Skilled Care at Birth, Inclusion and Exclusion Criteria - Research Paper Example

Mothers and Babies Student name Course name Institution of affiliation Instructor’s name Date Mothers and Babies Background Research Question: In the developing countries, the neonate and young infants are faced with numerous problems including neonatal mortality, hypothermia and initiation or exclusion from breastfeeding. From the research question, the PICO question is developed with considerations of Population, Intervention, Comparison and Outcome. PICO Question: Amongst the healthy newborns in developing countries, does the practices of skin-to-skin contact of the mother and baby in the first life hours matched up to drying and wrapping affect the baby’s neonatal hypothermia, mortality, or exclusion/initiation/breastfeeding duration? Population or P: Healthy newborns in developing nations Intervention or I: Skin-to-skin contact of mothers and babies during the first hours of life Comparison or C: In comparison to drying and wrapping Outcome or O: influence the neonate’s duration of breastfeeding/exclusion/inclusion, mortality, or hypothermia. Importance of Research Question to Nursing Practice, Patient Care, Professional Knowledge or Research The issue of routine newborn care is essential especially in the developing nations. According to WHO/UNICEF JOINT STATEMENT [WHO09], nearly 3.7 million babies do not live beyond their first four weeks of life. This is the case especially for the newborns in developing countries where they die at home. However, about two thirds of the newborn deaths can be prevented on the grounds that the mother and her newborn are provided with timely and effective interventions. WHO/UNICEF JOINT STATEMENT [WHO09] then highlights that through the use of a strategy that promotes access to antenatal care, skilled birth attendance and early postnatal care globally will demonstrate a sustained reduction in maternal and neonatal mortality. Ebrahim [Ebr98] reveals that although the transition duration from intrauterine life to an independent life is very small, this stage is very crucial in the baby’s development. During this transition, the baby’s body needs to adjust physiologically since the infant is no longer dependent on the placenta for nutrients, gaseous exchange or waste products’ elimination. Additionally, the baby is no longer dependent on the placenta as an endocrine organ. For survival, the newly born infant’s organs have to take control of the baby’s physiological systems. For instance, at birth, the baby has to cry in order to expand the lungs and prepare them for their functions in breathing or normal respiration. Additionally, this first cry is essential in the promotion of the opening up of the baby’s pulmonary blood vessels such that blood surges into the lungs, and blood oxygenation process commences. Further, physiological shunts like foramen ovale and the ductus arteriosus, which by-passed the pulmonary vasculature in fetal life, now close up and the flow modify to the more adult-like. Similarly, the baby’s gastrointestinal track kickoff the digestion and nutrients absorption functions while the role of waste excretion is taken over by the kidneys. During all this changes, lungs expansion at birth and regular respiration are the key changes since they are responsible for the brain’s dependence on a constant oxygen and glucose supply[Ebr98]. Any plunge in the levels of blood for any of these elements could lead to depression or everlasting brain function damage. Despite the fact that newborn problems in developing countries are common, there is no adequate data or even existing systems of collecting data in these countries. However, according to Ebrahim [Ebr98], the estimates indicated that in the high income countries, only 4 in 10000 of neonatal deaths occur while in the low income countries the rate is 33 for every 1000 live births. Additionally, of all the infants’ deaths, more than three quarters occurs in Sub-Saharan Africa and South Asia[Ebr98]. For the last 15 or so years, majority of the affected developing nations have made little impact on the reduction of stillbirths and neonatal deaths. This is far below the achievement by nations like America which has attained at least 40% neonatal rates of mortality. Additionally, while neonatal deaths in India account for a quarter of the world rates, there has been great reduction in the death falls by about 11%. World Health Organization [Wor12] highlights that of all the newborn deaths occurring during the first week of birth, two main causes include lack of skilled care at and immediately after birth and low access to healthcare. As a result, majority of these deaths happen at home in developing countries. Additionally, World Health Organization [Wor12] highlights the major death causes as prematurity and low weight at birth, birth trauma, and asphyxia or oxygen lack at birth and infections. After birth, the newborn should be provided with a vaccine for Hepatitis B, eye testing, eye cleaning using eye drops and vitamin K shot. However, the presence of skilled health workers is attributed to about two thirds of the survival rates for newborn. Skilled Care at Birth Ebrahim [Ebr98] reveals that at birth, skilled care is needed for performing a quick inspection which looks for breathing difficulties or other issues like cutting the umbilical cord and recording the number of vessels in it. The umbilical cord vessels are essential in the identification of congenital malformations where only one single umbilical artery exists. In cases where the baby is fine, dry wiping is done to ensure that the baby loses no more heat. Afterwards, the baby is wrapped in a towel then to the mother. At this point, the baby then starts breast feeding and the best breastfeeding method is skin-to-skin. Conversely, if the baby after birth is blue or pale in color, or vomits excessively, then the mother is recommended to withdraw the first feed and the baby kept under observation. Further, if subjecting the baby to a breastfeeding for a second time shows no recovery, the baby is fed through naso-gastric tube feeds. The naso-gastric tube feeds are common for babies born below 36 weeks of gestation since the baby does not have well developed reflexes to breastfeed[Ebr98]. WHO/UNICEF JOINT STATEMENT [WHO09] recommends the use of home care visits to care for the newborns in developing nations where access to health facilities or health care workers is difficult. Additionally, developing nations are required to take up Kangaroo mother care immediately after birth[Cue]. The mother should also receive anticipatory guidance on baby breastfeeding routine, cleaning and nutrients intake. Methods: Inclusion and Exclusion Criteria Development and Description For this study, a rigorous, predetermined and transparent search strategy has been established. Additionally, the documentation of searched databases is kept while the serach strategy specific about inclusions and exclusions is used. The methods used for inclusion are such that they are well worked out to avoid bias. Within the healthcare system, patient-centered decisions and public policies are informed by the most reliable evidence based on clinical research. Further, the healthcare employees are urged to use the most up to date best practice such that all decisions are founded on knowledge. Using different inclusion and exclusion criterion, several individual studies are then evaluated and their findings summarized. For this study, the inclusion criteria focuses on Meline [Mel06] highlights that the inclusion criteria should focus on one or more of the stated categories below. The categories are Study design and quality, outcome variables, form of intervention, period of time, and the range of culture and linguistics. For this study, the range of culture and linguistic, study population, outcome variables, form of intervention and time period will be used in determining inclusion and exclusion. The Study Design Within this systematic review, explicit descriptions of procedures and methods used are transparent[Cue]. The types of study most applicable for the evaluation of the study question are randomization study whose designs is intended at evaluating prevention within the population of healthy newborns. From the eligible infants, two groups are formed where one group receives the intervention and the other receives just an inactive placebo. The researcher will then use the outcome differences for linking to the intervention[Lib13]. Cohort study design will be used to include observations of what happened when one group had been exposed to some variable. Population In this case, the involved population is large such that the newborns subjected immediately to skilled nursing care are compared to others who have not be subjected to skilled nursing care at birth. Some of the pertinent attributes that are needed in the description of the population for this study are infants, gender, clinical settings, and age, geographic region and clinical diagnosis. Outcome Variables For this study, outcome variables are not a strong form of inclusion since the study has also to consider the relevance and validity. However, the researcher understands that without the outcomes being clearly stated early enough, the determination of the appropriateness of the study for the area under review. Some of the outcome considerations would be all mortality causes, mortality that is specific to disease, or outcomes associated to the presence of a given disease. The main strength of using the outcome variables in the study is that it will guide the researcher in isolating only the population of women at and immediately after birth from numerous studies and proceed with analyzing which is only possible when considering a larger study. Nature of Intervention In this study, the researcher addresses the question of treatment efficacy. Additionally, the researcher will proceed to understand whether or not this study on mothers and babies in developing nations and others are relevant in terms of the nature of intervention. This will be done through reporting of significant intervention interests like operational definitions for intervention, duration of timing and intervention intensity and examples of intervention that are included and those excluded for this specific study. Range of Culture and Linguistics Since this study is concerned with understanding the universal issue of care for infants and mothers at and immediately after birth, a wide range of culture and linguistics will be evaluated in this case. The implication here is that the study will as much as possible try to limit any instances publication bias by including both English and non-English studies. In so doing, there will be no threat to the validity of the paper’s content. However, the researcher will be keen to specify the reasons behind any exclusion on the basis of the systematic review. Exclusion Criteria With the inclusion criteria in place, titles and abstracts will be subjected to inclusion/exclusion criteria and the integrity of the study process evaluated. First, the inclusion/exclusion criteria will be piloted on a subset of studies from the list of bibliography candidates. Secondly, the identified study will then be tested for reliability of the decision by the evaluators. Throughout the selection process, the inclusion is expected to change and such will mean that the changes are applied retroactively to all bibliography citations of the candidate studies. In the case where the abstract will be inconclusive, the citation remains part of the candidate studies until the full text is obtained. Justification of the Inclusion and Exclusion Criteria During the research process on care of women and infants during and immediately after birth, the researcher has to focus on ensuring that the study is acceptable. Acceptability in research is arrived at through analysis the nature in which the research was conducted, whether the sample was representative of the reasonable population size, and whether the psychometric evaluation for the study was met. Additionally, the researcher will exclude studies that do not offer sufficient computation statistics for effect sizes despite the fact that such study qualifies in the eligibility criteria. Search Strategy After the formulation of an inclusion/exclusion criteria and the PICO question, the search strategy will be essential in the facilitation of searching for scientific literatures through an effective computerized way. In this search strategy, the focus is on using search of peer-reviewed professional literature to obtain the best external evidence using appropriate methodology. For this systematic review, studies involving individual randomized controlled trials or RCTs together with non-randomized studies that are well designed qualify in offering stronger evidence. The study revolves around PICO aspects where The population stands for healthy newborn babies in developing nations during and immediately after birth; the intervention is skin-to-skin contact of mothers and babies in the first hours of life; comparison involves using the alternative of drying and wrapping; and the outcome is the expected impact on the neonate’s duration of exclusion/inclusion/breastfeeding , mortality, or hypothermia. Two Electronics Databases and their Relevance to the Research Question The two main online electronic databases for use in this study will be Cochrane Database of Systematic reviews and Medline database. Cochrane Database of Systematic reviews is very crucial for this study given it offers a collection of well conducted controlled trials whose results are readily available for use in medicine guided by evidence. Cochrane is a subscription database but all nations are subjected to free access of two pages abstract for all study related Cochrane reviews coupled with summaries for the resulting articles[The141]. Additionally, the study of newborn babies in developing nations requires highest levels of reliability and validity. As a result, using Cochrane Database guarantees quality since the database contains internationally recognized high standard evidence based care[Cen091]. The studies obtained from this database also offer reliable information on effects of interventions for newborn mortality rates and the promotion of the benefits attained through skin-to-skin contact between the mother and the baby immediately after birth. Some of the benefits include bonding, control of pain and breastfeeding for the mother, while the baby benefits in temperature control, feeding, respiration among others. The second database is Medline. Although the focus of Medline is not specific to indexing of evidence based researches, Medline offers authoritative medical information on healthcare systems, nursing, dentistry, pre-clinical sciences and others. While at this website, one then uses the drop down menu to limit the search to systematic reviews[Lib14]. Medline is the United States National Library of Medicine or NLM where records are indexed using Medical Subject Headings or MeSH. Identified Keywords for Use in these Two Databases From the PICO question for this study, several concepts can be realized. Concept one: neonate or infant or newborns Concept two: skin-to-skin contact /kangaroo-mother care method With the keywords in place, connection will be done using words like OR, AND and NOT Simple Search Strategy Relevant to the Research Question Having defined the keywords, several steps will be required to obtain the relevant resources. 1. Determine synonyms In this study, the researcher will be needed to think of or search for synonyms of the search terms. In Medline, the MeSH database through http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=mesh, then search keywords to select the most apropriate suggested terms to represent the research area[Nat141]. In this case the most appropriate is infant, newborn from which the search can advance Concept one to infant, newborn diseases, or infant, newborn screening Concept two: Kangaroo-Mother Care Method After searching for keywords, synonyms and all search terms are combined logically in Medline database. For instance, the keywords can be combined in Medline like Infant, newborn diseases AND statistics and numerical data Cochrane Database of Systematic Reviews Here the search for keywords involves filtering using a drop down menu where one can search articles using author, all text, keywords, abstract, title and much more. The search can be normal or advanced. The provided results include all Cochrane reviews, other reviews, trials, method studies and others which one can choose from. During the search, it is essential to spell-check all the search terms. Since the search may involve keywords that are associated with numerous studies, truncation and wildcard operators are used[Tho13]. These operators are used in facilitating searching for terms where the researcher only has common initial spelling or where there is a variation by just one letter. The characters used are neither alphabetic nor numeric but are just symbols. They include *truncation, and? ,$ are wildcard. Additionally, Boolean operators are also used to search the databases using principles of Boolean logic. The principle behind the search is to combine specific terms in specific ways to obtain the effective matches. The Common Boolean operators are AND, OR, and NOT. The use of Boolean is highly used in the Medline Library. While using AND, the search results are narrow given that they include only documents that contain the two terms[Tho13]. If the search is too shallow, using OR expands the search since all documents containing both words are outlined. For instance, Boolean: Infant, Newborns AND Kangaroo-mother care method Truncation: Infant* AND kangaroo-mother care method or 5 Relevant Research Articles WHO09: , (2009, p. 2), Ebr98: , (1998, p. 68), Ebr98: , (Ebrahim, 1998, p. 69), Ebr98: , (1998, p. 2), Ebr98: , (Ebrahim, 1998, p. 2), Wor12: , (2012, p. n.p), Wor12: , (2012), Ebr98: , (1998, p. 70), Ebr98: , (Ebrahim, 1998, p. 4), WHO09: , (2009, p. 3), Cue: , (Cuervo, et al., 2013), Mel06: , (2006, p. 2), Lib13: , (Library guides, 2013), The141: , (The Cochrane Library, 2014), Cen091: , (Center for Reviews and Dissemination, 2009), Lib14: , (Library guides, 2014; National Library of Medicine, 2014), Nat141: , (National Center for Biotechnology Information, 2014), Tho13: , (Thomson Rivers University, 2013), References List WHO09: , (2009, p. 2), Ebr98: , (1998, p. 68), Ebr98: , (Ebrahim, 1998, p. 69), Ebr98: , (1998, p. 2), Ebr98: , (Ebrahim, 1998, p. 2), Wor12: , (2012, p. n.p), Wor12: , (2012), Ebr98: , (1998, p. 70), Ebr98: , (Ebrahim, 1998, p. 4), WHO09: , (2009, p. 3), Cue: , (Cuervo, et al., 2013), Mel06: , (2006, p. 2), Lib13: , (Library guides, 2013), The141: , (The Cochrane Library, 2014), Cen091: , (Center for Reviews and Dissemination, 2009), Lib14: , (Library guides, 2014; National Library of Medicine, 2014), Nat141: , (National Center for Biotechnology Information, 2014), Tho13: , (Thomson Rivers University, 2013), Read More