Research Article

A PROSPECTIVE STUDY ON RESPIRATORY DISTRESS

SYNDROME AMONG NEONATES IN NICU &
ASSESSMENT OF KNOWLEDGE,ATTITUDE & PRACTICE
ON NEONATAL CARE AMONG POSTNATAL MOTHERS
– A PILOT STUDY
NEETHU J*, CLINTON BABY, AVINASH M, ANJUSHA A K, AKHIL BABU
Department Of Pharmacy Practice, Sreekrishna College Of Pharmacy & Research Centre Parassala,
Thiruvananthapuram, Kerala Pin- 695502, Cosmopolitan Hospital, Pattom P.O Thiruvananthapuram, Kerala
Pin-695004, Email: Neeth245@Gmail.Com

ABSTRACT
Neonatal health is an area that needs primary and optimal care. Respiratory Distress Syndrome (RDS) is a major
cause of neonatal respiratory failure and death. The lack of knowledge and wrong practices of post natal mothers may
also harm the baby. The aim of our pilot study is to analyze the risk factors and prescription pattern for Respiratory
Distress Syndrome in neonates along with assessment of knowledge, attitude & practice(KAP) on neonatal care
among post natal mothers and to provide comprehensive knowledge if required. The data were collected and
recorded in specially designed pro forma. The KAP of mothers were assessed using a structured questionnaire.
Information were provided through patient information leaflet. The data analysis revealed that male patients (72%)
were mostly reported with RDS. The mostly occurred risk factor for RDS is prematurity (88%). Supplemental oxygen,
CPAP therapy, antibiotics & surfactant therapy were given to respective patients. The antibiotics given were
categorized into ampicillin+gentamycin (1st line agent), piperacillin+Tazobactem (2nd line agent), meropenam+Colistin
(3rd line agent). The knowledge, attitude & practice of mothers regarding neonatal care were dramatically increased
after effective counseling. By addressing the risk factors for RDS and educating about it to expectant mothers and by
providing information on neonatal care, we could improve the quality of life of the newborn.

Keywords: RDS, Prescription pattern, KAP

INTRODUCTION
Respiratory distress syndrome (RDS) is one of the
most common causes of neonatal respiratory failure
and neonatal death. Respiratory distress syndrome is
a breathing disorder in infants with immature lungs.
Respiratory distress syndrome (RDS) of the newborn,
also known as hyaline membrane disease (HMD) is a
breathing disorder of neonates. The risk factors for
RDS are a serious matter to be
addressed[1].Pregnancy period, child birth and
neonatal period have great emotional effects in
family. According to specific biological and
psychological characteristics of neonates, they need
higher attention regarding to neonatal care. Lack of
maternal knowledge about neonatal care cause
inappropriate action and could lead to various
diseases. Therefore maternal knowledge assessment
have valuable importance in health development. So
we also focus on their knowledge, attitude & practice
regarding neonatal care. The postnatal period,
defined as the time immediately after the birth of the
baby and up to 6 weeks (42 days) after birth, is
critical for newborn and mother. The majority of the
neonatal deaths (75%) occurs during the 1st week of
life, and between 25% and 45% occurs within first 24
hours of birth. Two-thirds of all neonatal deaths
occur due to prematurity, asphyxia, and sepsis while
inappropriate feeding and cultural practices during
the postnatal period may pose further risks to the life
of newborn. Postnatal care allows for the provision of
immunization of newborns to provide them with
optimal start to life. Inappropriate practices such as
delayed initiation of breastfeeding, early bathing,
and delayed clothing, not seeking care when
newborns are sick and applying harmful material on
cord-stump increase the risk of newborn
deaths[5].Care practices immediately after delivery
play a major role in causing neonatal morbidities
and mortalities. Essential new born care practices
were outlined to decrease the neonatal morbidity
and mortalities. These practices include clean cord
care, thermal care, and initiating breastfeeding
immediately after birth (within 1 hour). The
traditional practices like applying cow dung on the
umbilical stump, oil instillation into nose etc also
contribute to newborn’s risk of morbidity and
mortality. The purpose of this study is to assess the
correct knowledge, attitude and practice of postnatal
mothers regarding the newborn care.

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MATERIALS AND METHOD
In the pilot trial, the data of 25 patients were
collected for a period of one month. The trial
included patients diagnosed with respiratory
syndrome in NICU and parents who are willing to
participate their baby in the study. The study
excluded neonatal patients with congenital
abnormalities and patient who are not willing to
participate their baby in the study.The primary
objective of our study is to assess the risk factors for
respiratory distress syndrome (RDS) in neonates and
the prescription pattern for RDS in neonates. The
secondary objective is to assess the knowledge,
attitude and practice on neonatal care among
postnatal mothers of selected sample and to provide
comprehensive knowledge in the field of neonatal
care if necessary.A written informed consent was
taken from the parents of patients diagnosed with
RDS. The case records were analyzed and the
relevant information about the baby and the mother
was collected and documented in specially designed
pro forma. The extend of contribution of different
risk factors for RDS and its prescription pattern were
noted and statistically analyzed.The knowledge
attitude and practice regarding neonatal care was
assessed among the mothers using a structured
questionnaire and adequate counseling was
provided. The pre and post counseling effect was
noted and statistically analyzed.
RESULTS
During the study period 25 cases of neonatal
patients in NICU with respiratory distress syndrome
were analyzed. Out of the total patients 72% were
male babies and 28% were female babies. The
known risk factors for RDS in the study population
were assessed, which included Pregnancy induced
hypertension (64%), Gestational diabetes mellitus
(80%), Intra uterine growth restriction (56%),
Maternal fever (20%), Leaking per vaginal(52%),
Oligohydraminosis (48%),Prematurity (88%), General
anesthesia (24%) and Sepsis (20%). The most
commonly occurred risk factors is prematurity and
maternal fever along with sepsis were least occurred
(Fig 1).

Figure 1- Distribution according to risk factors

The prescription pattern analysis for RDS shows 25 patients that are 100% of study population were given
supplemental oxygen therapy. Antibiotic therapy was given in 80%, CPAP therapy was given in 40% neonates
and 16% cases were treated with surfactant therapy (Fig 2)

Figure 2- Distribution according to prescription pattern

Three combinations of antibiotics were given, which Considering the educational status of the total
are, Ampicillin+ Gentamycin, mothers, 36% were graduated, 28% had professional
Piperacillin+Tazobactem & meropenam+colistin. degree, 20% had higher secondary education, 12%
65% of patients were treated with Ampicillin+ were high school & 4% were illiterate. While
Gentamycin combination alone, 20% were given the distributing according to occupational status 52%
1st two combinations (Ampicillin+ Gentamycin & were professionals 24% were skilled workers & 24%
Piperacillin+Tazobactem) and 15% of neonates were were unemployed . The knowledge, attitude and
treated with, Ampicillin+ Gentamycin, practice regarding neonatal care were assessed
Piperacillin+Tazobactem & meropenam+colistin. among the mothers before and after counseling
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using a structured questionnaire containing 53 before counseling. The level of knowledge increased
questions. 60% of mothers had poor knowledge and to 80% excellent and 20% good after post counseling
40% had moderate knowledge on neonatal care assessment (Fig 3).

Figure 3- Knowledge assessment of mothers

The attitude of mothers on neonatal care was negative for all 25 cases before counseling. The level had
increased to 20% moderate positive attitude and 80% highly positive attitude after effective counseling (Fig 4).

Figure 4- Attitude assessment of mothers

The pre counseling practice on neonatal care was poor for all mothers. It had increased to 60% good
practice and 40% excellent after the counseling effect (Fig 5).

Figure 5- Practice assessment of mothers

The counseling were mainly given on the fields of
breastfeeding, thermoregulation, cord care,
immunization and danger signs.
DISCUSSION
The results of this study shows that pregnancy
induced hypertension, gestational diabetes mellitus,
intra uterine growth restriction, maternal fever,
leaking per vaginal, Oligohydraminosis, prematurity,
general anesthesia and sepsis are the risk factors for
RDS in neonates. In concordance with the findings of
Matthias –Roth Kleiner etal[2], prematurity is the main
factor for RDS in neonates. In our study 88% of the
cases were premature. Liu etal conducted a similar
study on the risk factor as seen in our study. Most of
the study population was male (72%) in our study as
similar to the study of Jing Liu etal[3].
We had also seen that supplemental O₂ therapy is
the primary and most important treatment option for
these patients. CPAP therapy, antibiotics and
surfactants is given if necessary along with oxygen
therapy. Surfactant therapy was given only to patients
with severe distress. Most of the patients received
antibiotic therapy( 80%) along with oxygen therapy.
Out of total patients received antibiotics, the distress
of 65% were resolved alone with first line agents,20%
patients were treated with second line antibiotics and
third line were only needed for 15% patients.The KAP
assessment of mothers shows that 60% of mothers
had poor knowledge on neonatal care and 40%
moderate knowledge prior to counseling which had
improved to 80% excellent and 20% good knowledge
after counseling. There is a significant increase in

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mean from 6.4 to 19.2 at 0.01 significance level attitude and practice level on neonatal care were
(Table 1). increased by effective counseling and is proven that
the care could be improved by proper attitude and
Table 1 Effectiveness of counseling on good practices through improved knowledge as
knowledge concordance with similar studies[4,5,6].
Mean Conclusion
Mea
SD N Differenc Paired t P Since respiratory distress syndrome (RDS) is a major
n
e cause of neonatal death, there is an urgent need to
6.4 2. 2 address it. As per our study, we had assessed the risk
Pre 6 5 16.21* 0.00 factor for RDS. To reduce its incidence, we could take
12.80 preventive measures is expectant mothers and avoid
Pos 19.2 1. 2 * 0
t 8 5 it to an extent. The knowledge, attitude and practice
**: - Significant at 0.01 level on neonatal care could be improved among post
While considering attitude, the negative attitude of all natal and expectant mothers through effective
mothers had changed to 20% moderately positive counseling. However further studies are required for
and 80% highly positive attitude after the counseling. its betterment.
The attitude mean had changed from 9.8 to 26.2 at
0.01 significance level (Table 2). Reference
Table 2 Effectiveness of counseling on attitude 1. Jing Liu, Na Yang, Ying Liu,“High-risk factors for
Mean respiratory distress syndrome in term neonates:
Mea A retrospective case-control study”,Balkan
SD N Differenc Paired t p
n Medical Journal. 31, 64-68(2014).
e
2. Matthias Roth- Kleiner etal,“Respiratory
9.8 2. 2
distress syndrome in near-term babies after
Pre 6 5 15.81* 0.00
16.40 caesarean section”,
Pos 26.2 3. 2 * 0 Swiss Medical Weekly.133,283-288(2003).
t 6 5 3. LIU Jing etal,“Clinical characteristics, diagnosis
**: - Significant at 0.01 level and management of respiratory distress
The effective counseling had improved negative syndrome in full-term neonates”,Chin Med
practice of mothers on neonatal care to 60% good J.123(19),2640-2644(2010).
and 40% excellent practices. 4. Vishnu Bhat etal,“Knowledge, attitude and
Table 3 Effectiveness of counseling on practice practice of breastfeeding among postnatal
mothers”,Current Pediatric Research
.14(2),147-152(2010).
Mean 5. Purani etal,“Knowledge, awareness and practice
Mea
SD N Differenc Paired t P of postnatal care among mothers”,Indian J Child
n
e Health.2(2),83-85(2015).
3.6 0. 2 6. Sharafi etal ,“Knowledge assessment of neonatal
Pre 8 5 22.67* 0.00 care among postnatal mothers”,Iranian Journal
6.80 Of Neonatology Vol.4,No.1(2013).
Pos 10.4 1. 2 * 0
t 0 5 7. Keerthi Swarnkar, Manish Swarnkar,“Neonatal
**: - Significant at 0.01 level respiratory distress in early neonatal period and
its outcome”,
The mean practices had increased from 3.6 to 10.4 International Journal Of Biomedical and
at 0.01 significance level (Table 3).The knowledge, Advance Research 6(09),643-647(2015).

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