RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

ANNEXURE-II

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION.

1. NAME OF THE

CANDIDATE AND

ADDRESS

Mrs.SHEEBA JAMES.

1ST YEAR M.Sc. NURSING STUDENT

RAJEEV COLLEGE OF NURSING,

K.R PURAM, HASSAN, KARNATAKA

2. NAME OF THE

INSTITUTION

RAJEEV COLLEGE OF NURSING,

K.R PURAM, HASSAN, KARNATAKA

3. COURSEOF THE

STUDYAND SUBJECT

MASTER OF SCIENCE IN NURSING,

OBSTETRICS AND GYNECOLOGICAL

NURSING

4. DATE OF ADMISSION

TO COURSE

31st MAY 2010

5. TITLE OF THE TOPIC KNOWLEDGE REGARDING SELECTED

MINOR PROBLEMS OF THE NEWBORN

AMONG PRIMI PARA MOTHERS WITH A

VIEW TO DEVELOP AN INFORMATION

BOOKLET.

5.1 STATEMENT OF THE

PROBLEM

“A STUDY TO ASSESS THE KNOWLEDGE

REGARDING SELECTED MINOR

PROBLEMS OF THE NEWBORN AMONG

PRIMI PARA MOTHERS WITH A VIEW TO

DEVELOP INFORMATION BOOKLET,IN

SELECTED HOSPITALS OF HASSAN,

KARNATAKA.”

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6. BRIEF RESUME OF THE INTENDED WORK:

“Experiences have clearly shown that an approach which “demedicalizes” birth,

restores Dignity and Humanity to the process of child birth and returns control to

the mother is also the safest approach”.

Michael Dent. MD.

INTRODUCTION:

Most mothers observe their babies carefully and are often worried by the minor physical

or physiological peculiarities which are of no consequence. It is important that her

complaints are listed carefully, and they are not ignored lightly with out doing proper

evaluation of the baby. She must be given reassurance, and advice regarding the minor

problems and difficulties that may be bothering her.1

The knowledge regarding various developmental variations and physiological

conditions and their evolution is important for giving proper advice, guidance and

reassurance to the mother.2

Today’s small and scattered families mean that most new mothers have no previous

experience of caring for the young babies. Literature for parents tends to stress the

positive, the reality of 24 hrs a day care of constantly crying baby, laundry, the difficult

in nipping out of the house, anxiety about what is or is not normal can be overwhelming.

So adequate reassurance and explanation of the mother is important and necessary to

allay her anxiety which may lead to lactation failure.3

The new borns and infants posses’ unique physiological capabilities to adapt to

stress both internal and external. Occasionally however interventions are necessary to

ensure or ease a return to wellness. Many problems identified during the neonatal and

infant periods can be managed through education and information methods such as

Information booklet on minor problems of new born and their management.4

As the new born are prone for some physical or physiological peculiarities which

are of no consequence even though there are some conditions which can threaten the life

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of the baby if not managed at earliest. Hence the conditions need to be evaluated to detect

any possible pathology underlying.

As mothers are the primary care takers for the new borns they should have adequate

knowledge to identify even minor changes and its consequences if neglected. For this

purpose, the Health care professionals should create awareness among primi Para

mothers regarding Minor problems of new borns, its early identification, causes,

prevention, management, and complications if neglected and mother needs adequate

reassurance in order to over come her anxieties.

6.1 NEED FOR THE STUDY:

Minor Problems in new born are a common Problems, which usually occurs during

the early stages of life and which are found to threat mothers with regard to its treatment,

but does not actually cause any life threatening condition in new born babies and they

subside with out requiring any special treatment. The minor disorders include-

Conjunctivitis, Skin conditions- diaper dermatitis, thrush, perianal dermatitis,

Physiological jaundice, Constipation, Infantile regurgitation, Diarrhea. 5

Relatively these trivial disorders of the new born babies may be magnified in a

mothers mind to cause intense worry and suffering, which often remain unvoiced unless

the opportunity is given. In the first week of life the newborn babies continue a process of

adjustment to independent existence, which begins abruptly at the moment of birth. Some

of the Minor problems during this period are due to incomplete adaptation to the new

environment. The primary minor problem of new born is Neonatal conjunctivitis which

presents during the first month of life and may aseptic or septic.5

Aseptic neonatal conjunctivitis most often is a chemical conjunctivitis. Bacteria,

Chlamydia and viral infection are major causes of septic neonatal conjunctivitis in which,

Chlamydia is found to be most frequent. The incidence of infectious neonatal

conjunctivitis ranges from 1-2% depending on socio-economic character area. The

incidence of ophthalmic neonatrum exists in developing countries. In a Nairobi Hospital,

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the incidence of Gonococcal and Chlamydial conjunctivitis were 40/1000 & 80/1000 per

live Newborn. 5

The second minor problem among newborn babies is diaper dermatitis. It results

from prolonged contact with irritant such as moisture, chemical substances and friction.

Urine ammonia formed from the breakdown of urea by fecal bacteria is irritating to

sensitive infant’s skin, infrequent diaper changes and constant urine & feces contact

prone to damage the skin.5

The next common prevailing problem in newborn babies is physiological

jaundice. Epidemiological studies provided a frame references for estimated incidence in

1986 by Maiseles and Gifford, who reported that 6.2% of newborns had serum bilirubin

levels of more than 220µ mole (12.9mg/dl). In 2003, study in United States showed 4.3%

of 47,801 infants with serum bilirubin levels in a range, in which phototherapy was

recommended by American Academy of Pediatrics.5

The other chief complaints in newborns are constipation which is found to be 3%

of general population, and which is found to be more common in bottle fed and formula

fed infants. Epidemiological research shows 16% of parents with children from birth to

22 month old reported constipation in their babies with a male to female ratio of 1:1.5

The alimentary tract and abdominal problems are common in newborn babies.

The commonly and frequently prevailing condition is infantile regurgitation or spilling of

milk, which has become a source of some worry in first week of life to the parents.

Spilling of milk, regurgitation of milk soon after feeding is of course entirely normal,

which could have been attributable to either bad feeding technique or large amount of air

swallowed by the newborn during feeding or due to lack of burping or handling the baby

immediately after feeding. Vomiting with bile is always a danger signal at this age which

probably indicates high intestinal obstruction (For ex: Duodenal Artesia) and which

requires immediate management of the condition. Hence the small regurgitation in

newborn needs to be considered and managed.5

4

Diarrhea is found to be a commonest cause of mortality among the newborns.

UNICEF proposed a target by 2015 to reduce the mortality rates among these high risk

groups by 2/3rd from 93 infants & newborns of every 1000 dying before the age of 5 in

1990 to 31 of every 1000 in 2015.5

Hence newborn period is a period whereby the babies due to their low immunity

are prone for many common minor problems. These problems appear minor if the prompt

action is taken at earliest by the mother or health care professionals, or else they can

emerge as a serious life threatening complications in newborns. Hence the knowledge of

mother regarding this aspect is very much essential.5

A study was conducted on “Incidence and bacterial etiology of neonatal

conjunctivitis”. About 229 infants born consecutive at maternity ward of the MIDDLE

HEIM HOSPITAL in Antwerp, over a period of 5 months and an additional 55 randomly

selected infants born at the same hospital were clinically investigated before leaving

maternity ward. All infants born at this maternity ward received eye drops immediately

after birth 26 (11%) of infants consecutively investigated as neonatal conjunctivitis.

While another infants were reported to have developed sticky eyes and/or red eyes. The

result of this study stated that overall one or more bacterial species could be isolated from

eyes of 143 (48%) of infants. But only viridians streptococci and staphylococci were

cultured significantly. More often from eyes of cases with conjunctivitis than from eyes

of infants without conjunctivitis.6

A study was conducted to evaluate the frequency of diaper dermatitis among

newborns visited the outpatient department, with specialties’ of pediatricians providing

services, demographic of babies and leading agents used in treatment. The study included

approximately 8.2 million newborns visiting OPD and who were diagnosed to have

diaper dermatitis, and pediatrician provided treatment for diaper dermatitis. Nystatin was

a leading treatment agent prescribed, followed by clotrimazole, a combination product of

Nystatin and triamcinolone and hydrocortisone. Hence finally study concluded that visits

for diaper dermatitis are frequent among newborns and frequent use of potent

5

corticosteroids containing combination agents is a potent target for improving the

management of diaper dermatitis.7

Hyperbilirubinemia is the commonest morbidity in the neonatal period and 5-10%

of all new borns require intervention for pathological jaundice. Neonates on exclusive

breast feeding have different patterns of physiological jaundice as compared to artificially

fed babies. Study included guidelines from American Academy of pediatrics (AAP) for

management of jaundice in a normal term newborn .study stated that management

protocol of hyperbilirubinemia have to be validated in Indian babies before they are

accepted for wide spread use.8

An epidemiological study was conducted to identify the models of postnatal

continuity of care, most likely to prepare mothers for discharge, to reduce new borns

readmission for jaundice. The study comprised of eligible mothers participated in

telephone interviews. Newborns who had presented with signs of jaundice, were

identified from theirs mothers. The results of the study showed that ‘Of participating

newborns, 45.5% presented with signs of jaundice and 3.2% were readmitted for

jaundice during first week of life and follow up procedures were given through

community based phototherapy services offered at home and there was no readmission

Hence the study concluded that an effective co ordination of community based perinatal

services and hospital linked home phototherapy in the form of integrated networks, is an

essential condition for monitoring of new born not only for jaundice but also for other

new borns problems.9

Assessing and Providing knowledge to the primipara mothers about selected

“Minor problems of new born” will help in decreasing anxiety among mothers. And since

mothers are the one caring the new borns, it is important that the education is best

provided to the mothers, so that they can care the new born babies in better way, there by

will be able to manage the condition. Thus it is essential for the student investigator to

enhance the knowledge of the primi Para mothers regarding Selected Minor problems of

6

newborn babies. Hence the investigator has decided to design study on knowledge of

primipara mothers on selected minor problems of new born.

6.2 REVIEW OF LITERATURES:

1. Studies related to incidence and prevalence of selected minor problems of new borns.

2. Studies related to knowledge of mothers on selected minor problems of new borns.

3. Studies related to management of selected minor problems of new born.

1. Studies related to incidence and prevalence of selected minor problems of new

borns.

A study was conducted to identify the prevalence of causative agents of

ophthalmia neonatrum. The study included 114 neonates with conjunctivitis in first 4

weeks of life and 2 swab specimens containing epithelial cells of conjunctiva was

obtained and bacterial culture and gram staining was performed and bacterial isolated

were identified. The results of the study showed that of 114 neonates with positive eye

swab Chlamydia trochomatis was the common cause of neonatal conjunctivitis. Hence

the study was concluded that prevalence of Chlamydia trochomatis in newborns was

14.9% and hence Chlamydia trochomatis is a common causative organism in acute

neonatal conjunctivitis.10

A study was conducted to document the earliest stage of rash in cohort of 31

healthy term newborns over the first 28 days of life. The diaper area was evaluated using

a standardized diaper rash grading scale. The anal, buttock, genital, waist band, leg areas

were assessed separately. At birth average grade was 0.1 and none of the infants were had

specific features of advanced rashes .19%had dryness and or slight redness. By day 7,

7%of the infants had some features of skin compromise. Both the frequency and over all

grade increased during postnatal weeks of 2 and 3. Over all scores for day 21 and 28 were

same. The perianal had highest over all regional rash grades. The study concluded that a

better understanding of the mechanisms conferring epidermal barrier protection at birth

7

may be important for developing skin care products and practices to the extend this

protection later in to life.11

Physiological jaundice is a common problem faced by newborns, approximately

60% full term and 80% preterm babies. Critical reviews of five research papers were

performed in an attempt to explore clinical uncertainties and reach a conclusion. This

study showed that, 1st the strongest review of research paper showed that near term

newborns were at significant risk for hyperbilirubinemia, 2nd review of research papers

showed the usefulness of predictive nomograms to identify infants at risk of significant

hyperbilirubinemia. 3rd review of research papers highlighted uncertainties among the

practitioner to the management and treatment of hyperbilirubinemia. Thus this study

concluded that new guidelines are required and should incorporate individual guidance

for near term newborn as they have been shown to be at increased risk of developing

significant hyperbilirubinemia.12

A study was conducted to know the relationship between Breast feeding, dietry

fiber intake and constipation in new born babies. The study population consists of 275

babies consecutively enrolled in two primary care clinic in city of Embu. The feeding

patterns were classified as breast feeding, partial breast and cows milk feeding and

artificial feeding. The results of the study showed that constipation was found in 25%

(69/275). False constipation was found only in 1st semester of life in 5.1% of 159 babies.

The prevalence of constipation was higher between 6 and 24 months than in the first

semester of life. The results showed that infants under artificial feeding were 4.53 times

more liable for constipation than infants who were breast fed.13

A study was conducted to compare the frequency of regurgitation in formula and

breast fed new born in first two days of life .The study consisted of 32 new born babies

who were formula fed and 31 were breast fed. All regurgitation was noted. Results of the

study stated that number of regurgitation per infant in the first 48 hrs of life was similar

in both formula fed and breastfed babies. There was also no difference in number of

regurgitation in second 24hr period. Hence the study concluded that Human milk feeding

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did not confer a “protection” on regurgitation in young new borns and that regurgitation

is common in new borns.14

A study was conducted to find the incidence of Entero aggregative

Escherichiacoli associated with out break of Diarrhoea in neonatal nursery ward. Over a

9 day period in febraury, 16 new borns babies (ranging from 2-11) days and 3 infants

( 24,47, 180 days) in a neonatal nursery ward developed Diarrhoea accompanied by

pyrexia and weight loss and cultures were done and known entero pathogenesis were not

detected in their stools but E- coli were found in 12(63%) ill infants and in none of 5 well

neonates. The illness lasted 3-9 days in 16 babies, hence study shows that source of

infection and mode of transmission was unclear but the out break of Diarrhoea was

present and those affected were with E- coli and expressed multiple antibiotic resistant.15

2. Studies related to knowledge of mothers on minor problems of new born

A study was under taken to assess the level of mothers knowledge on certain

aspects of new born health care and to find out any correlation between their level of

knowledge and number of years of formal education they had. In the study two part

questionnaire was distributed. The first part comprised information about mothers

nationality and age level of education and number of children. The second part consist of

40 statements about different aspects of child’s heath matters . A structured interview was

conducted and knowledge score was calculated from number of correct answers. Out of

373 questions the mean scores of samples was 25( out of 40) and minimum score was 14

and maximum score was 36. Hence the study concluded that mothers knowledge on new

borns health related matters is deficit and hence there should be proper disseminating

information on child health matters among mothers.16

Across sectional studies was conducted to assess the knowledge, attitude, and

behavior of mothers on jaundice in new borns. The study consists of 400 cases who

delivered at Ali-Ebne Abitaleb, hospital in Zahedan Iran during April and May 2006. The

mothers were interviewed with 21 point questionnaire on knowledge attitude and

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behavior on jaundice .The study results showed that knowledge score was 7.25+ 2out of

13.5 and also showed that their knowledge on causes, harmful symptoms, prevention of

disease was in adequate and attitude score was18.5+3.7out of 25 and mean of behavior

score was 6.8+2.3out of 10.5. Hence the study concluded that increasing the mother’s

knowledge about jaundice in new borns can be the first step to enhance healthy

behaviour through educational programmes.17

3. Studies related to management of selected minor problems of new born.

Randomized clinical trial was performed during the year 2004 to 2005 on

prophylaxis of Ophthalmic Neonatorum, comparison of betadine, erythromycin and no

prophylaxis. The study was conducted in the delivery section of VILI-e-ASR hospital on

330 neonates who were divided into 3 equal groups of 110. Group A received betadine

eye drops, Group B received erythromycin eye drops, Group C (Control group) received

no treatment. Result of the study showed that clinical conjunctivitis occurred in 52 babies

(17%). On the whole, 9% of infected newborns were from Group A, 18.4% from Group

B and 22.4% from Group C and hence the study was concluded that 2.5% sterile betadine

eye drops has pronounced effect on ophthalmic neonatrum.18.

A study was conducted to assess the rashes which are extremely common in

newborn. Although most rashes are transient and benign, some require additional work

up. This study states, evaluation of infants for unusual presentation or signs of systemic

illness like Candida viral and bacterial infection, Milia and miliaria resulting from

immaturity of skin structures. Miliaria rubra (known as Heat rash) usually improved after

cooling measures were taken. Seborrhic dermatitis, napkin dermatitis are also found to be

commonly occurring in newborn which needs to be assessed hence the study concluded

that parents should be reassured and observation should be made and also stresses on

application of tar containing shampoo, ketaconazole, or topical mild steroids if severe

skin condition occurs.19

10

A study was conducted to assess the effect of phototherapy in full term babies

with physiological jaundice. The studies included 40 consecutive babies with serum

bilirubin levels of 250µmo/l or more and were assigned randomly in to two treatment

groups. Phototherapy was started to one group early (n=20) when serum bilirubin level

was 250µmol/l and to another group it was started late (n=20) when serum bilirubin level

reached 320µmol/l. Phototherapy prevented a furture rise in bilirubin in almost all treated

babies. But early phototherapy produced more rapid decline in bilirubin levels which fell

to below 250µmol/l with in 18hrs and group with late phototherapy had decline in serum

bilirubin level with 54hrs. Hence the study concluded that early initiation of phototherapy

for physiological jaundice gave rise to early declination in serum bilirubin levels.20

Infantile regurgitation is a frequently occurring problem. Throughout the world.

A study was conducted on nutritional management of regurgitation in infants by General

practitioners; pediatricians and pediatric gastroenterologists who strived to alleviate

infantile regurgitation and its related parental stress. Optimal, cost-efficient management.

The intent of this paper was to disseminate this information to practicing physicians and

other health care professionals in an attempt to minimize the impact of this annoying

problem of infancy and to eliminate confusion and expensive diagnostic tests and use of

sub-optimal treatment modalities. Parental reassurance and dietary management by

feeding thickened formula are important components in managing regurgitation in infants

while maintaining optimal nutritional intake for adequate growth and development.21

A prospective study was conducted to know the effectiveness of lacto bacillus on

the Incidence and severity of acute Rota virus diarrhea in new borns. The study included

112 New born babies in Rural India who were randomized to receive a daily oral dose of

100 million lactobacillus sporogenes or a placebo for one year and morbidity was

monitored each week for 12 months . 94(84%) experienced diarrhea due to rotavirus

Infection. The group fed with lactobacillus sporogenes had fewer episodes of diarrhea.

The number of Newborns who presented with mild to moderate diarrhea was 11 in

treated group and 15 in placebo group compared to Infants who were not treated. Hence

11

the study observation concluded that prophylactic feeding of lactobacillus has a

preventive effect on the Incidence and duration of acute rotavirus diarrhea.22

STATEMENT OF THE PROBLEM:

A study to assess the knowledge regarding Selected “Minor problems of the new

born” among primi Para mothers with a view to develop Information booklet, in

selected hospitals of Hassan.

6.3 OBJECTIVES

1. To determine the knowledge regarding selected Minor problems of the new born

among the primi Para mothers.

2. To find out the association between the knowledge with their selected

demographic variables.3. To develop an Information booklet regarding minor problems of new born among

primipara mothers

6.3.1 HYPOTHESIS:

H1 –There will be a significant association between the knowledge scores and

selected demographic variables.

6.3.2 ASSUMPTIONS:

The awareness regarding Minor Problems in new born among the primipara

mothers may be enhanced through Information booklet combining knowledge of

selected demographic variables.

6.3.3 OPERATIONAL DEFINITION:

1. Assess –Here assess means to find out the extent of the knowledge of the

PrimiPara mothers regarding selected Minor problems of new born.

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2. Knowledge- Here word knowledge means, awareness of primipara mothers

regarding selected Minor problems of new born as measured by knowledge

questionnaire.

3. Minor problems of new born – These are the disorders which occur in new

born during their initial period of life and which subside on itself without any

management E.g. Physiological jaundice, conjunctivitis, skin rashes, infantile

regurgitation, constipation, diarrhea.

4. PrimiPara – Here it refers to mothers who have given birth and who require

knowledge regarding Minor problems of new born.

5. Information booklet- In this study, it refers to a formal and specific teaching

material which includes all information regarding Minor problems of new born

that is, its definition, causes, signs and symptoms, and management.

6.3.4 THEORITICAL FRAMEWORK:

“General system model”

6.3.5 DELIMITATION:

This study is delimited to

1. Primipara mothers.

2. 60 subjects only.

3. Data collection is limited to 4-6 weeks.

7. MATERIALS AND METHODS:

7.1 SOURCE OF DATA:

Data will be collected from Primipara mothers admitted in postnatal ward of

selected hospitals of Hassan.

7.1.1 SIGNIFICANCE OF THE STUDY:

The purpose of the study is to improve the knowledge of PrimiPara mothers

regarding Minor Problems of New Born.

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7.1.2 RESEARCH DESIGN:

Descriptive design.

7.2 METHOD OF DATA COLLECTION:

Part 1- Data will be collected after obtaining consent from authority and subject.

Part 2- The back ground information will be collected through socio demographic

variables and level of knowledge will be assessed by structured knowledge

questionnaire.

7.2.1 SAMPLING PROCESS:

CRITERIA FOR SAMPLE SELECTION:

7.2.2 SAMPLING CRITERIA.

Primi Para mothers:

1. Who are interested in participating in the study

2. Who are available during the period of data collection

3. Who are able to read and write either English or kannada.

7.2.2.1 POPULATION:

Primi Para mothers who are admitted in postnatal wards of selected

hospitals of Hassan.

7.2.2.2 SAMPLES:

Primi Para mothers who have fulfilled the sampling criteria.

7.2.2.3 SAMPLE SIZE:

In this study sample size will be 60.

7.2.2.4 SAMPLING TECHNIQUE:

Probability sampling-by Purposive sampling method.

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7.2.2.5 STUDY SETTING:

Setting is the general location and condition in which data collection takes

place in the study.

The setting for this study is Rajeev Hospital, Malnad Nursing Home,

Mangala Hospital (In Mangala Hospital 60 obstetric admission will come

per month, among these approximately 40 mothers will have delivery. In

Malanad 120 obstetric admission will come per month and approximately

80 mother’s will have delivery and in Rajeev Hospital 60 obstetric

admission will come per month among these approximately 20 will under

go delivery.

7.2.2.6 PILOT STUDY:

Pilot study is planned with 10% of the population.

7.2.2.7 VARIABLES:

EXTRANEOUS VARIABLES:

1. Age, mode of delivery, education, occupation, type of family,

vegetarian or non vegetarian, sex of the baby.

2. Knowledge regarding Minor Problems of new born.

7.2.2.8 PLAN FOR DATA ANALYSIS:

The plan for data analysis includes Descriptive and Inferential statistics.

Descriptive Statistics:

To describe the demographic variables and level of knowledge, frequency,

percentage, Mean, and standard deviation will be used.

Inferential Statistics:

The chi square test will be used to find the association between the

demographic variables and knowledge scores.

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7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTIONS TO BE CONDUCTED ON PATIENTS?Yes, information booklet on this topic is used as an intervention and it is found to

be useful.

7.4 HAS THE ETHICAL CLEARANCE BEING OBTAINED FROM

YOUR INSTITUTION?Yes, ethical clearance has been obtained from the research committee of Rajeev

College of nursing and authorities of selected Hospitals in Hassan. Informed

consent will be obtained from Subjects who are selected for the study.

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8. REFERENCES:

1. Parathasarathy A, I A P Text book of pediatrics. Edition -2. New Delhi : Jaypee

brothers Medical publishers (P) Ltd, Page no 56.

2. Meharban Singh, care of new born. Edition-5. New Delhi: Sagar publications 72,

Janapath ved Mansion, Page no 145.

3. Christian Henderson, et al, Essential Midwifery. Mosby publications, London, Page no

247

4.Laveen. N.Sherwan, et al, Maternity Nursing. Edition -3, Page no 976.

5. David. Vulliamy, Problem of New born. British Medical Journal, Year 1971, 4, Page

No 547-551..

6. Clara and p. Piot,L.Frasen I,P. Vanden Berghe, A.Mertens, K.Van Brussel Et al,

Incidence and bacterial etiology of neonatal conjunctivitis. Eur J Pediatr (1987) 146:152-

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7.Daniel. B. Ward.B.S,Alan B. Fleischer.Jr, MD,Steven R.Feldman,Daniel P.Krowchuk

Chacterization of Diaper Dermatitis, 2000, Page no 943- 946. 10. 8.Ramesh Agarwal,

Jaundice in new born. All India institute of medical science., Ansari nagar , New Delhi -

110029.

9. Lise Goulet A i,Ssatou Fall, Daniel D’Amour, Raynald Pineault,M.D.Ph. D

Preparation for discharge, maternal satisfaction and new born readmission for Jaundice,

June 2007.

10.Tahami Zanjami.N, Tabatabaei.S, Afijee.A, karimi.A, Fallah. F, Study of bacterial

conjunctivitis in neonates. 19th European Congress of clinical Microbiology and

infectious disease, Helsinki, Finland, 16-19 May 2009.

11. 14. Visscher. M. O, Chatterjee, Munson. K.A, Bare.E, Hoath.S.B, Development of

Diaper rash in the new born, 2000, volume 17, Page no 75- 83.

12. Sarici et al, Hyperbilirubinemia in the new born babies. Published 4th October 2010,

U.K

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13.. Andrea Noguiera de compose, Vitolo, Marcia Regina, Puccini, Rosana Fiorini,

Constipation in New borns: Influence of the type of feeding and dietry fiber intake,

2002, Volume 78, n.3, pp 202- 208.

14 http://www.lieberton line.com/doi/abs/10.1089/bfm. 2006.1.16.

15.M. cobelijic,B Milikovic – Selimovic, D Paunovic- Todosijevic, Z. Velickovic, Z.

Lepsanovic et al, Entero aggregative Eschericha coli associated with the out break of

Diarrhoea , Epidemiology of Infection(1996) , vol 17, Issue 01, 117: 11- 16.

16.Ibrahim H. Ai Ayed, Mothers knowledge on child health matters, Department

ofPaediatrics,Vol17,Issue1,RiyadhSaudiArabia,Pag22-28.

17. http://www.jpma.org.pk/full-article – text. Php? Article- id=1567.

18. Zamani Ali, Amini Elahe, Daneshjou Khadije, Nayeri Fateme, Zamani Nargese, et

al, Prophylaxis of Opthalmia Neonatorum – comparision of Betadine, Erythromycin, and

no prophylaxis. Published by Oxford University Press 2007.

19Nina R O’Connor,Maura R Mc Laughlin, Peter Ham, Common rashes in new born :

American Family Physician, volume 77, 2008, January.

20. Helen Lewis,Richard H.A, Garry Habbleton, Use of phototherapy for physiological

Jaundice in new born infants, volume 320, Issues 8295, Page no 408- 410, 21 August

1982.

21..Yvan vanden et al, Infantile Nutrition, Journal of the American college of Nutrition ,

volume 17, No 4, Page no 308- 316, (1998).

22. Chandra.R.K., Effect of Lactobacillus on incidence and severity of diarrhea in infants,

volume 22, Issue 1, January 2002, Page no 65- 69.

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