The Effect of Swaddling Method on Stress Level in Newborns Administration to Nasal CPAP
Condition: Nursing Caries; Newborn Illness; Nurse's Role
Study type: Interventional

Summary: 
      Transient tachypnea of newborn (TTN) causes 42.5%-60% of non-infectious respiratory distress
      cases in newborns, it is seen in only 1% of all newborns. In the etiology of TTN, it results
      from the inability to effectively clear the fetal lung fluid immediately after birth. The
      most known risk factors of TTN are; prematurity, malpresentation, abnormal birth, premature
      rupture of the membrane, meconium aspiration, fetal distress, multiple pregnancy, male
      gender, and low Apgar score. TTN; It typically occurs in term and late preterm newborns
      within the first two hours of life. For the diagnosis of TTN, respiratory rate >60/min in the
      first 6-12 hours shows signs of groaning and retraction and improve spontaneously within a
      few days with 40% or less supportive oxygen therapy.

      However, in some rare cases, prolongation of symptoms, noninvasive mechanical ventilation
      support [nasal continuous positive airway pressure (nCPAP), nonsynchronized nasal
      intermittent mandatory ventilation (NIMV)] and in some cases invasive (intubated) mechanical
      ventilation may be required.

      Reducing pain and stress in mechanically ventilated infants is important for the prevention
      of complications that may occur in the future-early period and for recover process. While
      providing standard health care in the Neonatal Intensive Care Unit (NICU), sources of pain
      and stress should be identified and controlled. It is necessary to minimize the interventions
      that will cause pain and stress and to ensure that the newborn copes with the pain. In order
      to relieve pain and stress, various pharmacological (opioid, non-opioid analgesics) and
      non-pharmacological (breast milk, pacifier, kangaroo care, flexion posture, swaddling etc.)
      within the framework of family-centered care and individualized developmental care methods
      should be used. Pain control is a priority in neonatal nursing care, and it is the nurses;
      responsibility to select and implement a non-pharmacological intervention to reduce the level
      of pain. A limited number of studies have been found examining the effects of therapeutic
      touch and mothers voice on pain and comfort level in newborns, as a behavioral intervention,
      on relieving stress of body positioning in premature newborns who underwent nCPAP. There was
      no study found that the swaddling method applied during the procedure in patients followed up
      on nCPAP had an effect on reducing the stress level of newborns.
    

Detailed description: 
      The aim of the proposed study is to determine the effect of the swaddling method applied to
      newborns in noninvasive mechanical ventilators on the stress level, by using the neonatal
      stress scale and salivary cortisol levels.

      Type of the research: The research was planned to be conducted in a single group with a
      pre-test, post-test pattern experimental type.

      Research variables Independent variable: Swaddling method. Dependent Variables: The stress
      felt by the newborn and the salivary cortisol level

      The Hypothesis of the Study: H1: Post-intervention (swaddling method) stress and cortisol
      levels of newborns on CPAP/noninvasive mechanical ventilator are lower than pre-intervention
      stress and cortisol levels.

      Neonatal Stress Scale: The scale consists of 8 sub-dimensions (facial expression, body color,
      respiration, activity level, comfortability, muscle tone, extremities, posture), and 3-point
      Likert type. The items in the scale were graded according to the level of stress and grouped
      into 8 subgroups. In scoring, each subgroup is evaluated between 0-2 points. A minimum of 0
      points and a maximum of 16 points are taken from the scale. The baby whose condition is
      stable and balanced will get a score of 0 from the scale. A high total score from the scale
      indicates that the baby's stress level is high.
    

Intervention name(s): nonpharmacologic intervention (swaddling)
Intervention type(s): Other
Intervention description(s): Swaddling method;The newborn will be placed on a square fabric blanket in the flexion and abduction position and will be loosely swaddled with a blanket.
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Intervention model description: The one-group, pretest, posttest research design.
Masking: Single (Investigator)
Primary purpose: Health Services Research