newborn resuscitation teena2
TRANSCRIPT
SYNOPSIS
ON
“A STUDY TO EVALUATE THE EFFECTIVENESS OF
STRUCTURED VIDEO TEACHING PROGRAMME ON
NEONATAL RESUCITATION OF NEWBORNS
DEVELOPING NEONATAL ASPHYXIA
CONDUCTED AMONG STAFF NURSES WORKING
IN SVS HOSPITAL.
BY
SUBMITTED TO
DR. NTR UNIVERSITY OF HEALTH SCIENCES, VIJAYAWADA,
IN PARTIAL FULFILLMENT OF THE REQUREMENT
FOR THE DEGREE OF MASTER OF
SCIENCE IN NURSING
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATIN
1
Name of the candidate and address
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Name of the Institution
3
Course of Study and Subject M Sc Nursing First YearPediatric Nursing
4
Date of admission to course
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Title of the study “A study to evaluate the effectiveness of structured video teaching programme on neonatal
resuscitation of newborns developing perinatal asphyxia conducted among staff nurses
working in SVS Hospital, Mahabubnagar, AP”
6. BRIEF RESUME OF THE INTENDED WORK
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6.1 INTRODUCTION
“Minds are like parachutes. They only function when they are open”
Sir James Dewar
The birth of an infant is one of the most awe-inspiring and emotional events
that can occur one’s lifetime. After nine months of anticipation and preparation, the
neonate arrives amid a flurry of excitement of parents and also the other family members.
But if the neonate is not the healthy robust infant who was expected it creates problem
. Perinatal asphyxia is a common neonatal problem. The World Health
Organization has defined birth asphyxia as “failure to initiate and sustain breathing at
birth” and based on Apgar score as an Apgar score of <7 at one minute of life. Birth
asphyxia may result in adverse effects on all major body systems. Many of these
complications are potentially fatal. In a term infant with perinatal asphyxia renal,
neurological, cardiac and lung dysfunction occurs in 50%, 28%, 25% and 23% cases
respectively.
Early initiation of basic resuscitation interventions within 60 seconds in apneic
newborn infants is thought to be essential in preventing progression to circulatory
collapse based on experimental cardio-respiratory responses to asphyxia. Basic
resuscitation would substantially reduce itrapartum-related neonatal deaths. Where births
occur in facilities, it is a priority to ensure that nurses attending the births and also those
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working in the neonatal units are competent in resuscitation. Strategies to address the gap
for home births are urgently required. Fetal surveillance and attention to signs of
asphyxia must be improved; there should be cooperation between professionals in the
labour unit and, to create security barriers.
Even though all nurses are trained in cardiopulmonary resuscitation, or CPR,
they may not realize that newborns have different needs. American Heart Association
recently issued guidelines that effective chest compressions are far more important than
ventilations for adult victims while newborns primarily need ventilation. Suction devices
are not necessary to remove mucus from the newborn nose and throat. The lungs of the
rescuer can remove such secretions or they can be allowed to drain naturally by tipping
the baby's face down and holding the baby's body aloft on one arm. Vigorous babies can
clear their own airways. Such measures should be considered by the nurse while
resuscitating a newborn with asphyxia.
China’s Neonatal Resuscitation Program (NRP), also known as Freedom of
Breath, Fountain of Life launched in 2004. Since the program neonatal mortality caused
by birth asphyxia has declined in China by more than 53 percent, based on evaluated
program sites in 20 target provinces (each of which has more than 20,000 hospitals). The
success of the program has led to a policy change in China. Now, neonatal resuscitation
certification is a professional requirement for nurses, midwives and obstetricians working
in labor and delivery.
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6.2 NEED FOR THE STUDY
The National Neonatology Forum of India has defined asphyxia as “gasping or
ineffective breathing or lack of breathing at one minute of life”. . In India, between
250,000 to 350,000 infants die each year due to birth asphyxia, mostly within the first
three days of life. The National Neonatal Mortality Rate is 44 per 1000 live births per
year. The Neonatal Mortality Rate in the A P state is between 45 and 50.
Perinatal asphyxia is a serious neonatal problem and contributes significantly to
neonatal morbidity and mortality. It ranks as the second most important cause of neonatal
death after infections accounting for around 30% mortality worldwide. Each year
approximately 10 million babies do not breathe immediately at birth, of which about 6
million require basic neonatal resuscitation. The major burden is in low-income settings,
where health system capacity to provide neonatal resuscitation is inadequate.
Between 5%–10% of all babies born in all facilities need some degree of
resuscitation, such as tactile stimulation or airway clearing or positioning and
approximately 3%–6% require basic neonatal resuscitation, consisting of the simple
initial steps and assisted ventilation.
Delays in assisting the non-breathing newborn to establish ventilation may
exacerbate hypoxia, increase the need for assisted ventilation, and contribute to neonatal
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morbidity and mortality. Each year there is an estimated 904000 neonatal deaths
immediately after birth due to lack of proper resuscitative measures.
Experience over the last century has demonstrated that perinatal mortality can be
reduced by improved obstetrical and neonatal care. With the aim to avoid errors in care
by implementing system-based changes, a systematic review of the pitfalls and mistakes
in the clinical practice of perinatal medicine can be useful.
An evaluative study was conducted by Sophie Berglund and Mikael Norman of
Department of Clinical Science and Education, Stockholm, (2008), on neonatal
resuscitation after sever asphyxia in selected hospitals, Sweden among 177 cases. The
results showed that there are possibilities for improvement in the immediate neonatal
resuscitation within labour units. The most important contributions may be made by
improving compliance with the guidelines concerning ventilation, and the paging for the
early assistance of skilled personnel in cases of imminent asphyxia. The researchers
concluded that it is crucial that all of the staff on the labour ward is familiar with how to
initiate extensive neonatal resuscitation. Every case of unexpected asphyxia, also those
that recover without sequelae, should be scrutinized to enable the creation of security
barriers and improvements in each labour unit, concerning both obstetrical care and
neonatal resuscitation. They also stress the importance of improving the documentation
of neonatal resuscitation to enable accurate and reliable evaluation.
Vinod Paul of the All India Institute of Medical Sciences in New Delhi
presented a perspective on birth asphyxia in India. As in some other developing regions,
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birth asphyxia is the cause of 20% of neonatal deaths in India. Dr. Paul referred to the
studies of Bang et al who found that the incidence of severe birth asphyxia (no cry or
breath absent, slow or gasping at five minutes) was 4.6% of all births. He described
Dr.Bang’s studies of community-based interventions that involved training health
workers in neonatal resuscitation. These interventions resulted in a significant reduction
of asphyxia-related deaths.
When the necessary skills are learned, the attending nurse can approach any
resuscitation with a good comprehension of transitional physiology and adaptation, as
well as an understanding of the infant's response to resuscitation. Resuscitation involves
much more than possessing an ordered list of technical skills and having a resuscitation
team; it requires excellent assessment skills and a grounded understanding of physiology.
Competency in neonatal resuscitation should be developed and maintained by every
practicing nurse-midwife, although it is difficult to obtain the necessary experience. Thus
training the nurses on neonatal resuscitation can contribute a lot in reducing mortality and
morbidity due to birth asphyxia.
The above facts and findings along with the personal clinical experience
motivated the researcher to plan an educational programme on neonatal resuscitation for
staff nurses, helping them to give better care to their little clients; so that the mortality
and morbidity due to birth asphyxia can be reduced.
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6.3 STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of structured video teaching programme
on neonatal resuscitation of newborns developing birth asphyxia conducted among staff
nurses working in SVS Hospital, Mahabubnagar, AP”
6.4 OBJECTIVES OF THE STUDY
To assess the existing knowledge of staff nurses on neonatal resuscitation of
newborns developing birth asphyxia by pretest on staff nurses at SVS Hospital,
Mahabubnagar, AP.
To develop and implement structured video teaching programme on neonatal
resuscitation of newborns developing birth asphyxia to staff nurses working in
SVS Hospital, Mahabubnagar, AP.
To analyze the effectiveness of structured video teaching programme on neonatal
resuscitation of newborns developing birth asphyxia in terms of gain in
knowledge scores in post-test on staff nurses at SVS Hospital, Mahabubnagar,
AP.
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To determine the association between the pretest knowledge on neonatal
resuscitation of newborns developing birth asphyxia of staff nurses working in
SVS Hospital, Mahabubnagar, AP, with their selected demographic variables.
6.5 OPERATIONAL DEFINITIONS
Evaluate: It refers to grading based on statistical scale the knowledge of staff nurses ,to
determine the significance, importance or value of knowledge on neonatal resuscitation
of newborns developing birth asphyxia by a structured questionnaire among the staff
nurses.
Effectiveness: It refers to determine the extent to which the video teaching programme
has achieved the desired effect in terms of gain in knowledge scores obtained on a
structured questionnaire among the staff nurses.
Structured video teaching programme: It refers to planned video teaching on neonatal
resuscitation of newborns developing birth asphyxia by health education and by using
various teaching aids.
Knowledge:It refers to information or skills acquired through education or experiences.
Neonatal resuscitation: Neonatal resuscitation refers to the set of interventions at the
time of birth to support the establishment of breathing and circulation of a newborn
Newborns: Babies of age from birth to 28 days.
Birth asphyxia: In this study, birth asphyxia refers to the failure of newborn to initiate
breathing within one minute of birth.
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Staff nurses: In this study, staff nurses refers to those who have completed a nursing
course conducted by a registered university or board, registered as nurse midwives and
working in labour room, gynecology operation theatre and maternity wards.
6.6 ASSUMPTIONS
1. Birth asphyxia is one of the primary causes of early neonatal mortality.
2. Staff nurses can manage birth asphyxia by improving their knowledge &
skill in neonatal resuscitation.
3. Staff nurses possess some knowledge regarding neonatal resuscitation of
newborns developing birth asphyxia.
4. Structured video teaching programme is an accepted strategy to improve
the knowledge.
5. Staff nurses have a need to acquire information regarding the neonatal
resuscitation of newborns developing birth asphyxia.
6.7 HYPOTHESES
1. H1: There will be a significant difference between pre test knowledge score and
post test knowledge scores of staff nurse working in SVS Hospital,
Mahabubnagar, regarding the neonatal resuscitation of newborns developing birth
asphyxia.
2. H2: There will be a significant association in the knowledge levels of staff nurse
working in SVS Hospital, Mahabubnagar, regarding the neonatal resuscitation of
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newborns developing birth asphyxia, with selected demographic variables such as
nursing education status (BSc or GNM), years of experience, clinical area of
experience etc.
6.8 REVIW OF LITERATURE
A randomized, controlled trial was conducted by Opiyo et al.(2008), on health
workers receiving early training on newborn resuscitation (n = 28) or late training (the
control group, n = 55) in Pumwani Maternity Hospital in Nairobi, Kenya. The aim of the
study was to test resuscitation training on practices by randomly assigning labour ward
and theatre staff to either early or late training, considering the health worker as a unit of
clustering. Data were collected on 97 and 115 resuscitation episodes over 7 weeks after
early training in the intervention and control groups respectively. The results showed that
the trained providers demonstrated a higher proportion of adequate initial resuscitation
steps compared to the control group (trained 66% vs control 27%; risk ratio 2.45, [95%
CI 1.75–3.42], p<0.001, adjusted for clustering). The study concludes that
implementation of a simple one day newborn resuscitation training can be followed by
significant, short-term improvement in health workers' practices.
An evaluative study was conducted by Deorarai et al on the impact of a neonatal
resuscitation programme on staff nurses in fourteen Indian teaching hospitals. The
purpose of the study was to evaluate the impact of a training programme for a rational
approach to neonatal resuscitation. The results showed that there was a statistically
significant reduction in the use of chest compression and medications ( p < 0.001) and an
increase in the use of bag mask ventilation and asphyxia related deaths declined
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significantly (p <0.01). The researchers concluded that the study reflected a more rational
approach to neonatal resuscitation with more effective and appropriate use of bag and
mask ventilation leading to less need for chest compressions and resuscitation drugs.
A randomized, controlled trial study was conducted on immediate effect of
training of nurses on newborn care at birth and implications for management of asphyxia
by Ayesha Sania et.al on 26 nurses of obstetric unit in a tertiary-level sub-urban hospital
in central Bangladesh during November 2005–January 2006. The objective of the study
was to assess the immediate newborn care practices pertaining to recognition and
management of birth asphyxia in delivery room prior to, and following, training of nurses
of delivery room. The results showed that before the training, only 5 babies were assessed
to identify the need for resuscitation, whereas 17 babies were assessed during the post-
training period. The study concluded that a wide gap existed between the evidence-based
standard of immediate newborn care and the actual practices. Need-based training of staff
in delivery rooms is needed for timely recognition and management of asphyxiated births
in hospital deliveries.
A multicentric trial study was conducted by Ramji S et. al on resuscitation of
asphyxiated newborn infants with 21% or 100% Oxygen: Follow-Up at 18 to 24 Months.
The aim of the study was to follow-up children who had been resuscitated at birth with
either 21% or 100% oxygen (O2). 410 infants for whom resuscitation was performed with
either 21% or 100% O2 were selected as samples for the study. A follow-up between ages
18 and 24 months was performed. A simple questionnaire was filled out and neurologic
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assessment was performed in addition to measuring anthropometric data. The results
showed that there were no significant differences in weight, height, or head
circumference between the 2 groups. The researchers concludes that there were no
significant differences in somatic growth or neurologic handicap at an age of 18 to 24
months in infants resuscitated with either 21% or 100% O2 at birth.
A multicentric quasi randomized control trial was conducted by J A Dawson
et.al, (2006), on oxygen saturation and heart rate during delivery room resuscitation of
infants <30 weeks’ gestation with air or 100% oxygen. The aim of the study was to
describe changes in preductal oxygen saturation (Spo2) and heart rate (HR) in the first 10
min after birth in very preterm infants initially resuscitated with 100% oxygen (OX100) or
air (OX21). There were 20 infants in the OX100 group and 106 in the OX21 group. The
results showed that in the OX100 group, Spo2 had risen to a median of 84% after 2 min and
94% by 5 min. In the OX21 group, median Spo2 was 31% at 2 min and 54% at 5 min.The
study concludes that most very preterm infants received supplemental oxygen if air was
used for the initial resuscitation.
A prospective descriptive observational study was conducted by Ersdal HL et. al
among 5845 newborns born in a rural hospital in Tanzania. The aim of the study was to
assess the effectiveness of early initiation of basic resuscitation interventions including
face mask ventilation in reducing birth asphyxia related mortality in low-income
countries. The results were the risk for death or prolonged admission increases 16% for
every 30s delay in initiating resuscitation up to six minutes (p=0.045) and 6% for every
minute of applied resuscitation (p=0.001). The researchers concluded that infants who
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required resuscitation were more likely to die particularly when ventilation was delayed
or prolonged.
A monocentric randomized controlled trial was conducted by Vento M et al,
(2001), in Spain comparing the use of air versus 100% oxygen for the resuscitation of 40
term infants with clinical and biochemical evidence of asphyxia. The results showed that
the time to establish regular respirations was significantly less in the room air group
(p<0.05). They concluded that there were no apparent disadvantages to resuscitation with
room air and potentially significant advantages.
A comparative study was conducted to assess the functionality and acceptability
of selected neonatal resuscitation devices in Durban, South Africa (2008) on 34 health
workers. The goal of this study was to reduce neonatal mortality and childhood disability
in South Africa by ensuring that health care providers have access to affordable, high-
quality neonatal resuscitation devices and have appropriate skills in neonatal
resuscitation. This study used a participatory methodology to engage users and potential
users within the health system in the evaluation of the functionality and acceptability of a
select group of resuscitators. Participants recorded their observations about individual
devices using a structured 5-point Likert-type scale instrument The study concluded that
the Laerdal device was universally evaluated as superior, and most of the participants
chose the Besmed resuscitator as their second choice. The researchers recommended that
comprehensive neonatal resuscitation training is essential for all new staff and for all staff
when a new resuscitator is introduced.
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A retrospective study was conducted in neonatal unit of National Institute of
Child Health (NICH) from 1st January to 31st August, 2001. The objective of the study
was to look for risk factors leading to birth asphyxia in new borns admitted in a tertiary
care unit. Patients and Methody Records of 235 new borns admitted with birth asphyxia
during this period were analyzed. The results showed majority (71%) of mothers were
booked and had antenatal care, similarly most (88%) of the babies were born at term and
75.3% were delivered in maternity homes or hospitals. Caesarian sections were
performed in 14% cases and rest was all vaginal deliveries. The study concluded that
birth asphyxia occurring in such a high number of booked cases delivered at term with
good weight, reflects the poor perinatal services offered in those maternity homes or
hospitals. It recommended that trained personnel and neonatal resuscitation equipment
should be made mandatory in all maternity homes/hospitals.
A comparative study was done by Abhay T B et. al on effectiveness of two types of
birth attendants and of resuscitating with mouth-to-mouth, tube mask or bag-mask in
management of birth asphyxia in home deliveries in Rural Gadchiroli. Trained birth
attendants used mouth-to-mouth resuscitation in the baseline year (1993-1995).
Additional village health workers only observed in 1995-1996. In the intervention years
(1996-2003) they used tube-mask and bag-mask. The incidence case fatality (CF) &
asphyxia specific mortality rate (ASMR) were compared. The results of the study showed
decrease in incidence of mild birth asphyxia by 60% from 14% in the observation year to
6% in the intervention year (P< 0.0001). The incidence of severe asphyxia did not change
significantly.
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A meta-analysis was conducted on neonatal resuscitation and immediate
newborn assessment and stimulation for the prevention of neonatal death of 3 studies of
neonatal resuscitation studies examining the effect of resuscitation training on
intrapartum-related neonatal deaths .The results showed that immediate newborn
assessment and stimulation would reduce both intrapartum-related and preterm deaths by
10%, facility-based resuscitation would prevent a further 10% of preterm deaths, and
community-based resuscitation would prevent further 20% of intrapartum-related and 5%
of preterm deaths. The study concluded that neonatal resuscitation training in facilities
reduces term intrapartum-related deaths.
7.0 MATERIALS AND METHODS
Research methodology involves the systematic process, which the investigator
starts from the initial identification of the problems to its final conclusion. It is a science
of study how research is done scientifically. It is a backbone of the study. So
methodology is a significant part of an investigator under which the investigator is able to
project conclusion of the research undertaken.
This chapter includes description of research approach, research design, study
setting, sampling technique, development and description of the tool, data collection
technique and plan for data analysis.
7.1 Research Approach
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Research Approach is a systemic, objective method of discovery with empirical
evidence and rigorous control. Research Approach spells out the basic strengths that the
researcher adopts to develop information that is accurate and interpretable. The control is
achieved by holding conditions constant and varying only the phenomenon under study.
Evaluative research was considered as an appropriate approach for the present study.
Quasi – experimental research design is used for the present study.
7.2 Source of data / Subjects
Staff nurses working in labour room, gynecology operation theatre and
maternity wards in SVS Hospital, Mahabubnagar, AP.
7.3 Population
Population selected for the study is working staff nurses working in SVS
Hospital, Mahabubnagar, AP.
7.4 Sample
Sample size of 20 staff nurses that are randomly grouped as 10 experimental
group and 10 control group working in SVS hospital, Mahabubnagar, A.P.
7.5 Sampling technique
In this study the researcher will use convenient sampling technique.
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7.6 Method of data collection
A structured Questionnaire with Interview method consists of two parts namely
section A& B. Section –A represents the demographic data, Section –B represents the
knowledge on neonatal resuscitation of newborns developing birth asphyxia. A structured
questionnaire consists 30 questions will be given to the subjects. After obtaining the
consent and prior permission from the subjects and significant others, data will be
collected back immediately from the subjects after making sure about their completion.
7.7 Does the study require any investigation or interventions to conducted on
patients or other humans or animals? If so, please describe briefly.
Yes, the study will be conducted on staff nurses working in SVS hospital,
Mahabubnagar, AP.
7.8 Has ethical clearance being obtained from your institution in case of 7.7?
Yes, ethical approval has obtained from the ethical committee.
7.9 Plan for data analysis
The data obtained will be analyzed in terms of objectives of descriptive and
inferential statistics.
8.0 List of references
1. Lawn J.E,Haws R.A,Darmsatdt L.G.Reducing one million child deaths from birth
asphyxia.Biomed Central Ltd.2007;22(4):314-317
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2. WHO (2005) The world health report: 2005: make every mother and child count
3. Department of Reproductive health and Research. Basic new born resuscitation; a
practical guide.WHO.Geneva;1997
4. www.pubmed.com .
5. www.google.com.
6. Sophie Berglund, Mikael Norman, Charlotta Grunewald, Neonatal resuscitation
after severe asphyxia – a critical evaluation of 177 Swedish cases.Acta Paediatrica.
2008 June; 97(6): 714–719.
7. N Opiyo, Newton .O, Fred.W, Fridah.G, Grey.F .Effect of newborn resuscitation
training on health worker practices. PLoS Clinical trials.2008 Oct; 16 (10): 1886-97.
8. Deorari AK, Paul VK, Singh M, Vidasagar D. Impact of education and training on
neonatal resuscitation practices in 14 teaching hospitals in India. Annals of Tropical
Paediatrics: International Child Health. March 30, 20122001; 21 (1): 29-33
9. Ramji S, Rasaily R, Mishra PK, Narang A, Jayan S, Kapoor AN, Kambo I, Mathur
A, Saxena BN. Resuscitation of asphyxiated newborns with 21% or 100% oxygen at
birth: a multicentric trial. Indian Pediatr. 2003 Jun;40(6):507-9
10. Dawson JA, Yam CH, Schmölzer GM, Morley CJ, Davis PG. Heart rate changes
during resuscitation of newly born infants <30 weeks gestation: an observational
study.Arch Dis Child Fetal Neonatal Ed. 2011 Mar;96(2):F102-7.
11. Ersdal HL, Mduma E, Svensen E, Perlman JM. Early initiation of basic resuscitation
interventions including face mask ventilation may reduce birth asphyxia related
mortality. Journal of Paediatr Child Health 2002 Jan;38: 241–245
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12. Vento M, Asensi M, Sastre J, Carcia-Sala F, Pallardo F, Vina J. Resuscitation with
room air instead of 100% oxygen prevents oxidative stress in moderately asphyxiated
term neonates. Pediatrics. April 2001;107(4):642-647
13. Elwyn C, ElIzebeth M.M, Linda L.W,WalderA.L . Effect of WHO Newborn care
training on neonatal mortality by education. Ambulatory Pediatrics.2006
September;8(5)
14. O’Hare B.A, Nakakeeto M,Southhall D.P.A study to determine if nurses trained in
basic neonatal resuscitation would impact the outcome of neonates delivered in
Kampala.Tropical pediatrics Advance 2006 June; 52(2):376-379.
15. Raina N, Kumar V. Management of birth asphyxia by traditional birth attendants.
World Health Forum. 1989;10(2):243-6
16. Abhay T.B,Rani A.B,Sanjay B.BHanimi M.R, Management of birth asphyxia in
home deliveries in rural Gadchiroli.Journal of tropical pediatrics Advance.2006June
25 (2): 130 – 41
17. Linn S, Theresa A.S, Meta analysis on neonatal resuscitation and immediate
newborn assessment and stimulation for the prevention of neonatal death
Midwifery.2004 March;20(1):51-60
18. Rose marie nieswiadong. Foundation of nursing research. 2nded appketion and
lange; Norwalk 9us).2008 Aug; 100(8):625-9.
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9.0 Signature of the Candidate :
10.0 Remarks of Guide :
11.0 Name and Designation Of
11.1 Guide :
11.2 Signature :
11.3 Head of the department :
.
11.4 Signature :
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12.1 Remarks of the Chairman and Principal:
12.2 Signature of the principal :
Principal
S.V.S. College of Nursing
Mahabubangar.
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