Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 20445

AbstractMaterial and MethodsResultsDiscussionConclusionAcknowledgementReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : SC05 - SC08 Full Version

Kangaroo Mother Care versus Prone Position in Preterm Neonates: A Non Randomised Clinical Study


Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/59239.17093
Arghya Roy Naskar, Prativa Biswas, Neha Karar, Dipanjan Halder

1. Senior Resident, Department of Paediatric Medicine, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India. 2. Assistant Professor, Department of Paediatric Medicine, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India. 3. Assistant Professor, Department of Biochemistry, Prafulla Chandra Sen Government Medical College and Hospital, Arambagh, Hooghly, West Bengal, India. 4. Assistant Professor, Department of Paediatric Medicine, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India.

Correspondence Address :
Dr. Dipanjan Halder,
C/o Asit Roy Naskar, AB-7/1, Kestopur Main Road, No. 3 Camp, Near Indian Overseas Bank, PO Krishnapur, PS Baguiati, Kolkata-700102, West Bengal, India.
E-mail: drdipanjan2022@gmail.com

Abstract

Introduction: One of the major problems of preterm neonates is immature alimentation. This may lead to inadequate weight gain, higher chances of sepsis and increased mortality. Positioning during and after feeding affects nutritional tolerance. Kangaroo Mother Care (KMC) is a method of skin-to-skin contact between mother and neonate, claimed to improve infant outcomes.

Aim: To compare prone and Kangaroo Mother Care positioning of preterm neonates of 28-32 weeks gestational age during orogastric tube feeding.

Materials and Methods: The study was a single-centre Institution-based, non randomised cross-over clinical study, carried out at Sick Newborn Care Unit and Neonatal Intensive Care Unit (NICU), Department of Paediatrics, R.G. Kar Medical College and Hospital, Kolkata, India, from April 2020 to March 2021. The studied parameters included gastric residual volume (three hours postprandial), vital signs like respiratory rate, heart rate, SpO2 level, body temperature, Capillary Blood Glucose (CBG), also comfort scores using a comfort scale. Total 110 preterm neonates of 28-32 weeks gestational age were sampled as per inclusion criteria and divided into two groups. Each group was fed by orogastric tube feeding in its respective position, in which they were kept for three hours. Vital signs, comfort scores and gastric residual volume were re-assessed. Groups were crossed over on the next day. Statistical analysis was done by t-test.

Results: Of the total 110 neonates, KMC sample and prone position sample were compared after three hours. Heart rate was 147.5±4.3 and 151.08±9.1 beats per minute and respiratory rate 52.8±2.9 and 55.6±4.9 cycles per minute, which were lower in KMC than in prone position. There was better glycaemic control {n=107 (97.27) and 80 (72.73) mg/dL}, higher comfort scores (11.2±1.1 and 10.1±2.0) and minimal to negligible gastric residuals (0.03±0.05 mL and 0.13±0.12 mL) in KMC position, when compared to prone position, respectively.

Conclusion: Kangaroo mother care produced more stable physiological indices, and was more comfortable for preterm neonates and resulted in better feeding, absorption and metabolism.

Keywords

Comfort, Feeding, Orogastric tube, Vital signs

Infants born before 37 weeks from the 1st day of the last menstrual period are termed premature by World Health Organisation (WHO) (1). Prematurity hampers normal alimentation. Proper nutrition in preterm neonates decreases mortality, improves weight gain and shortens hospitalisation. Neonatal positioning during and after feeding can have significant effect on nutritional tolerance. Different positions have different effects; prone position improves respiration and attenuates regurgitation (2). Kangaroo Mother Care (KMC) is a technique associated with improved infant and maternal outcomes. The kangaroo position consists of skin-to-skin contact between mother and infant in a vertical position between the mother’s breasts with the provider being in a semi-reclining position. Baby’s head is turned to one side, in a slightly extended position; hips flexed and abducted; arms flexed; abdomen at the level of mother’s epigastrium [3,4]. A Cochrane review on benefits of KMC demonstrated improved exclusive breastfeeding rates at discharge, reduction in the risk of mortality, reduction in nosocomial infection/sepsis, reduction in hypothermia, reduction in length of hospital stay, increase in length head circumference and weight gain (5).

A single homogenous study comparing effects of KMC and prone positioning on preterm neonates is scarce. The present study aimed to fulfil this void in knowledge by directly comparing the two positions in neonates. This will help in re-evaluating the existing knowledge base. KMC and prone positioning are inexpensive interventions, targeted for improved neonatal survival, hence relevant in resource-poor settings.

The aim of the present study was to compare prone and kangaroo mother care positioning of preterm neonates of 28-32 weeks gestational age during intragastric tube feeding. Further research will help in revising treatment guidelines, which could be implemented in health policies. The null hypothesis of the present study was, no difference existed between kangaroo mother care and prone positions after feeding in preterm neonates.

Material and Methods

The study was a single-centre Institution-based non randomised cross-over clinical trial. The study was conducted at Sick Newborn Care Unit (SNCU) and Neonatal Intensive Care Unit (NICU), Department of Paediatrics, R.G. Kar Medical College and Hospital, Kolkata, India for a duration of 12 months, from April 2020 to March 2021. Study population were neonates of 28-32 weeks gestational age.

Ethical clearance was obtained from the Institutional Ethics Committee, R.G. Kar Medical College (Registered with The Drugs Controller General India Registration No. ECR/322/Inst/WB/2013): RKC/171 dated 12.02.2020. Written informed consent was obtained from parents of all neonates enrolled in the study.

Inclusion criteria: Neonates having full consent from parents, gestational age of 28-32 weeks, birth weight of 800 grams or more, mean Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score at birth ≥6, stable physiological indices (heart rate, respiratory rate, SpO2, body temperature, capillary blood glucose), not on intravenous fluids, feeding expressed breast milk, feeding via gavage feeding, having atleast two days of hospitalisation were included.

Exclusion criteria: Neonates with lack of consent, development of intraventricular haemorrhage, development of necrotising enterocolitis, congenital malformations, having convulsions, sepsis, feed intolerance, unstable vital signs, on mechanical ventilation or Continuous Positive Airway Pressure (CPAP) were excluded.

Sample size calculation: The formula for calculation of sample size for comparison between two groups when end point is quantitative data, was:

N=[2×SD2×(Zα+Zβ)2]÷d2

Where, SD=Standard Deviation (from previous study by Ozdel D and Sari HY (6);
Z is standard normal variate:
Zα=1.96 at Type 1 error of 5% (p-value <0.05),
Zβ=0.84 at 80% power;
d is effect size (difference between mean values).
SD2=35.93; (Zα+Zβ)2=7.84; d2=10.24.

On calculating, the sample size was found to be 55.02. Hence, the sample size for this study was set as 55 for each group. Total sample size of 110 neonates were divided into two groups A and B.

Study Procedure

On the first day, group A neonates were placed in kangaroo mother care position intermittently and group B neonates were placed in prone position intermittently. They were fed by orogastric tube feeding in their respective positions by the prescribed amount of expressed breast milk. Vital signs (respiratory rate, heart rate, SpO2, body temperature, capillary blood glucose) and comfort scores of the neonates were assessed 10 minutes before feeding while the neonates were supine. The neonates were then placed in their respective positions and feeds were given 10 minutes afterwards. The neonates were kept in their respective positions for three hours, at the end of which vital signs were reassessed. The neonates were then kept supine and comfort scores reassessed by their positions. Postprandial gastric residual volume was measured by aspirating gastric contents from the orogastric tube gently into a 2 mL syringe three hours after feeding. Heart rate and SpO2 were measured by pulse oximetry while CBG was measured by point of care glucometry. Body temperature was measured with digital thermometer via axillary route. All the readings were recorded in preformed and pretested score cards. Such readings were taken four times in a day at 6 am, 12 pm, 6 pm and 12 am. The same procedure was repeated on the second day but now, groups were crossed over to eliminate confounding factors, i.e., group A neonates were placed in prone positions intermittently while group B neonates were placed in KMC positions intermittently. The same readings were taken.

Data gathering tool was a form with two sections. Section 1 dealt with demographics of the participants. In section 2, a table was made which was used for recording the parameters at the four specified time intervals of the day. The parameters were: amount of expressed breast milk fed (at 6 am, 12 pm, 6 pm and 12 am), volume of gastric aspirate/ three hours postprandial gastric residual volume (at 9 am, 3 pm, 9 pm and 3 am), vital signs such as respiratory rate, heart rate, SpO2 level, body temperature, capillary blood glucose recorded 10 minutes before feed (at 5:50 am, 11:50 am, 5:50 pm and 11:50 pm) and three hours after feed (at 9 am, 3 pm, 9 pm and 3 am), comfort scores were-recorded 10 minutes before feed (at 5:50 am, 11:50 am, 5:50 pm and 11:50 pm) and three hours after feed (at 9 am, 3 pm, 9 pm and 3 am), using appropriate comfort scale, which was Infant Position Assessment Tool (IPAT) (Table/Fig 1) (4). The average of the four readings of each parameter was taken for each participant in each position.

Statistical Analysis

Data was entered in Microsoft Excel spreadsheet and analysed using software RStudio version 1.3.1056. Test applied was t-test and p-value <0.05 was taken as statistically significant.

Results

In the present study, 31 neonates amongst the 110 sample were of 30 weeks gestational age, contributing to 28.18% followed closely by 27 (24.54%) neonates with a gestational age of 31 weeks. Neonates were taken with birth weights ranging from 0.8 kg to 1.499 kg and were divided into weight bands of 99 grams. 34 neonates belonged to the weight band of 1.0 to 1.099 kg, showing highest percentage of 30.91%. The mean birth weight was 1.1 kgs. Sixty neonates were girl babies (54.55%) while 50 neonates were boy babies (45.45%). In the present study, 60 neonates (54.55%) were born by caesarean section while, the rest were delivered by normal vaginal delivery. A maximum of 40 neonates showed a mean APGAR score of 8 (36.36%) followed closely by 34 newborns (30.9%) with a mean APGAR score of 9. The total mean AGPAR score was 7.9 (Table/Fig 2).

All vital parameters as well as comfort scores were recorded before positioning to obtain baseline values. These baseline values of vital parameters were all within normal range. Hence, before positioning the neonates in either position, it was shown that all neonates were physiologically stable and comfortable.

Total 22 neonates (20%) had tachypnoea (respiratory rate >60 per minute) after being placed in prone position as opposed to only three neonates (2.73%) who had tachypnoea after KMC positioning. The mean respiratory rate in KMC position was 52.8 per minute while that in prone position was 55.6, implying lower and more normalised respiratory rate after being fed in KMC position. About 22 neonates (20%) had tachycardia (heart rate >160 beats per minute) after prone positioning as compared to only 3 neonates (2.73%), who had tachycardia after being placed in KMC position. The mean heart rate in KMC position was 147.5 beats per minute while that in prone position was 151.08 beats per minute, implying lower and more normalised heart rate after being fed in KMC position. A higher number of neonates i.e., 42 (38.18%) attained SpO2 of 99% after being placed in KMC position while 36 neonates (32.73%) attained SpO2 of 99% after being placed in prone position. The mean SpO2 was however similar; being 97.9% and 97.7% respectively in KMC and prone positions. Neonates placed in KMC position attained body temperature of 37.3-37.6°C, with a maximum of 52 babies (47.27%) having ideal physiological body temperature of 37.5°C, whereas neonates placed in prone position attained a body temperature of 36.6-37.3°C. The mean temperatures were 37.5°C in KMC position while 37.0°C in prone position. Thirty neonates (27.27%), following prone positioning had hyperglycaemia (CBG >125 mg/dL), most likely ascribed to stress, as opposed to only 3 neonates (2.73%) placed in KMC position, suggesting increased comfort and more normalised metabolism in KMC position. 107 out of 110 newborns representing 97.27% neonates had comfort score >8 (acceptable IPAT scores) after positioning in KMC compared to 88 neonates (80%) in prone position having an IPAT score >8. The mean scores, in KMC and prone positions, were respectively 11.2 and 10.1. Hence, contrary to prone position comfort levels were higher in KMC. With respect to gastric residual volume, 80 neonates amongst 110 (72.73%) in KMC had no gastric residuals as opposed to only 37 (33.64%) in prone position. The range of volume was less in KMC, being 0.1-0.2 mL as opposed to prone where it was 0.1-0.3 mL. The mean gastric residual volume was 0.03 mL in KMC position contrary to 0.13 mL in prone position. All these figures clearly signify better alimentation and utilisation of nutrients in KMC position (Table/Fig 3).

Discussion

The Cochrane review on benefits of KMC demonstrated improved exclusive breast feeding at discharge or 40-41 weeks’ postmenstrual age and at 1-3 months’ follow-up; reduction in the risk of mortality; reduction in nosocomial infection or sepsis; reduction in hypothermia; reduction in length of hospital stay with mean difference being 2.4 days; increase in weight gain with mean difference being 4.1 gm/day; increase in length with mean difference being 0.21 cm/week; increase in head circumference gain with mean difference being 0.14 cm/week (5). Prone positioning stabilises the chest wall and may reduce apnoea (7).

In the study conducted by Miltersteiner AR et al., mean gestational age was 34 weeks, mean birth weight was 1.78 kg, male: female ratio was 13:7, caesarean deliveries were 43% while normal vaginal deliveries were 57% (8). In a study, conducted by Bera A et al., mean gestational age was 33.2±3.3 weeks, mean birth weight was 1.45±0.31 kg (9). In the study, conducted by Ozdel D and Sari HY, mean gestational age was 30.2±2.6 weeks ranging between 24 to 34 weeks, mean birth weight was 1.45±0.6 kg, 25 neonates were delivered by caesarean section while five neonates were delivered by normal vaginal delivery and there were nine female with 21 male neonates (6). In the present study, most of the neonates were of 30 weeks gestational age, with birth weight around 1.1 kg. Majority were females; majority were delivered by caesarean section; most neonates had an APGAR score around 8 at birth.

Moore ER et al., found higher body temperature, increased SpO2, decreased respiratory rate following KMC positioning (10). In the study conducted by Bera A et al., mean temperature was increased by 0.4°C; respiratory rate increased by three per minute; heart rate increased by five beats per minute; SpO2 increased by 5% after 1-3 hours of KMC position (9). In the study, by Defilipo EC et al., there was significant reduction in respiratory rate and distress (as assessed by Silverman Anderson scoring system) after 90 minutes of KMC position while other vital signs showed no difference (11). In the study conducted by Ozdel D and Sari HY, there was a decline in mean heart rate by nine beats per minute, decline in mean respiratory rate by 3.2 breaths per minute, rise in mean SpO2 by 0.57%, rise in mean body temperature by 0.03°C in KMC position as compared to prone position, 30 minutes after placing in KMC position and three hours after placing in prone position postfeeding (6). In the present study, the mean respiratory rate and heart rate in KMC position was lower and more normalised than that in prone position. A higher number of neonates had tachypnoea and tachycardia in prone position three hours after feed as compared to KMC position, signifying discomfort. The mean SpO2 in the two positions were almost similar. Several studies have established the positive effects of prone position on ventilation and oxygenation, which could lead to similar saturations in both [6,8,9,12-14]. Neonates placed in KMC position attained body temperature nearer to normal physiological body temperature of 37.5°C as compared to those placed in prone position. This is because KMC keeps neonates warm and protects against cold stress and hypothermia (15). Stress causes hormonal and metabolic changes (16). Higher number of neonates had hyperglycaemia after being placed in prone position as compared to KMC position. The findings were consistent with previous studies [8-11].

In the study, conducted by Ozdel D and Sari HY, there was a significant reduction of mean comfort scores by 2.8, 30 minutes after feeding and by 8.17, three hours after feeding in KMC position as compared to prone position. In the present study, the mean comfort score in KMC position was higher than that in prone position. More neonates had comfort score ≤8 (unacceptable) in prone position than in KMC (6).

In the present study, the mean gastric residual volume was lower in KMC as compared to prone position three hours after feeding. Though there are limited studies available on gastric residual volumes in preterms. Chen SS et al., found lower gastric residual volume in prone position as compared to supine position; whereas, Valizadeh S et al., found lower gastric residual volume in KMC position as compared to supine position two hours after feeding [17,18]. In the study conducted by Ozdel D and Sari HY, there was a reduction in mean gastric residual volume by 0.06 three hours after feeding. Hence, these findings were consistent with former studies [6,18].

Limitation(s)

The present study was a single-centre study of short period (12 months) only. This period needed to be longer for more accurate results. Neonates were not randomised for feeding position. Further studies with randomisation for a longer duration of time can be conducted in future.

Conclusion

Kangaroo mother care position resulted in more stable vital signs and physiological indices, more comfort and better feeding evidenced by minimal or negligible gastric residual volume, as compared to prone position. Hence, it can be concluded that, kangaroo mother care is a much better position as compared to prone position during feeding in preterm neonates. Kangaroo mother care and prone positioning have the capabilities of better neonatal survival and outcome, especially in resource-limited countries.

Acknowledgement

Authors are indebted to Prof. (Dr.) Gobinda Chandra Das, Head, Department of Paediatrics, R.G. Kar Medical College and Hospital, Kolkata for his continuous guidance. Authors are also thankful to Dr. Basundhara Saha, Senior Resident, Department of General Medicine, NRS Medical College and Hospital, Kolkata for her support.

Author contributions: ARN: contributed to the conception and design of the present study, ARN: Contributed to the conception and design of the present study, collected the data, performed statistical analysis, interpreted the data and drafted the manuscript. PB: Contributed to the conception and design of the present study, performed statistical analysis, interpreted the data and critically reviewed the manuscript. NK: Contributed to the design of the present study, performed statistical analysis and critically reviewed the manuscript. DH: Contributed to the conception and design of the present study, performed statistical analysis, interpreted the data and critically reviewed the manuscript.

References

1.
Brady JM, Poindexter BB. Extremely and Very Preterm Infants. In: Kliegman RM, St Geme III JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, Behrman RE, editors. Nelson Textbook of Pediatrics. 21st edition. Philadelphia: Elsevier 2020; p. 902. (Textbook reference in Vancouver system).
2.
Hwang SK, Ju HO, Kim YS, Lee HZ, Kim YH. Effects of body position and time after feeding on gastric residuals in LBW infants. Taehan Kanho Hakhoe Chi. 2003;33(4):488-94. [crossref] [PubMed]
3.
Agarwal R, Deorari A, Paul V, Sankar MJ, Sachdeva A, editors. AIIMS Protocols in Neonatology. 2nd Edition. New Delhi: Noble Vision (Medical Book Publishers) 2019; p. 617-23.
4.
Sengupta A, editor. Workshop on Developmentally Supportive Care (DSC) in Preemies & Neuroprotection in the NICU. New Delhi: Development and Supportive Care (DSC) Foundation for Newborn & Children (India), 2019; p. 38.
5.
Conde-Agudelo A, Belizan JM, Diaz-Rossello J, Jose L. Kangaroo mother care to reduce morbidity and mortality in low birth weight infants. Cochrane Database Syst Rev. 2011;(3):CD002771. [crossref]
6.
Özdel D, Sari HY. Effects of the prone position and kangaroo care on gastric residual volume, vital signs and comfort in preterm infants. Jpn J Nurs Sci. 2020;17(1):e12287. https://doi.org/10.1111/jjns.12287. [crossref] [PubMed]
7.
Stark AR. Apnea. Eichenwald EC, Hansen AR, Martin CR, Stark AR, editors. Cloherty and Stark’s Manual of Neonatal Care. 8th edition. New Delhi: Wolters Kluwer. 2017;p.430.
8.
Miltersteiner AR, Miltersteiner DR, Rech VV, Molle LD. Physiological responses of the Kangaroo Mother position in preterm, low birth weight and spontaneously ventilating infants. Brazilian J Matern and Child Health. 2003;3(4):447-55. [crossref]
9.
Bera A, Ghosh J, Singh AK, Hazra A, Som T, Munian D. Effect of kangaroo mother care on vital physiological parameters of the low birth weight newborn. Indian J Community Med. 2014;39(4):245-49. [crossref] [PubMed]
10.
Moore ER, Anderson GC, Bergman N, Dowswell T. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2012;5(5):CD003519. [crossref]
11.
Defilipo EC, Chagas PSC, Nogueira CCL, Ananias GP, Silva AJ. Kangaroo position: Immediate effects on the physiological variables of preterm and low birth weight newborns. Physical Therapy in Movement. 2017;30(1):219-27. [crossref]
12.
Torabian H, Alinejad S, Bayati A, Rafiei F, Khosravi S. Comparison of the effects of supine and prone positions on oxygen saturation and vital signs in premature infants: A Crossover Clinical Trial. Iran J Neonatol. 2019;10(2):30-36.
13.
Çağlayan S, Gözen D. Effect of supine and prone flexion positions on heart rate, oxygen saturation and pain score of preterm infants. Erciyes Med J. 2021;43(1):26-30.
14.
Abdeyazdan Z, Nematollahi M, Ghazavi Z, Mohhamadizadeh M. The effects of supine and prone positions on oxygenation in premature infants undergoing mechanical ventilation. Iran J Nurs Midwifery Res. 2010;15(4):229-33.
15.
Agarwal R, Paul VK, Deorari AK. Newborn Infants: Paul VK, Bagga A, Sinha A, editors. Ghai Essential Pediatrics. 8th Edition. New Delhi: CBS Publishers & Distributors Pvt Ltd. 2013;p.148.
16.
Spruill CT, LaBrecque MA. Preventing and treating pain and stress among infants in the Newborn Intensive Care Unit: Eichenwald EC, Hansen AR, Martin CR, Stark AR, editors. Cloherty and Stark’s Manual of Neonatal Care. 8th edition. New Delhi: Wolters Kluwer. 2017;p.1024.
17.
Chen SS, Tzeng YL, Gau BS, Kuo PC, Chen JY. Effects of prone and supine positioning on gastric residuals in preterm infants: A time series with cross-over study. Int J Nurs Stud. 2013;50(11):1459-67. [crossref] [PubMed]
18.
Valizadeh S, Hosseini MB, Asghari Jafarabadi M. Comparison of the effect of nutrition in kangaroo mother care and supine positions on gavage residual volume in preterm infants. Evid Based Care. 2015;5(1):17-24.

DOI and Others

DOI: 10.7860/JCDR/2022/59239.17093

Date of Submission: Jul 22, 2022
Date of Peer Review: Aug 20, 2022
Date of Acceptance: Oct 17, 2022
Date of Publishing: Nov 01, 2022

AUTHOR DECLARATION:
• Financial or other competing interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects? NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jul 23, 2022
• Manual Googling: Sep 12, 2022
• iThenticate Software: Oct 15, 2022 (5%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com