The effect of training of behavior observation based care to the mother on intraventricular hemorrhages and ventilation period of preterm infant

Document Type : Original Quantitative and Qualitative Research Paper


1 Evidence Based Care Research Centre, Instructor of Nursing, Department of Pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

2 MSc Neonatal Intensive Care Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

3 Associate professor of Neonatology, Faculty of Medicine, Tabriz University of Medical Science, Tabriz, Iran


Background: Intraventricular hemorrhages and respiratory distress syndrome are two common diseases in preterm infants. Observation-based care, may reduce the rate of these complications through energy saving, diminishing apnea periods and cerebral blood flow changes.
Aim: to evaluate the effect of behavior observation-based care training for mothers on intraventricular hemorrhages and ventilation period.
Methods: In this two-group clinical trial, 70 infants with gestation age of less than 32 weeks were observed in neonate intensive care unit of Omolbanin Hospital, 2014. In the intervention group, the mothers and nurses received training in infant behavior and care program, and preterm infants’ behavior were observed and recorded by means of Assessment of Preterm Infants’ Behavior. At the end of the intervention, incidence of cerebral hemorrhage and the hours of ventilation were recorded. The data were analyzed performing independent t-test, Chi-square and Pearson correlation coefficient, using SPSS.
Results: The mean gestational age for the intervention and control groups were 29.7±1.7 and 29.6±1.7 weeks, respectively. The incidence of cerebral hemorrhage was 54.3% (19 cases) for the control group and 22.9% (8 cases) for the intervention group. The Chi-square test showed a significant relationship between the two groups (P=0.01). The mean ventilation period was 28.8±14.7 days for the intervention group and 17.3±8.6 for the control group. The results of independent t-test demonstrated a significant relationship between the two groups (P<0.001).
Conclusion: The implementation of care training programs for mothers, based on behavior of premature infants, lowers the incidence of cerebral hemorrhage and ventilation period. Conducting this program is recommended to reduce prematurity complications.


  1. References

    1. Newnhama C, Milgroma j, Skouteris H, Effectiveness of Modified Mother – Infant Transaction Program on Outcomes for Preterm Infants from 3 to 24 Months of Age, Infant Behav. Dec 2009; 32: 17-26
    2. Mardanian F, Shahzamani S. Frequency of Preterm Delivery and Premature Infants Requiring Intensive Cares at a Refferal Hospital in Isfahan. Journal of Isfahan Medical School. Vol 28, No 113, 1st week, January 2011 1/3/2011, Vol. 28 Issue 113, p1 
    3. Liaw J-J, Yang L, Wang K-WK, Chen C-M, Chang Y-C, Yin T, Non-nutritive Sucking and Facilitated Tucking Relieve Preterm Infant a Pain During Heel-stick Procedures: a Prospective Randomized Controlled Crosover Trial. Int J Nurs Stud. 2011
    4. Solimani F. Development Outcome of Low Birth Weight Premature Infants. Iran J Pediatr 2007; 17(1):117-25. (Persian)
    5. Axelin A. Parents as pain killers in the Pain Management of Preterm Infants. Early Human Development 2006; 82,241-7.
    6. Hala Obeidat IKLCC, Froelicher ES. Use of Facilitated Tucking for Nonpharmocological Pain Management in Preterm Infants. J Perinat Neonat Nurs, Vol 23, No 4, pp 372-7
    7. Egan LA, Cuevas MP, Lucio JR. Epidemiological Profile of Premature labor. Ginecol Ostetmex 2008; 76(9):542- 8.
    8. Mirlashari J, Rassouli M. Nursing Care of Infant and Children. 1st ed. Tehran: Andishehe Rafee; 2007.
    9. Dieter JN, Field T, Hernandez-Reif M, EmoryEK, Redzepi M. Stable Preterm Infants Gainmore Weight and Sleep less After Five Days Of Massage Therapy. J Pediatr Psychol 2003; 28(6): 403-11.
    10. Arezumaniyan S. Neonatal Nursing, 1st Ed. Tehran, Boshra Publication. 2004. (Persian)
    11. Horbar JD, Badger GJ, Carpenter JH, Fanaroff AA, Kilpatrick S, LaCorte M, et al. Trends in mortality and morbidity for Very Low Birth Weight Infants, 1991-1999. Pediatrics. 2002; 110:143–51. [PubMed]
    12. Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, et al. NICHD Neonatal Research Network.Trends in morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol. 2007; 196:147.e1. 8. [PubMed]
    13. Fanaroff A, Martin R, Walsh M. Neonatal Prinatal Medicine. Eight Ed. Philadelphia: Mosby Elsevier Co; 2006;43:1057-72
    14. Noruzi A, MohammadPour M, Fallah R. Nelson Infants. 1th ed. Tehran: Pub Andishe Raffee; 2011. (Persian)
    15. Neal DO, Lindeke LL. Music as a Nursing Intervention for Preterm Infants in The NICU. Neonatal Netw 2008; 27: 319-27.
    16. Standley JM. Music Therapy for the Neonate. NewbornInfant Nurs Rev 2001; 1: 211.
    17. Mathai S, Fernandez A, Mondkar J, Kanbur W. Effects of Tactile-Kinesthetic Stimulation Inpreterms: a Controlled Trial. Indian Pediatr 2001; 38(10):1091-8.
    18. Als H, et al: Early Experience Alters Brain Function and Structure, Pediatrics 2004; 113: 846.
    19. Sami P. Wong, s Nursing Care of Infants and Childern. Pub Boshra. 2007;11:365-72 (Persian)
    20. Diego M, Field T, Rief M, Procedural Pain Heart Rate Responses in Massaged Preterm Infants Behavior, Infants Behavior and Development, 2009; 32: 226-9
    21. Grunau RE, Holsti L, Peters JWB. Long-term Consequences of Pain in Human Neonates. Seminars in Fatal and Neonatal Medicine. 2006; 11: 268-75
    22. Ballweg D. Neonatal and Pediatric Pain Management: Standard and Application. Pediatrics and Child Health. 2007: s61-s6.
    23. Gibbins S, Fowler L. A Combined Approach to Pain Management in the Surgical Neonate. Newborn and Infant Nursing Reviews. Sep, 2007; Vol 7, No.3 : 171-4
    24. Marlene Walden CC. The Ten Commeandments of Pain Assessment and Management in Preterm Neonates. Crit. Care Nurse Clin 2009: 235-52
    25. Cignacco E, Hamers JP, Stoffel L, Van Lingen RA, Gessler P, McDougall J, et al. The Efficacy of non-Pharmacological Interventions in the Management of Procedural Pain in Preterm and Term Neonates. A Systematic Litrature Review. European Journal of Pain. 2007; 11(2): 139-52
    26. Shoghy MH, Sanjari MH. Lifer Textbook of Nursing Mothers and Neonatae. 10 Editions. Pub Boshra; 2008.
    27. Khan Z. Individualised Developmental Supportive Care in The NICU. Journal of Neonatal Nursing 2003; 9 (5).
    28. Arezomanians S.Wongs Text book of pediatric Nursing. Comminuty publishity;1387 (Persian)
    29. Long JG, Philip AGS, Lucey JF. Excessive Handling as a Cause of Hypoxaemia. Pediatrics 1998; 65:203-7.
    30. Kleberg A, Westrup B, Stjernqvist K. Developmental outcome, child behavior and mother-child interaction at 3 years of age following Newborn Individualized Developmental Care and Intervention Program (NIDCAP) intervention. Early Hum Dev. 2000;60(2):123–35
    31. Als H, et al: Individualized developmental care for the very low birth weight preterm infant: medical and neurofunctional effects, JAMA 1994; 272:853
    32. Joke M. Wielenga, Bert J. Smit, Maruschka P. Merkus, Joke H. KokActa Pediatrica 2007; 96: 1409-15        
    33. Fleisher BF, et al. Individualized developmental care for verylow-birth-weight premature infants, Clin Pediatr 1995; 34:523.
    34. Buehler DM, et al: Effectiveness of individualized developmental care for low-risk preterm infants: behavioral and electrophysiological evidence, Pediatrics 1995; 96:923
    35. A Örtenstrand, B Westrup, E Berggren Broström, I Sarman, S Åkerström, T Brune, L Lindberg, U WaldenströmThe Stockholm Neonatal Family Centered Care Study: effects on length of stay and infant morbidity Karolinska Institute, Stockholm Sweden Pediatrics Jan. 2010;125: e278–e85