming in on 1st day.
05, 09 Pre assessment of temperature on second day.
06, 07, 08 assessment of temperature after 1 hour, after 3hours, and after 5 hours of
mummifying and rooming in on 2nd day.
VARIABLES:
Variables are the qualities, properties or characteristics of person, things or situation that change
or vary.
The variables are mainly included in this study are independent variable and dependent variable.
Dependent variable explains the effect of independent variable and dependent variable.
Dependent variable explains the effect of independent variable
INDEPENDENT VARIABLES:
An independent variable is the variable that stands alive is not dependent on any other. In this
study independent variable refers to mummifying and rooming in.
DEPENDENT VARIABLES:
Dependent variable is the variable that the researcher is interested in understanding, explaining
or predicting. In this study the dependent variable refers to neonatal temperature.
EXTRANEOUS VARIABLES:

The extraneous variables under the study are age (in years), education, occupation, type of work,
family income, type of family, habitant, religion, social support of the post natal mothers, sex of
the baby, gravidae, para, abortion, still birth and gestational age and weight of neonate.
SETTING OF THE STUDY:
Setting is the general location and condition in which data collection takes place in the study.

The present study was conducted in post natal ward and labour room of M.G.M Hospital &
research centre, Katni, Madhya Pradesh. The hospital is a multispecialty hospital. It was started
in the year 2004. There are approximately 200 normal vaginal deliveries per month. In that 70%
consist of primi and second gravidae mothers only.

TARGET POPULATION:
Population is defined as the entire aggregation of cases that meet the designed set of criteria. The
target population of the present study includes the neonates immediately after birth in the labour
room and post natal ward of M.G.M Hospital & research centre. Katni
SAMPLE AND SAMPLING TECHNIQUE:
Sample consists of a subset of a population selected to participate in a research study.
Sampling refers to the process of selecting a portion of the population, to represent the entire
population.

SAMPLE SIZE:
The sample used for the study was 60 neonates. A total of 60 neonates were equally divided in to
two groups as experimental group with 30 neonates, and control group with 30 neonates.

SAMPLING TECHNIQUE:
In this study the simple random sampling was used. The researcher selected the subjects
randomly for both the experimental and control group in post natal ward of M.G.M Hospital and
research centre, Katni.

SCHEMATIC OUTLINE OF SAMPLING DESIGN

All the neonates who are in the postnatal ward and
labour room of M.G.M Hospital & research centre,
Katni

population

All the 60 neonates who fulfilled the inclusion

and exclusion criteria who are in postnatal ward
and labour room of M.G.M Hospital & research
centre, Katni

sample

Fig. no. : 3 schematic outline of sampling design

CRITERIA FOR THE SELECTION OF THE SAMPLE:

INCLUSION CRITERIA:
Neonates who are born after completion of 37 weeks.
Neonates immediately after birth.
Mothers who delivered at M.G.M Hospital & research centre, Katni and admitted in post
natal ward.
Neonates delivered through normal vaginal delivery.
Mothers who are all willing to participate and available during the time of study.

EXCLUSION CRITERIA:
Neonates with low birth weight and small for gestational age.
Neonates with congenital anomalies.
Neonates of mother who had undergone LSCS.

WILLINGNESS OF THE PARTICIPANTS:

Informed consent from the mothers obtained for the willingness of participants in the study.

DEVELOPMENT OF THE TOOL:

The investigator prepared the semi-structured questionnaire to collect the socio-demographic
variables, obstetric variables, and assessment tool for temperature to assess the effectiveness of
mummifying and rooming in on neonatal temperature among neonates.

STEPS IN THE CONTRUCTIION OF THE TOOL:

The investigator had involved the following steps in preparing tool.

Related literature was reviewed in the preparation of the tool.
Guidance and consultation of the pediatric experts in construction of tool and
modification of the tool was done as per guidance.
Consultation with the statistician was done for the preparation of the plan for statistical
analysis.

DESCRIPTION OF TOOL:
The developed tool was organized in two sections. They are as follows,
SECTION I
Socioeconomic demographic variables and obstetric variable. It consist of age, education,
occupation, type of work, family income, type of family, habitant, dietary pattern, religion, social
support of the mother, sex of the baby, gravidae, para, abortion, still birth, and gestational age,
and weight of the baby.

SECTION II
Modified temperature chart
Variable

Days

Before
mummifying and
rooming in
D1
D2
D3

1 hour after
mummifying and
rooming in
D1 D2 D3

3 hours after
mummifying and
rooming
D1 D2 D3

Table no. 4. Assessment tool for temperature

VALIDATION OF THE TOOL:

5 hours after
mummifying and
rooming in
D1 D2 D3

Validation refers to whether an instrument accurately measures what it is supposed to measure.

When an instrument is valid it truly reflects concept, it is supposed to measure. Content validity
of the instruments was assessed by obtaining opinion from experts in the field of obstetrics and
gynecology and pediatrics. As per recommendation, the necessary changes were made in the
tool.

RELIABILITY OF THE TOOL:

The reliability of the measuring instrument is major criteria to assess the quality and adequacy.
Reliability of the instrument is the degree of consistency with which it means the attribute it is
supposed to measure. A pilot study was conducted to test the reliability of the tool.
The reliability of the tool was established using test-re test technique. The reliability value of the
tool is 0.86. So tool was feasible and reliable.

PILOT STUDY:

Pilot study is a small scale version of trial run for the major study. The function of this is to
obtain information for improving the project or for assessing its feasibility and practical hitches.
After obtaining permission from the concerned authority a pilot study was conducted during 1st
week of November 2014.

METHOD OF DATA COLLECTION:

Written permission was taken from the hospital authority for conducting study and with the
cooperation of the nursing personnel in the labour room and post natal ward of M.G.M Hospital
& research centre, Katni, the feasibility of conducting study was ensured.
Data collection started from 15th September to 15th November 2014. The investigator established
good rapport with the mothers who are admitted in the labour room and post natal ward of
M.G.M Hospital & research centre, Katni and took consent from each mother to participate in
this study and collected the socio-demographic data, obstetric data was collected. The room
temperature was maintained at 24degree C and pretest was conducted for neonates in both the
experimental and control group. The post test was done after mummifying and rooming in after
one hour, after three hours and after five hours and this was repeated for three days. Temperature
assessed by using electronic axillarys thermometer.

PLAN FOR DATA ANALYSIS:

Data were collected and observed for 60 mothers out of which, 30 neonates were in experimental
group and 30 neonates were in the control group admitted in the postnatal ward of M.G.M
Hospital & research centre, Katni. The collected data conveniently summarized and tabulated by
applying descriptive statistics such as mean, mean deviation, frequency, percentage and standard,
deviation, and inferential statistics.

DATA ANALYSIS AND STATISTICAL METHODS USED

NO.

DATA ANALYSIS

1.

Descriptive
Frequency and
analysis
percentage
Inferential analysis Mean score and
deviation

2.

STATISTICAL
METHOD

REMARK

To analysis the
demographic variables.
To assess the level of
thermoregulation before
mummifying and
rooming in among
neonates in
Experiment and control
group.
To evaluate the level of
thermoregulation after

mummifying and
rooming in among
neonates in experimental
and control group.
Chi square test

ANOVA test
Student test

To compare the level of

thermoregulation
between experimental
and control group.
To associate the level of
thermoregulation with
demographic variable in
experimental and control
group.

Table no. 5. Data analysis and statistical methods used.

SUMMARY OF THE CHAPTER:

This chapter has dealt with the research approach, research design, study setting, sample
selection, development and description of the tool, pilot study, data collection procedure and the
plan for data analysis, which includes both descriptive and inferential statistics.
Fig.no.4 schematic representation of the study
Selection of 60 neonates who meet inclusion/exclusion criteria

Screening of the neonates admitted in labour room and

postnatal
Katni
Mummifying and
roomingward of M.G.M Hospital & research centre,
No
intervention
Experimental
group
control
group
st
nd
rd
Monitor
the
temperature
Monitor
the
temperature
in given during 1 ,2 ,3
Sampling technique- simple random
day
n=respectively
30 mothers
n=30 mothers
Plan for data analysis