borns treated with the Infant Flow method

● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 1/2016 (20-25)
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20
Students’ knowledge about the care of newborns treated with the Infant Flow method
(Wiedza studentek na temat opieki nad noworodkiem leczonym metodą
Infant Flow)
M Lewicka 1,A,D, E Taras 2,B,C, M Sulima 1,E,F
Abstract – Introduction. Neonates are naturally prone to respiratory problems which may potentially lead to life-threatening conditions. The causes are usually disturbances in the adaptation to
life outside the uterus. The clinical findings made so far indicate
that the Infant Flow method is promising and its high effectiveness reduces the likelihood of pulmonary complications. Newborns treated with the Infant Flow method require special care by
the medical personnel.
Aim of the study. The purpose of the study was to learn about the
knowledge of the Infant Flow method in treating newborns possessed by students of obstetrics.
Materials and methods. The study was conducted among 211 BSc
(3rd year) and MSc (2nd year) students at the Faculty of Nursing
and Health Sciences at the Medical University of Lublin. The
method used in this study was a diagnostic survey and the research technique was the author’s own survey questionnaire.
Results. Knowledge of the methods of respiratory support in
newborns was possessed much more frequently by students aged
over 25 studying in a master’s programme and those who underwent training at a neonatal unit than by students aged under 25
studying in a bachelor’s programme and those who did not train
at a neonatal unit (p<0.05). From the analysis of the survey, it
results that the care of newborns treated with the Infant Flow
method involves close observation and diagnosis based on modern methods (71.56%), monitoring the vital functions (56.87%) as
well as performing nursing tasks in the incubator and limiting
them to the minimum (66.35%).
Conclusions. The students’ knowledge of non-invasive respiratory support methods in newborns is significantly correlated with
age, degree of studies as well as training at a neonatal unit. Students of obstetrics possess knowledge about the care of neonates
treated with the Infant Flow method and they recognise the need
to encourage parents to have early contact with their newborn
children.
artery disease, the duration of the surgery, and physical activity.
Streszczenie – Wstęp. W okresie noworodkowym występuje naturalna skłonność do występowania zaburzeń oddychania, w wyniku których może dojść do stanów zagrożenia życia. Przyczyną
tego stanu są najczęściej zaburzenia w procesie adaptacji do życia
pozamacicznego. Dotychczasowe doniesienia kliniczne wskazują,
że metoda Infant Flow jest obiecująca i efektywna a jej wysoka
skuteczność zmniejsza występowanie powikłań płucnych. Noworodek leczony metodą Infant Flow wymaga szczególnej opieki ze
strony personelu medycznego.
Cel pracy. Celem pracy było poznanie wiedzy studentek kierunku
położnictwa na temat opieki nad noworodkiem leczonym metodą
Infant Flow.
Materiał i metodyka. Badania przeprowadzono wśród 211 studentek kierunku położnictwo, pierwszego (III rok) i drugiego (II rok)
stopnia Wydziału Pielęgniarstwa i Nauk o Zdrowiu Uniwersytetu
Medycznego w Lublinie. Metodą zastosowaną w niniejszej pracy
był sondaż diagnostyczny, techniką badań był kwestionariusz
ankiety własnego autorstwa.
Wyniki. Wiedzę odnośnie metod wspomagania czynności oddechowej u noworodka istotnie częściej posiadały studentki powyżej 25 lat, będące na studiach II stopnia oraz te, które odbyły
praktyki w oddziale noworodkowym aniżeli studentki w wieku
poniżej 25 lat, będące na studiach I stopnia, oraz które nie odbyły
praktyk w oddziale noworodkowym (p<0,05). Z analizy badań
wynika, że pielęgnowanie noworodka leczonego metodą Infant
Flow polega na wnikliwej obserwacji oraz diagnostyce opartej na
nowoczesnych metodach (71,56%), monitorowaniu czynności
życiowych (56,87%), wykonywaniu zabiegów pielęgnacyjnych w
inkubatorze i ograniczeniu ich do minimum (66,35%).
Wnioski. Wiedza studentek na temat nieinwazyjnych metod
wspomagania czynności oddechowej u noworodka jest istotnie
zależna od wieku, poziomu studiów i realizacji praktyk w oddziale noworodkowym. Studentki kierunku położnictwa posiadają
wiedzę na temat opieki i pielęgnacji noworodka leczonego metodą Infant Flow oraz dostrzegają potrzebę zachęcania rodziców do
wczesnego kontaktu z dzieckiem.
Key words - infant, newborn, neonate, respiratory support, care,
knowledge.
Słowa kluczowe – noworodek, wspomaganie oddechu, opieka,
wiedza
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.1/2016 ●
Author Affiliations:
1. Department of Obstetrics, Gynaecology and ObstetricGynaecological Nursing Faculty of Health Sciences, Medical
University of Lublin
2. Department of Obstetrics and Perinatology, Department of
Neonatology, Independent Public Clinical Hospital No. 4 in Lublin
Authors’ contributions to the article:
A. The idea and the planning of the study
B. Gathering and listing data
C. The data analysis and interpretation
D. Writing the article
E. Critical review of the article
F. Final approval of the article
Correspondence to:
Dr Magdalena Lewicka Department of Midwifery, Gynaecology
and Gynaecological Nursing; Faculty of Nursing and Health Sciences, Medical University of Lublin, Chodźki 6 Str., PL-20-093
Lublin, Poland, e-mail: [email protected]
Accepted for publication: January 8, 2016.
I. INTRODUCTION
eonates are naturally prone to respiratory problems
which may potentially lead to life-threatening conditions. The causes are usually disturbances in the adaptation to life outside the uterus. The incidence of respiratory failure in newborns is inversely proportional to gestational age and it depends on the maturity of the systems
participating in gas exchange. The infant respiratory distress syndrome (IRDS) is the most frequent reason for neonate treatment at intensive care units. It affects ca. 1% of all
infants, 90% of infants born before the 25th week of pregnancy, and 70% of infants born between the 28th and 32nd
week of pregnancy [1-5].
Over the last decades, immense progress has taken place
in obstetrics and neonatology. The development of diagnostic methods for assessing the condition of the foetus and
its maturity has enabled predicting risks to the infant’s life
even before it is born. Early detection and diagnosis of
risks as well as treatment and prophylaxis decrease the perinatal mortality rate [4].
The introduction in the 1970s, to infant respiratory therapy, of a non-invasive method of supporting ventilation
with continuous positive airway pressure has made it possi-
N
21
ble to considerably limit intubation and mechanical ventilation.
Technical progress has led to improving the system and to
the appearance of the Infant Flow device in 2001. This
method is a modified CPAP technique (Continuous Positive Airway Pressure) which enables the stimulation of
breathing in newborns and extends the monitoring of the
respiratory function [6,7]. The clinical findings made so far
indicate that the Infant Flow method is promising and its
high effectiveness reduces the incidence of pulmonary
complications. The introduction of the modern Infant Flow
treatment method has initiated a new era in the history of
Polish neonatology [1].
A newborn treated using the Infant Flow method requires
special care from the medical personnel.
The purpose of the study was to learn about the
knowledge that students of obstetrics have concerning the
care of neonates treated with the Infant Flow method.
II. MATERIAL AND METHODS
The study was conducted among 211 BSc (3rd year) and
MSc (2nd year) students at the Faculty of Nursing and
Health Sciences at the Medical University of Lublin. Most
respondents were aged 21-22, (n=72; 34.12%), and
27.01%, (n=57) were aged 19-20. Respondents aged 23-24
composed 12.32%, (n=26) and those 25 years old and more
comprised 26.55%, (n=56). The majority of students had
trained at the Neonatal Unit (n=182; 86.26%) and at the
Neonatal Intensive Care Unit (n=114; 54.03%).
In order to conduct the study, the diagnostic survey
method was used. The tool used was a survey questionnaire
prepared especially for this study.
The results obtained were subjected to statistical analysis. A significance level of p<0.05 pointing to statistically
significant differences was adopted. The database and statistical research were based on STATISTICA 10.0 software
(StatSoft, Polska).
III.
RESULTS
Table 1 presents the respondents’ knowledge of noninvasive respiratory support in infants.
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.1/2016 ●
Table 1. Respondents’ knowledge of non-invasive respiratory support methods in newborns
Knowledge of non-invasive respiratory support methods
Total
Age
yes
impaired gas exchange
141
66.82
disturbed thermoregulation
4
1.90
mucus plugging the airways
48
22.75
2
0.95
limb swelling
33
24
57
I don’t know
16
7.58
Total
211
100.00
57.89%
42.11%
100.00%
56
16
72
77.78%
22.22%
100.00%
21
5
26
80.77%
19.23%
100.00%
54
2
56
old
96.43%
3.57%
100.00%
Statistical analysis: Chi2=24.40; p=0.00002
n/%
n/%
n/%
Bachelor’s
123
43
166
(BSc)
74.10%
25.90%
100.00%
41
4
45
8.89%
100.00%
91.11%
2
Statistical analysis: Chi =5.92; p=0.01
neonatal unit
%
n/%
over 25 years
Training at
n
n/%
23-24 years old
Master’s (MSc)
Problems
n/%
21-22 years old
ies
Table 2. Knowledge of the problems affecting newborns
treated with the Infant Flow method
no
19-20 years old
Degree of stud-
22
n/%
n/%
n/%
154
28
182
84.62%
15.38%
100.00%
10
19
29
65.52%
100.00%
yes
In course of the statistical analysis, it was found that the
respondents indicated correctly that the most frequent problem affecting newborns treated with the Infant Flow method was impaired gas exchange (66.82%). The respondents
further pointed to mucus plugging the airways (22.75%),
disturbed thermoregulation (1.90%), and swelling of the
limbs (0.95%). However, 7.58% of the respondents were
not able to name any problems affecting newborns treated
using the Infant Flow method.
Table 3 presents the students’ knowledge of the most
frequent reasons for considerable anxiety of the infant during therapy. The survey indicated that according to 32.70%
of the respondents, the most frequent cause of the newborn’s anxiety during Infant Flow therapy was the inappropriate size of the nasal attachment, while 34.60% of the
respondents pointed to the inappropriate fitting of the Infant Flow system. In turn, 7.58% of the students indicated
ineffective thermoregulation, and 25.12% did not have any
knowledge in that scope.
no
34.48%
2
Statistical analysis: Chi =33.47; p<0.000001
From the survey conducted, it results that 77.73%,
(n=164) of students claimed that they knew non-invasive
neonate respiratory support methods, whereas 22.27%,
(n=47) admitted to not having any knowledge in this scope.
Knowledge of respiratory support methods in newborns
was possessed significantly more often by students aged
over 25 studying in a master’s program and those who had
completed training at a neonatal unit than by students under
25 studying in a bachelor’s programme or those who had
not trained at a neonatal unit (p<0.05).
Table 2 presents the respondents’ knowledge of problems affecting newborns treated with the Infant Flow method.
Table 3. Student’s knowledge about the causes of considerable anxiety of the infant during therapy
Causes
n
%
distrubed thermoregulation
16
7.58
inappropriate size of the nasal attachment
69
32.70
inappropriate fitting of the Infant Flow
system
73
34.60
I don’t know
53
25.12
Total
211
100.00
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.1/2016 ●
Table 4 presents the respondents’ knowledge about the
care of newborns treated with the Infant Flow method.
Table 4. Respondents’ knowledge about nursing a newborn
treated with the Infant Flow method
Nursing a newborn
n
%
151
71.56%
monitoring vital functions
120
56.87%
preventing damage to nostrils
81
38.39%
preventing infections
80
37.91%
66
31.28%
57
27.01%
attentive observation and diagnosis
based on modern methods
ensuring suitable temperature of the
internal and external environment
Newborn body care
*The values do not add up to 100% because it was possible to select
several answers
From the analysis of the survey, it results that the care of
infants treated with the Infant Flow method involves attentive observation and diagnosis based on modern methods
(71.56%) as well as the monitoring of vital signs (56.87%).
Less often, the respondents pointed to preventing damage
to the nostrils (38.39%), keeping infections at bay
(37.91%) as well as to providing appropriate ambient temperature (31.28%).
Table 5 presents the students’ knowledge about providing comfortable conditions to the newborn during therapy
with the Infant Flow method.
Table 5. Students’ knowledge about providing comfortable
conditions for the infant during therapy with the Infant
Flow method
Ways of providing comfortable conditions
nursing activities must be performed in
the incubator and limited to the minimum
using baby support pillows, frequent
changes of body and head position
frequent changes of nappies and buttock
skin care
dimming the incubator lights and limiting noise
* The values do not add up to 100% because
several answers
n
%
140
66.35%
113
53.55%
66
31.28%
81
38.39%
it was possible to select
23
The respondents usually knew that one of the ways to
ensure comfortable conditions for the newborn undergoing
Infant Flow therapy was to carry out nursing activities in
the incubator and limiting them to the minimum (66.35%)
as well as using baby support pillows and frequently changing the body and head positions (53.55%). In turn, 38.39%
of the respondents mention that one of the methods is to
dim the incubator lighting and limit the noise. Also,
31.28% of the respondents stated that nappies must be
changed often and the buttock skin protected.
Table 6 presents the respondents’ knowledge about feeding newborns treated with the Infant Flow method.
Table 6. Respondents’ knowledge about feeding the newborn treated with the Infant Flow method
Feeding methods
n
%
brestfeeding
44
20.85%
formula feeding
17
8.06%
61
28.91%
42
19.91%
107
50.71%
feeding with mother’s milk through a
gastric tube
feeding with mother’s milk using a syringe or pipette
feeding methods depend on the general
condition of the newborn
* The values do not add up to 100% because it was possible to select
several answers
Over half of the respondents (50.71%) had knowledge
about the way of feeding newborns treated using Infant
Flow, declaring that the feeding method depended on the
baby’s condition. Yet, the remaining students indicated that
the infant should be breastfed (20.85%), formula-fed
(8.06%), fed with mother’s milk through a gastric tube
(28.91%) or with mother’s milk using a syringe or pipette
(19.19%).
The survey results obtained also indicated that 91.00%
of the respondents (n=192) correctly stated that shaping an
emotional bond between the parents and child was an important element of therapy, whereas as many as 84.36%
(n=178) of the respondents believed that parents ought to
be involved in nursing activities during treatment.
Furthermore, based on the analysis of survey results it was
found that 35.55% (n=75) of the respondents believed that
too little time was devoted to the Infant Flow method as
part of the obstetrics degree. In addition, 27.96% (n=59) of
the respondents conceded that the theoretical knowledge of
Infant Flow obtained during studies should be supported by
a larger amount of practical hours.
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.1/2016 ●
IV.
DISCUSSION
Non-invasive ventilation is any method of generating
positive pressure in the lungs without the use of an endotracheal tube. The advantages of non-invasive ventilation include: maintaining the physiological nasal airway, natural
air heating and humidification mechanisms, natural protection against infections (function of the ciliated epithelium),
avoidance of intubation (elimination of associated complications), possibility to feed the newborn through the oral
cavity, possibility of direct contact between mother and
child during kangaroo care, and the similarity to physiological processes taking place in the infant’s body [8,9]. From
the analysis of the author’s own survey, it results that the
students possess knowledge of non-invasive respiratory
support methods in neonates (77.73%).
In the process of nursing an infant connected to the Infant Flow set, attention must be paid to the following elements: monitoring the basic vital functions, ensuring appropriate ambient temperature, airway hygiene, body care,
feeding the baby, preventing damage to the nostrils, protection against infections, and taking relevant action in the
event of considerable anxiety of the infant [10,11]. The
survey results demonstrate that 56.87% of the respondents
knew that an infant connected to an Infant Flow apparatus
requires continuous monitoring of the basic vital signs,
ensuring an appropriate temperature of the internal and
external environment (31.28%), and preventing damage to
the nostrils (38.39%). In terms of feeding the neonate, over
half of the students surveyed (50.71%) answered that it
depended on the infant’s general condition, while 20.85%
of the respondents believed that the newborn should be
breastfed, and 28.91% pointed to feeding with mother’s
milk through a gastric tube. In turn, 19.19% found that the
baby may be fed with mother’s milk, yet using a pipette or
syringe, whereas 8.06% of the students provided that an
optimum method was formula feeding.
According to Szymczyk [11], nursing activities may lead to
unpleasant sensations, apnoea and cyanosis in newborns.
All interventions ought to be adjusted to the sleep and
wakefulness states of the newborn. If the neonate is in an
incubator,
it
should
be
placed
on
a soft surface, baby support pillow or laid down on a waterfilled mattress. This will provide the baby with a sense of
security and produce a calming effect. Crucial factors include dimming the incubator lighting and limiting noise
[12]. In accordance with the survey results, 66.35% of the
students believe that one of the ways to ensure comfortable
conditions for the newborn undergoing Infant Flow therapy
is to carry out nursing activities in the incubator and limit-
24
ing them to the minimum. 53.55% of the student respondents were of the opinion that placing the baby on a support
pillow and frequently changing the body and head positions
contributed to the baby’s comfort, and finally 38.39% of
those surveyed pointed to the need to dim incubator lighting and limit noise.
Kmita [13] provides that a crucial element of therapy is to
encourage parents to have contact with the baby at an early
stage. Parents may be supported in that their sense of helplessness is reduced and their competences are strengthened.
The results of the author’s own study have indicated that
84.36% of the respondents believe that parents should be
involved in nursing the baby undergoing treatment; 6.16 %
believed that parents should not be involved in nursing the
newborn, and 9.48% of the respondents admitted to not
having any knowledge in that respect. Moreover, 91.00%
of the students were of the opinion that shaping an emotional bond between the parents and child was an indispensable element to nursing.
The care of a neonate with respiratory failure treated with
the Infant Flow method requires considerable theoretical
knowledge and practical skills from the medical personnel.
Correctly performed nursing enables the fast identification
of problems and taking adequate steps in order to eliminate
such issues [14]. Therefore, it is important to increase the
number of hours dedicated to non-invasive methods of respiratory support in neonates during the formation of midwives studying in bachelor’s and master’s programmes.
From the author’s own research, it results that 35.55% of
the respondents were of the opinion that too little time was
devoted to the Infant Flow method during midwifery studies. In turn, 27.96%, (n=59) of the respondents admitted
that the theoretical knowledge about the Infant Flow method amassed during university courses should be supported
by a greater number of practical hours.
V.
CONCLUSIONS
 Students’ knowledge of non-invasive breathing
support methods in newborns is significantly
correlated with their age, degree of studies and
training at a neonatal unit.
 Students of obstetrics have knowledge concerning the
care and nursing of neonates treated with the Infant
Flow method and they see the need to encourage
parents to have early contact with the baby.
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.1/2016 ●
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