Nesting Merger PDF

Effectiveness Of Use Of Nesting On Body Weight, Oxygen Saturation
Stability And Breath Frequency In Prematures In Nicu Room
Gambiran Hospital Kediri City
DISUSUN OLEH
AI VIRAWATI (11202063)
FIRMA WAHYU(11202082)
HARYANI RATNA DEWI (11202085)
MAYSAROH (11202096)
MILA NARFIANTI (11202098)
SULISTYOWATI (11202123)
YAYA NURCAHYA(11202130)
PROGRAM STUDI S-1 KEPERAWATAN NON REGULER
SEKOLAH TINGGI ILMU KESEHATAN PERTAMEDIKA
202
KATA PENGANTAR
Puji syukur penulis panjatkan kehadirat Allah SWT, yang atas rahmatnya
maka dapat menyelesaikan Analisa Jurnal yang berjudul “Effectiveness
Of Use Of Nesting On Body Weight, Oxygen Saturation Stability And
Breath Frequency Gambiran Hospital Kediri City” tepat pada
waktunya.Dalam penulisan Analisa Jurnal ini kami merasa masih banyak
kekurangan, baik pada teknik penulisan maupun materi, mengingat akan
kemampuan yang kami miliki. Untuk itu kritik dan saran dari semua
pihak sangat penulis harapkan demi penyempurnaan Analisa jurnal
ini.Dalam penyusunan Analisa jurnal ini kami menyampaikan ucapan
terimakasih kepada pihak yang membantu dalam menyelesaikannya.
Semoga Analisa Jurnal ini bermanfaat bagi pembaca, oleh Karena itu
kritik dan saran dari semua pihak yang bersifat membangun, penulis
harapkan demi mencapai kesempurnaan Analisa Jurnal ini.
Sekian penulis sampaikan terimakasih kepada semua pihak yng

telah membantu semoga ALLah SWT senantiasa meridhai segala usaha
kita , Aamiin.
Jakarta, Oktober 2020
Tim Penulis
i
i
DAFTAR ISI
KATA PENGANTAR……………………………………………………………………………………..i
DAFTAR ISI……………………………………………………………………………………………….ii
BAB I ........................................................................................................................................................... 1
PENDAHULUAN.........................................................................................................................................1
BAB II........................................................................................................................................................... 4
ANALISA JURNAL..................................................................................................................................... 4
1. Jurnal Utama............................................................................................................................................. 4
2. Jurnal Pendukung...................................................................................................................................... 4
3. PICO..........................................................................................................................................................5
BAB III..........................................................................................................................................................8
TINJAUAN TEORI...................................................................................................................................... 8
A. KONSEP PENYAKIT............................................................................................................................. 8
1. Pengertian ............................................................................................................................. 9
2. Klasifikasi.............................................................................................................................. 9
3. Etiologi.................................................................................................................................12
4. Faktor Resiko.......................................................................................................................14
5. Patofisiologi......................................................................................................................... 15
6. Manifetasi Klinis...................................................................................................................10
7. Komplikasi............................................................................................................................10
B.ASKEP KEPERAWATAN PADA BAYI PREAMTURE..................................................................... 10
1.Pengkajian..................................................................................................................................10
2.Diagnoas Keperawatan............................................................................................................ 210
C.NESTING................................................................................................................................................ 24
D.Hell Lance Procedure (Heel Stick)..........................................................................................................28
BAB IV.PENUTUP....................................................................................................................................34
BAB V DAFTAR PUSTAKA....................................................................................................................35
LAMPIRAN. ..........................................................................................................................................
ii
BAB I
PENDAHULUAN
1. LATAR BELAKANG
Kelahiran prematur bertanggung jawab atas dua pertiga dari kematian bayi.
Prematur atau prematur diartikan sebagai lahir sebelum usia kehamilan 37
minggu, berapapun berat badannya (Bobak, 2015). Bayi prematur tidak
memiliki kemampuan untuk menyesuaikan diri dengan baik dengan kehidupan
ekstrauterin sehingga kemungkinan bayi untuk memiliki kelangsungan hidup
atau kesehatan yang baik dapat terancam. Organisasi Kesehatan Dunia (WHO)
menyatakan bahwa bayi yang lahir dengan berat kurang dari 2500 gram dan
lahir setelah usia kehamilan 37 minggu memiliki prospek hidup yang lebih
baik dibandingkan dengan bayi yang lahir prematur. Angka kematian BBLR
kurang dari 5% jika kehamilan berlangsung sampai usia cukup bulan (Bobak,
2015). Permasalahan yang sering terjadi pada bayi prematur antara lain lahir
dengan berat badan lahir rendah kurang dari 2500 gram, sebagai kompensasi
atas kurangnya cadangan lemak. Bayi yang lahir cukup bulan akan mengalami
penurunan berat badan sekitar 5-10% dalam 7 hari pertama. Penurunan berat
badan puncak terjadi pada hari kedua setelah lahir. Penelitian yang dilakukan
oleh Davanzo dkk menjelaskan bahwa penurunan berat badan sebesar 8%
merupakan batas aman teratas untuk penurunan berat badan bayi baru lahir.
Penurunan berat badan ≥8% dapat meningkatkan risiko mortalitas dan
morbiditas pada bayi, seperti hiperbilirubinemia dan dehidrasi akibat
hipernatremia.
Berdasarkan survei kesehatan Jawa Timur tahun 2016, didapatkan
20.836 bayi lahir dengan berat badan <2500 g dari 580.153 kelahiran bayi
atau sekitar 3,6%. Di Kota Kediri, lahir 127 bayi BBLR dari 4.324 bayi yang
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lahir tahun itu, Jumlah bayi BBLR yang dirawat selama tiga bulan terakhir di
Ruang Neonatus RSUD Kota Gambiran Kediri (September-November 2018)
diperoleh 98 data, dengan berat badan lahir <2500 gram, 36 diantaranya
dirawat di ruang NICU dan 15 diantaranya meninggal dunia karena berbagai
komplikasi (Rekam Medis, 2019).
Bayi prematur juga sangat rentan mengalami hipotermia karena
cadangan lemak yang tipis di bawah kulit dan pusat kendali panas yang belum
matang di otak (Zaviera, 2012). Kondisi hipotermia tersebut menyebabkan
perubahan sistem saraf pusat permanen yang pada akhirnya menyebabkan
kematian. Bayi yang kedinginan mengeluarkan kalori untuk menghangatkan
tubuh dan sebaliknya berusaha menstabilkan suhu tubuh agar normal. Kondisi
hipotermia menyebabkan peningkatan konsumsi oksigen dan jika tidak
terpenuhi menyebabkan keadaan hipoksia dan menyebabkan takikardia atau
bradikardia sebagai respons terhadap penurunan oksigenasi. Pada neonatus
prematur, kuantitas kehilangan cairan melalui penguapan kulit dan saluran
pernapasan lebih tinggi dibandingkan pada neonatus yang lahir cukup bulan.
Selain itu, neonatus yang lahir prematur memiliki komponen ekstraseluler
yang lebih besar, yang menyebabkan diuresis yang lebih besar pada neonatus
prematur. Hal inilah yang menyebabkan neonatus yang lahir prematur
mengalami penurunan berat badan yang lebih tinggi dibandingkan neonatus
yang lahir aterm. Sedangkan pada neonatus yang lahir kurang bulan,
penurunannya bisa terjadi hingga 15%. Penurunan berat badan fisiologis tidak
terjadi setelah neonatus berusia 5-7 hari dan berat badan meningkat pada 12-
14 hari (Rahardina, 2015)
Masalah pernapasan menjadi salah satu penyebab kematian pada bayi
yang lahir prematur. Masalah pernafasan pada bayi sering dikaitkan dengan
kondisi Respiratory Distress Syndrome (RDS) yang disebut juga penyakit
membran hialin (HMD), merupakan penyebab tersering morbiditas dan
mortalitas pada bayi berat lahir rendah yang sering disebabkan oleh
prematuritas. Kejadian RDS sekitar 5-10% ditemukan pada bayi kurang dari
50 bulan, 50% pada bayi dengan berat badan 500-1500 gram.
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Nesting adalah penggunaan alat yang berbentuk seperti kondisi dalam
rahim ibu yang terbuat dari linen dan dapat disesuaikan dengan panjang
tubuh bayi. Alat ini ditempatkan sebagai pelindung posisi bayi, menjaga
perubahan posisi bayi akibat gaya gravitasi. Nesting adalah salah satu
perawatan intervensi pemberian posisi yang tepat bagi neonatus. Nesting
dapat memfasilitasi perkembangan bayi prematur yang berupa kondisi
fisiologis dan neurologis. Nesting merupakan penyangga pada posisi tidur
bayi agar tetap pada posisi fleksi, hal ini dimaksudkan untuk mencegah
terjadinya perubahan posisi bayi secara drastis yang dapat mengakibatkan
hilangnya energi dari tubuh neonatus. Berdasarkan fenomena di atas maka
peneliti tertarik untuk melakukan penelitian lebih lanjut mengenai
“Effectiveness Of Use Of Nesting On Body Weight, Oxygen Saturation
Stability, And Breath Frequency In Prematures In Nicu Room Gambiran
Hospital Kediri City”.
2. TUJUAN PENELITIAN
Penelitian ini bertujuan untuk mengetahui Efektivitas Penggunaan Nesting

terhadap Berat Badan, Kestabilan Saturasi Oksigen, dan Frekuensi
Pernapasan pada Bayi Prematur di Ruang NICU.
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BAB II
ANALISA JURNAL
1. JURNAL UTAMA
1. Judul jurnal : Effectiveness Of Use Of Nesting On Body Weight,
Oxygen Saturation Stability, And Breath Frequency In Prematures In
Nicu Room Gambiran Hospital Kediri City
2. Peneliti : Miftakhur rohmah, Nurwinda Saputri, Justitia Bahari
3. Populasi, sample dan Teknik sampling: populasi berjumlah 30 bayi
premature , menggunakan purposive sampling technique, sehingga
didapatkan jumlah sample 14.
4. Desain penelitian : quasi-experimental
5. Instrument yang digunakan :
Instrumen yang digunakan untuk pengambilan variabel Saturasi
Oksigen adalah oksimetri dengan SPO2 normal 88-95%, variabel
frekuensi nafas menggunakan stetoskop dengan indikator RR normal:
30-60x / min, Variabel Berat menggunakan instrumen digital skala
Bayi. Pemberian nesting diberikan selama 30 menit per hari selama 5
hari pada kelompok 1 dan 7 hari pada kelompok 2.
6. Uji satatistik yang digunakan : Kolmogorov Shmirov Test
2. JURNAL PENDUKUNG
1. Judul Jurnal : The Effect of Nesting Positions On Pain,
Stress And Comfort During Heel Lance In Premature İnfants
2. Peneliti : Ays‚e Kahraman, Zümrüt Bas‚bakkal, Mehmet
Yalaz, Eser Y. Sözmen
3. Populasi : 33 neonatus prematur dengan usia kehamilan 31
sampai 35 minggu yang dirawat di NICU
4. Desain penelitian : Experimental, repeated measurement design
5. Instrument :
Prosedur heel lance terekam di kamera. Rekaman kamera dimulai
sebelum prosedur dan dilanjutkan sampai tangisan bayi selesai. Setelah
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proses pengumpulan data berakhir, pencatatan dievaluasi oleh dua
pengamat berpengalaman pada bayi prematur, perawatan bayi baru
lahir dan penilaian nyeri. Para pengamat menilai tingkat rasa sakit,
stress, dan kenyamanan bayi menurut Neonatal Infant Pain Scale
(NIPS) dan skala COMFORTneo.
6. Hasil penelitian :
Studi ini menentukan bahwa posisi tengkurap mengurangi rasa
sakit, stres, waktu menangis dan kadar kortisol saliva pada bayi pada
usia kehamilan 31-35 minggu. Studi ini menekankan bahwa posisi
nesting memiliki efek mengurangi rasa sakit, memberikan rasa
nyaman dan menghilangkan stres pada bayi premature di NICU
selama prosedur heel lance.
3. PICO
1. Problem :
Kelahiran prematur bertanggung jawab atas dua pertiga kematian
bayi karena kurangnya kebaikan kemampuan beradaptasi terhadap
kehidupan ekstrauterin sehingga prospek untuk kelangsungan hidup
dan kesehatan bayi sangat terancam.
Bayi menghabiskan kalori untuk menghangatkan tubuh dan
sebagau upaya untuk menstabilkan suhu tubuh menjadi normal.
Kondisi hipotermia menyebabkan peningkatan oksigen konsumsi dan
jika tidak terpenuhi menyebabkan situasi hipoksia dan menyebabkan
takikardia atau bradikardia sebagai respons terhadap penurunan
oksigenasi.
2. Intervension :
Waktu pelaksanaannya adalah pada 1 Mei hingga 31 Juli,2019.
Instrumen yang digunakan untuk mengambil variabel Saturasi Oksigen
adalah oksimetri dengan indicatorsaturasi oksigen normal 88-95%,
variabel frekuensi napas menggunakan stetoskop dengan indikator RR
normal: 30-60x / min. Variabel Berat menggunakan timbangan bayi
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digital. Nesting diberikan selama 30 menit per hari selama 5 hari
dalam kelompok 1 dan 7 hari di grup 2.
3. Comparison
a. Judul jurnal : The effect of position on oxygen saturation and
heart rate in very low birth weight neonates
b. Peneliti : Zahra Akbarian Rad (MD) ,Mohsen Haghshenas
Mojaveri (MD), Mahmoud Hajiahmadi (PhD), Azita
Ghanbarpour (MD), Samaneh Mirshahi (MSc)
c. Hasilnya :
Dalam penelitian ini 40 neonatus 7-28 hari (30.17 ± 79.50)
dipelajari.dengan presentase 12 (45%) laki-laki dan 18 (55%)
wanita. Usia kehamilan minimal dan maksimal adalah 27 dan
35 minggu, masing-masing (30,10 ± 2,158). Itu bobot
minimum dan maksimum bayi baru lahir itu 754g dan 1490 g
masing-masing (1180,38 ± 205,318). Rata-rata saturasi oksigen
dan detak jantung masuk. Posisi terlentang, tengkurap, dan
miring kekiri. Saturasi oksigen arteri secara signifikan berbeda
pada posisi terlentang, tengkurap dan miring kiri selama 120
menit (P = 0,023). Apalagi studi tentang saturasi oksigen arteri
antara dua posisi kiri lateral dan rawan menunjukkan tidak
signifikan perbedaan antara kedua posisi ini (P = 0,392).
Denyut jantung maksimum dan minimum adalah 123.44 dan
175.33, 124 dan 165.78, dan 164.56 dan 124,11 (detak / menit)
dalam posisi terlentang, tengkurap dan miring kiri posisi,
masing-masing. Variabilitas detak jantung adalahsedikit lebih
rendah pada posisi tengkurap dibandingkan dua lainnya
posisi tetapi perbedaan ini tidak signifikan(P = 0,596). Hasil
juga menunjukkan bahwa mean denyut jantung tidak signifikan
antara posisi terlentang dan posisi lateral kiri (P = 0,233).
4. Outcome
Peningkatan saturasi oksigen rata-rata secara signifikan pada kedua
kelompok setelah nesting. Meningkat saturasi oksigen lebih tinggi
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pada kelompok perlakuan bersarang selama 7 hari (4,71%)
dibandingkan pada kelompok perlakuan bersarang selama 5 hari
(2,28%). Terjadi penurunan rata-rata pernafasan pada kedua kelompok
setelah nesting. Itu kelompok yang ditempatkan bersarang selama 7
hari (10,57 x / menit) menunjukkan perlambatan rata-rata frekuensi
pernafasan yang lebih signifikan dibandingkan kelompok nesting 5
hari (3,71 x /min). Terjadi peningkatan rata-rata berat badan pada
kedua kelompok. Perawatan nesting 7 hari kelompok mengalami
peningkatan berat badan lebih dari 15,72 gram dibandingkan
kelompok kelompok perlakuan selama 5 nesting hari sebanyak 28,57
gram. Pada kedua kelompok didapatkan hasil nilai p (nilai p) variabel
saturasi oksigen sebelum dan setelah dilakukan tindakan (0,001) <α
(0,05), maka H0 ditolak dan H1 diterima. Sehingga dapat disimpulkan
bahwa penggunaan nesting efektif dalam menjaga saturasi oksigenbayi
prematur. Pada kedua kelompok hasil penghitungan nilai p (nilai p)
variabel respirasi frekuensi sebelum dan sesudah tindakan diperoleh p
(0,002) <α (0,05), maka H0 ditolak dan H1 diterima. Sehingga dapat
disimpulkan bahwa penggunaan nesting efektif dalam mengurangi
frekuensi pernapasan pada bayi prematur. Pada kedua kelompok
dilakukan penghitungan nilai p (nilai p) variabel bobot sebelum dan
setelah dilakukan tindakan diperoleh p (0,001) <α (0,05), maka H0
ditolak dan H1 diterima. Sehingga dapat disimpulkan bahwa
penggunaan nesting pada bayi prematur efektif dalam meningkatkan
berat badan.
Kelompok perlakuan bersarang untuk 7 orang memberikan hasil yang
lebih signifikan dibandingkan dengan perlakuan bersarang kelompok
selama 5 hari.
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BAB III
TINJAUAN TEORI
A. KONSEP PENYAKIT
1. PENGERTIAN
Bayi prematur adalah bayi yang lahir pada usia kehamilan kurang
atau sama dengan 37 minggu, tanpa memperhatikan berat badan lahir.
(Donna L Wong 2004). Prematuritas dan berat lahir rendah biasanya
terjadi secara bersamaan, terutama diantara bayi dengan badan 1500 gr
atau kurang saat lahir, sehingga keduanya berkaitan dengan terjadinya
peningkatan mordibitas dan mortalitas neonatus dan sering di anggap
sebagai periode kehamilan pendek (Nelson 1988 dan Sacharin 1996).
Bayi prematur adalah bayi lahir hidup sebelum usia kehamilan minggu
ke-37 (dihitung dari hari pertama haid terakhir).(Who,2000)
Dengan demikian, persalinan premature dapat terdiri dari :
1. Persalinan premature dengan usia kehamilan kurang dari 37 minggu

dengan berat badan janin sama untuk masa kehamilan (SMK)
2. Persalinan premature dengan usia kehamilan kurang dari 37 minggu

dengan berat badan kecil untuk masa kehamilan (KMK).
Nama lainnya dari golongan ini adalah
a. Small for gestational age (SGA)
b. Intra uteri grouth retardation (IUGRat)
c. Inta uteri grout restriction (IUGRst)
Menurut WHO, persalinan premature murni dapat digolongkan menurut

usia kehamilan dan berat badan lahir, yaitu :
1. Sangat premature
2. Premature sedang
8
3. Premature borderline
Prematuritas dan berat lahir rendah biasanya terjadi secara

bersamaan, terutama diantara bayi dengan berat 1500 gr atau kurang saat
lahir. Keduanya berkaitan dengan terjadinya peningkatan morbilitas dan
mortalitas neonatus.
2. KLASIFIKASI
1) Persalinan prematur murni sesuai dengan definisi WHO
Batasan Kriteria Keterangan
a. Sangat premature
1. Usia kehamilan 24-30 minggu BB bayi 1000-1500 g
2. Sangat sulit untuk hidup, kecuali dengan inkubator canggih
3. Dampak sisanya menonjol,terutama pada IQ nerologis dan

pertumbuhan fisiologis
b. Prematur Sedang
1. Usia kehamilan 31-36 minggu
2. BB bayi 1500-2000 gr
3. Dengan perawatan cangih masih mungkin hidup tanpa dampak

sisa yang berat
c. Premuatur borderline
1. Usia kehamilan 36-38 mingu
2. Berat bayi 200-2499 gr
3. Lingkaran kepala 33 cm
4. Lingkaran dada 30 cm
5. Panjang badan sekitar 45cm
Masih sangat mungkin hidup tampa dampak sisa yang berat
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Perhatikan kemungkinan :
1. Ganguan napas
2. Daya isap lemah
3. tdak tahan terhadap hipotermia
4. mudah terjadi infeksi
2) Persalinan prematur berdasarkan pengolangan faktor penyebab
Penggolongan Kriteria Keterangan
1. Golongan 1
1) Dapat terjadi prematur teratur tidak menimbulkan proses

“rekuren”
2) Solusio plasenta
3) Plasenta previa
4) Hidramnion /oligohidromnion
5) Kehamilan ganda
6) Kejadian persalinan prematur sangat jarang berulang dengan

sebab yang sama
2. Golongan 2
1) resiko kejadian persalinan prematur tidak dapat dikontrol oleh
penderita sendiri.
2) hamil usia muda ,tua (umur kurang 18 tahun atau diatas 40tahun )
3) terdapat anomali alat reproduksi
4) sebagian masih dapat diupayakan untuk dikendalikan
5) anomali alat reproduksi sebagian sulit dikendalikan sekalipun
dengan tindakan operasi
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3. Golongan 3
faktor yang menimbulkan pesalinan prematur dapat dikendalikan
sehinga kejadian prematur dapat diturunkan :
1. Kebiasaan :
1) Merokok ketagihan obat
2) Kebiasaan kerja keras ,kurang tdur dan istirahat
2. Keadaan sosial ekonomi yang menyebabkan konsumsi gizi

nutrisi rendah
3. Kenali berat badan ibu hamil yang kurang
4. Anomali serviks, serviks inkompeten
5. Kemampuan pengendalian faktor sosial yang berada ditengah
masyarakat ,merupakan program obstetr social
3. ETIOLOGI
1. Faktor Maternal
Toksenia, hipertensi, malnutrisi /penyakit kronik, misalnya diabetes

mellitus kelahiran premature ini berkaitan dengan adanya kondisi
dimana uterus tidak mampu untuk menahan fetus, misalnya pada
pemisahan premature, pelepasan plasenta dan infark dari plasenta
2. Faktor Fetal
Kelainan Kromosomal (misalnya trisomi antosomal), fetus multi

ganda, cidera radiasi (Sacharin. 1996)
Faktor yang berhubungan dengan kelahiran premature :
a. Kehamilan
1. Malformasi Uterus
2. Kehamilan ganda
3. TI. Servik Inkompeten
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4. KPD
5. Pre eklamsia
6. Riwayat kelahiran premature
7. Kelainan Rh
b.Kondisi medis
1) Kondisi yang menimbulkan partus preterm
a. Hipertensi
Tekanan darah tinggi menyebabkan penolong cenderung

untuk mengakhiri kehamilan, hal ini menimbulkan
prevalensi persalinan preterm meningkat.
b. Perkembangan janin terhambat
Perkembangan janin terhambat (Intrauterine growth

retardation) merupakan kondisi dimana salah satu
sebabnya ialah pemasokan oksigen dan makanan
mungkin kurang adekuat dan hal ini mendorong untuk
terminasi kehamilan lebih dini.
c. Solusio plasenta
Terlepasnya plasenta akan merangsang untuk terjadi

persalinan preterm, meskipun sebagian besar (65%)
terjadi aterm. Pada pasien dengan riwayat solusio
plasenta maka kemungkinan terulang akan menjadi lebih
besar yaitu 11%.
d. Plasenta previa
Plasenta previa sering kali berhubungan dengan

persalinan preterm akibat harus dilakukan tindakan pada
perdarahan yang banyak. Bila telah terjadi perdarahan
12
banyak maka kemungkinan kondisi janin kurang baik
karena hipoksia.
e. Kelainan rhesus
Sebelum ditemukan anti D imunoglobulin maka kejadian

induksi menjadi berkurang, meskipun demikian hal ini
masih dapat terjadi.
f. Diabetes
Pada kehamilan dengan diabetes yang tidak terkendali

maka dapat dipertimbangkan untuk mengakhiri
kehamilan. Tapi saat ini dengan pemberian insulin dan
diet yang terprogram, umumnya gula darah dapat
dikendalikan.
2) Kondisi yang menimbulkan kontraksi
a. Kelainan bawaan uterus
Meskipun jarang tetapi dapat dipertimbangkan hubungan

kejadian partus preterm dengan kelainan uterus yang ada.
b. Ketuban pecah dini
Ketuban pecah mungkin mengawali terjadinya kontraksi

atau sebaliknya. Ada beberapa kondisi yang mungkin
menyertai seperti : serviks inkompeten, hidramnion,
kahamilan ganda, infeksi vagina dan serviks, dan lain-lain.
c. Serviks inkompeten
Riwayat tindakan terhadap serviks dapat dihubungkan

dengan terjadinya inkompeten. Chamberlain dan Gibbings
menemukan 60% dari pasien serviks inkompeten pernah
mengalami abortus spontan dan 49% mengalami
pengakhiran kehamilan pervaginam.
d. Kehamilan ganda
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Sebanyak 10% pasien dengan dengan partus preterm ialah
kehamilan ganda dan secara umum kahamilan ganda
mempunyai panjang usia gestasi yang lebih pendek.
c. Sosial Ekonomi
– Tidak melakukan perawatan prenatal
– Status sosial ekonomi rendah
– Mal nutrisi
– Kehamilan remaja
4. FAKTOR RESIKO
1. Resiko Demografik
1) Ras
2) Usia ( 40 tahun)
3) Status sosio ekonomi rendah
4) Belum menikah
5) Tingkat pendidikan rendah
2. Resiko Medis
1) Persalinan dan kelahiran premature sebelumnya
2) Abortus trimester kedua (lebih dari 2x abortus spontan atau

elektif)
3) Anomali uterus
4) Penyakit-penyakit medis (diabetes, hipertensi)
5) Resiko kehamilan saat ini :Kehamilan multi janin,

Hidramnion, kenaikan BB kecil, masalah-masalah plasenta
(misal : plasenta previa, solusio plasenta), pembedahan
14
abdomen, infeksi (misal : pielonefritis, UTI), inkompetensia
serviks, KPD, anomaly janin
3. Resiko Perilaku dan Lingkungan
1) Nutrisi buruk
2) Merokok (lebih dari 10 rokok sehari)
3) Penyalahgunaan alkohol dan zat lainnya (mis. kokain)
4) Jarang / tidak mendapat perawatan prenatal
4. Faktor Resiko Potensial
1) Stres
2) Iritabilitas uterus
3) Perestiwa yang mencetuskan kontraksi uterus
4) Perubahan serviks sebelum awitan persalinan
5) Ekspansi volume plasma yang tidak adekuat
6) Defisiensi progesteron
7) Infeksi
(Bobak, Ed 4. 2005)
5. PATOFISIOLOGI
Persalinan preterm dapat diperkirakan dengan mencari faktor resiko

mayor atau minor. Faktor resiko minor ialah penyakit yang disertai
demam, perdarahan pervaginam pada kehamilan lebih dari 12 minggu,
riwayat pielonefritis, merokok lebih dari 10 batang perhari, riwayat
abortus pada trimester II, riwayat abortus pada trimester I lebih dari 2
kali
Faktor resiko mayor adalah kehamilan multiple, hidramnion, anomali

uterus, serviks terbuka lebih dari 1 cm pada kehamilan 32 minggu,
serviks mendatar atau memendek kurang dari 1 cm pada kehamilan 32
15
minggu, riwayat abortus pada trimester II lebih dari 1 kali, riwayat
persalinan preterm sebelumnya, operasi abdominal pada kehamilan
preterm, riwayat operasi konisasi, dan iritabilitas uterus.
Pasien tergolong resiko tinggi bila dijumpai 1 atau lebih faktor resiko
mayor atau bila ada 2 atau lebioh resiko minor atau bila ditemukan
keduanya. (Kapita selekta, 2000 : 274).
6. MANIFESTASI KLINIS
Tanda klinis atau penampilan yang tampak sangat bervariasi,

bergantung pada usia kehamilan saat bayi dilahirkan. Makin prematur
atau makin kecil umur kehamilan saat dilahirkan makin besar pula
perbedaannya dengan bayi yang lahir cukup bulan.
Adapun tanda dan gejala dari bayi prematur adalah:
1. Berat badan 33 cm,lingkar dada 37 minggu.

2. kepala lebih besar dari pada badan.
3. kulit tipis transparan,rambut lanugo banyak,terutama pada
dahi,pelipis telinga dan lengan,lemak kulit berkurang.
4. Lemak subkutan kurang.
5. Otot hipotonik lemah.
6. Reflek tonus otot masih lemah,reflek menghisap dan menelan
serta reflek batuk belum sempurna.
7. Tulang rawan dan daun telinga imature (elastis daun telinga
masih kurang sempurna).
8. Pernapasan tidak teratur dapat terjadi apnea(gagal nafas)
9. Ekstermitas : paha abduksi,sendi lutut/kaki fleksi-lurus.
10. Kepala tidak tegak
11. pernapasan sekitar 45 – 50 kali/permenit,dan frekuensi nadi
100 – 140x/menit
12. sering anemia
13.Genitalia belum sempurna,labio minora belun tertutup oleh labia
minora(pada wanita) dan pada laki-laki testis belum turun.
16
14. garis pada telapak kaki belum jelas dan kulit teraba halus.
7. KOMPLIKASI
1. Sindrom Gawat Napas (RDS)
Tanda Klinisnya : Mendengkur, nafas cuping hidung, retraksi,

sianosis, peningkatan usaha nafas, hiperkarbia, asiobsis respiratorik,
hipotensi dan syok
2. Displasin bronco pulmaner (BPD) dan Retinopati prematuritas

(ROP)
Akibat terapi oksigen, seperti perporasi dan inflamasi nasal,

trakea, dan faring. (Whaley & Wong, 1995)
3. Duktus Arteriosus Paten (PDA)
Suatu pembuluh darah yang dilapisi oleh otot dan memiliki fungsi
khusus.apabila sensor oksigen yang normal tidak ada pada otot
duktus atau karena kelemahan menyebabkan duktus tidak menutup
atau hanya menutup sebagian.
4. Necrotizing Enterocolitas (NEC)
Suatu kondisi medis terutama pada byi prematur,dimana bagian

dari usus mengalami nekrosis (kematian jaringan). (Bobak. 2005)
8. Pemeriksaan Diagnostik :
1. Jumlah darah lengkap : Hb/Ht
2. Kalsium serum
3. Elektrolit (Na , K , U) : gol darah (ABO)
4. Gas Darah Arteri (GDA) : Po2, Pco2
(Doengoes. Ed. 2, 2001)
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9. Penatalaksanaan
Penatalaksanaan pada bayi berat badan lahir rendah atau prematur

dapat dilakukan dengan beberapa cara, yaitu :
1) Perawatan bayi dalam inkubator

Inkubator adalah suatu alat untuk membantu terciptanya suatu
lingkungan yang optimal, denfan demikian dapat terciptanya suatu
suhu lingkungan yang normal. Suhu lingkungan yang netral adalah
suatu keadaan dimana panas yang dihasilkan dapat
mempertahankan suatu suhu tubuh yang tetap.
2) Perawatan post resusitasi
Dilakukan untuk mengatasi terjadinya asfiksia, yang dapat
memperburuk keadaan bayi lahir prematur.
3) Perawatan bayi dengan terapi sinar
Dalam perawatan ini yang perlu diperhatikan tidak saja terapinya,
tetapi juga perangkat yang digunakan. Lampu yang digunakan
sebaiknya tidak dipergunakan lebih dari 500 jam, untuk
menghindari turunnya energi yang dihasilkan oleh lampu yang
dipergunakan.
4) Menyiapkan bayi untuk transfusi tukar
Yang dimaksud dengan transfusi tukar adalah mengeluarkan darah
dari tubuh bayi untuk ditukar dengan darah yang tidak sesuai
(patologis) untuk mencegah peningkatan kadar bilirubin dalam
darah.
5) Menolong bayi dalam keadaan kejang.
Dengan selalu bersikap teratur dalam sebisa mungkin menolong
bayi dalam keadaan kejang.
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B. ASUHAN KEPERAWATAN PADA BAYI PREMATUR
1. PENGKAJIAN
1. Masalah yang berkaitan dengan ibu

Penyakit seperti hipertensi,toksemia,placenta previa,abrupsio
placenta,incompeten servikal,kehamilan kembar,mal nutrisi dan
diabetes melitus.status sosial ekonomi yang rendah dan tiadanya
perawatan sebelum kelahiran, Riwayat kelahiran premature atau
aborsi, penggunaan obat – obatan, seperti alcohol, rokok, kafein.
Riwayat ibu : umur dibawah 16 atau diatas 35 tahun dan latar
belakang pendidikan rendah, jarak kehamilan yang
berdeketan,ataupun penyakit hubungan seksual
2. Bayi pada saat kelahiran
Umur kehamilan biasanya antara 24 – 37 minggu,rendahnya berat
badan pada saat kelahiran , SGA, atau terlalu besar dibanding umur
kehamilan : berat biasanya kurang dari 2500 gr,kurus,lapisan
lemak subkutan sedikit atau tidak ada,kepala relative lebih besar
dibanding badan,3 cm lebih besar dibanding lebar dada,kelainan
fisik yang mungkin terlihat,nilai APGAR pada satu sampai lima
menit,0-3 menunjukkan kegawatan yang parah,4 – 6 kegawatan
sedang,dan 7-10 normal.
3. Kardiovaskular
Denyut jantung rata – rata 120 – 160/m pada bagian apical dengan
ritme yang teratur : pada saat kelahiran, kebisingan jantung
terdengar pada seperempat bagian intercostals,yang menunjukkan
aliran darah dari kanan ke kiri karena hipertensi atau atelektasis.
4. Gastrointestinal
Penonjolan abdomen : pengeluaran mekonium biasanya terjadi
dalam waktu 12 jam : refleks menelan dan menghisap yang lemah :
ketidaknormalan kongenital lain.
5. Integumen.
Kulit yang berwarna merah atau merah muda,kekuning – kuningan,
sianosis atau campuran bermacam warna : sedikit vernik
19
kasiosa,dengan rambut lanugo di sekujur tubuh,kulit tampak
transparan,halus dan mengkilat,edema yang menyeluruh atau
dibagian tertentu yang terjadi pada saat kelahiran, kuku pendek
belum melewati ujung jari, rambut jarang atau tidak ada sama
sekali, ptekie atau ekimosis.
6. Muskuloskeletal
Tulang kapilago telinga belum tumbuh sempurna, lembut dan
lunak ,tulang tengkorak dan tulang rusuk lunak,gerakan lemah dan
tidak aktif atau letargi.
7. Neurologi
Refleks dan gerakan pada tes neurologis tanpa tidak resisten, gerak
refleks hanya berkembang sebagian;menelan,menghisap,dan batuk
sangat lemah atau tidak efektif;tidak ada atau menurunnyatanpa
neurologis;mata mungkin menutup atau mengatup apabila umur
belum mencapai 25 sampai 26; suhu tubuh tidak stabil, biasanya
hipotermia ; gemetar, kejang, mata berputar – putar, biasanya
bersifat sementara, tetapi mungkin juga mengindikasikan adanya
kelainan neurologis.
8. Paru
Jumlah pernapasan rata – rata antara 40 sampai 60/menit diselingi

dengan apnea;pernapasan tidak teratur, dengan laring nasal (nasal
melebar) dengkuran,
retraksi(interkostal,suprasternal,substernal);terdengar gemerisik
9. Ginjal
Berkemih terjadi setelah 8 jam kelahiran ; ketidakmampuan untuk
melarutkan eksreksi kedalam urin.
10. Reproduksi
Bayi perempuan : clitoris yang menonjol dengan labia minora yang
belum berkembang; bayi laki – laki : skrotum yang belum
berkembang sempurna dengan ruga yang kecil.testis tidak turun ke
skrotum.
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11. Sikap
Tangis yang lemah, tidak aktif dan tremor.
1. DIAGNOSA KEPERAWATAN.
1. Kerusakan pertukaran gas berhubungan dengan ketidakseimbangan
perfusi ventilasi
2. Ketidak efektifan pola napas berhubungan dengan imaturitas pusat
pernafasan perkembangan otot, penurunan energi / kelelahan
3. Resiko perubahan nutrisi kurang dari kebutuhan tubuh berhubungan
imaturitas produksi enzim.
4. Resiko terjadi penurunan hipotermia berhubungan dengan
perkembangan SSP imatur, ketidak mampuan merasakan dingin
berkeringat.
5. Resiko infeksi berhubungan dengan respon imun imatur, prosedur
invasif.
6. Ketidakseimbangan cairan berhubungan dengan imaturitas, radiasi
lingkungan, efek fototherapy atau kehilangan melalui kulit atau paru.
7. Resiko tinggi kerusakan integritas kulit berhubungan dengan rapuh
dan imaturitas kulit
8. Gangguan sensori persepsi : visual, auditory, kinestehetik, gustatory,
taktil dan olfaktory berhubungan dengan stimulasi yang kurang atau
berlebihan pada lingkungan intensive care
9. Defisit pengetahuan (keluarga) tentang perawatan infant yang sakit
di rumah.
3. RENCANA ASUHAN KEPERAWATAN
Diagnosa Keperawatan Noc Nic Rasional
1) Gangguan pertukaran O2 b/d Asfiksia Setelah dilakukan tindakan

keperawatan 3x 24 jam di harapkan gangguan pertukaran D2
kembali normal, dengan criteria hasil:
1. Nafas spontan
2. Frekuensi nafas normal 30-76x/ menit
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3. Sianosis negatif
1) Guidance
Monitor irama, kedalaman frekuensi pernafasan bayi.
2) Support
Therapy O2 sesuai kebutuhan.
3) Teaching
Mengatur posisi kepala bayi sedikit ekstensi
4) Development Environment
Menciptakan lingkungan yang tenang
5) Collaboration
Kolaborasi pemberian obat sesuai kebutuhan
Mengetahui kadar O2 pada jaringan dalam batas
normal/ terjadi gangguan.
1. Mempertahankan kadar O2 dalam jaringan.
2. Membuka jalan nafas dan mempermudah oksigenasi
3. memberi suasana yang tenang dan nyaman
4. Membantu menurunkan sesak
2) Resiko hipotermia b/d immaturitas transisi lingkungan ekstra uterus
neonatus
Setelah dilakukan tindakan keperawatan 3x 24 jam hipotermia tidak

terjadi.Kriteria hasil :
Mempertahankan suhu lingkungan tetap normal dan bayi tidak

kedinginan
1) Guidance
Mengkaji suhu rectal/axilla setiap 2 jam bila perlu dan
mengkaji status infant yang menunjukkan stress dingin.
2) Support
Menempatkan bayi dibawah pemanas/inkubator.
3) Teaching
22
Menginformasikan kepada keluarga untuk tidak
meletakkan bayi dekat dengan sumber dingin/daerah
terbuka
4) Development Environment
Memberi lingkungan dengan suhu yang stabil
5) Collaboration
Kolaborasi dengan ibu dan keluarga untuk menghangatkan

tubuh bayi.
1) Untuk memantau suhu tubuh bayi dan mengetahui sedini

mungkin bila ada riwayat/keadaan yang stress terhadap
singin.
2) Agar suhu tubuh bayi tetap stabil
3) Agar terhindar dari penurunan suhu secara mendadak
akibat pengaruh lingkungan.
4) Agar lingkungan tidak mempengaruhi kondisi klien
5) Mengembalikan suhu tubuh kembali normal
3) Resiko infeksi b/d kerentanan bayi/immaturitas, bahaya lingkungan,

luka terbuka (tali pusat) Setelah dilakukan tindakan keperawatan
selama 3x 24 jam infeksi dapat dicegah
1) Guidance
Kaji perubahan suhu tubuh serta tanda/gejala klinis yang
timbul
2) Support
Monitor tanda – tanda infeksi dan pantau serta rawat tali
pusat bayi secara benar
3) Teaching
Menganjurkan orang tua atau keluarga untuk selalu
mencuci tangan sebelum menyentuh klien
4) Development Environment.
Memberi lingkungan yang melindungi klien dari infeksi.
23
5) Collaboration
1) Kolaborasi dengan keluarga klien dan dokter.
2) Untuk mengetahui setiap perubahan yang terjadi.
3) Agar tanda dan gejala infeksi dapat segera diketahui.
4) Agar bayi terhindar dari resiko terjadinya infeksi.
5) mengurangi resiko terjadinya infeksi
6) mengurangi resiko infeksi
C. NESTING
1. Pengertian Nesting
Nesting berasal dari kata nest yang berarti sarang. Filosofi ini diambil
dari sangkar burung yang dipersiapkan induk burung bagi anak-
anaknya yang baru lahir, ini dimaksudkan agar anak burung tersebut
tidak jatuh dan induk mudah mengawasinya sehingga posisi anak
burung tetap tidak berubah (Bayuningsih, 2011).
2. Landasan Teori
Nesting adalah suatu alat yang digunakan diruang NICU/Perinatologi
yang terbuat dari bahan phlanyl dengan panjang sekitar 121 cm-132 cm,
dapat disesuaikan dengan panjang badan bayi yang diberikan pada bayi
prematur atau BBLR.
Nesting ditujukan untuk meminimalkan pergerakan pada neonatus
sebagai salah satu bentuk konservasi energi merupakan salah satu
bentuk intervensi keperawatan (Bayuningsih, 2011).
Neonatus yang diberikan nesting akan tetap pada posisi fleksi sehingga
mirip dengan posisi seperti didalam rahim ibu. Posisi terbaik pada bayi
BBLR adalah dengan melakukan posisi fleksi karena posisi bayi
mempengaruhi banyaknya energi yang dikeluarkan oleh tubuh,
diharapkan dengan posisi ini bayi tidak banyak mengeluarkan energi
yang sebenarnya masih sangat dibutuhkan bagi pertumbuhan dan
perkembangannya. Pemberian nesting atau sarang untuk menampung
pergerakan yang berlebihan dan memberi bayi tempat yang nyaman,
24
pengaturan posisi fleksi untuk mempertahankan normalitas batang
tubuh dan mendukung regulasi dini (Kenner & McGrath, 2004).
Pemasangan nesting atau sarang harus mengelilingi bayi, dan posisi
bayi fleksi, sesuai dengan perilaku bayi berat lahir rendah atau prematur
yang cenderung pasif dan pemalas (Indriansari, 2011). Ekstermitas
yang tetap cenderung ekstensi dan tidak berubah sesuai pemosisian
merupakan perilaku yang dapat diamati pada bayi berat lahir rendah
atau prematur (Wong et all., 2009), ini tentu berbeda sengan bayi yang
cukup bulan yang menunjukan perilaku normal fleksi dan aktif,
sehingga nesting merupakan salah satu asuhan keperawatan yang dapat
memfasilitasi atau mempertahankan bayi dalam posisi normal fleksi.
Posisi fleksi merupakan posisi terapeutik karena posisi ini bermanfaat
dalam mempertahankan normalitas batang tubuh dan mendukung
regulasi dini karena melalui posisi ini bayi difasilitasi untuk
meningkatkan aktivitas tangan kemulut dan tangan mengenggam
(Kenner & McGrath, 2004).
Gambaran bahwa bayi mampu mengorganisir perilakunya dan
menunjukan kesiapan bayi untuk berinteraksi dengan lingkungan
terlihat dari adanya kemampuan regulasi diri (Wong et al., 2009).
Menurut Bobak (2005) bahwa sikap fleksi pada bayi baru lahir diduga
untuk mengurangi pemajanan permukaan tubuh pada suhu lingkungan
sehingga posisi ini berfungsi sebagai pengaman untuk mencegah
kehilangan panas, karena bayi baru lahir berisiko tinggi untuk
mengalami kehilangan panas, tubuh bayi baru lahir memiliki rasio
permukaan tubuh besar terhadap berat badan.
3. Tujuan Penggunaan Nesting
Untuk meminimalkan pergerakan bayi, memberikan rasa nyaman,
meminimalkan
stress.
4. Manfaat penggunaan Nesting
Manfaat penggunaan nesting pada neonatus diantaranya adalah:
1. Memfasilitasi perkembangan neonatus
25
2. Memfasilitasi pola posisi hand to hand dan hand to mouth pada
neonatus sehingga posisi fleksi tetap terjaga
3. Mencegah komplikasi yang disebabkan karena pengaruh
perubahan posisi akibat gaya gravitasi
4. Mendorong perkembangan normal neonatus
5. Dapat mengatur posisi neonatus
6. Mempercepat masa rawat neonatus
5. Kriteria
1. Neonatus (usia 0-28 hari)
2. Prematur atau BBLR
6. Metodologi
1. Persiapan
1) Pengkajian sebelum dan sesudah melakukan tindakan
2) Evaluasi tindakan
3) Alat-alat yang dibutuhkan: Bedongan bayi sebanyak 7 buah,
perlak dan selotip
2. Pelaksanaan
1) Lakukan pengkajian awal pada bayi yang dirawat diruang
Perinatologi/NICU khususnya untuk bayi prematur dan
BBLR
2) Pengkajian meliputi skala nyeri, TTV serta tindakan-
tindakan yang akan dilakukan
3) Saat melakukan tindakan perhatikan keadaan umum bayi,
bila bayi dalam keadaan stress dapat ditunjukan dengan
tangisan yang melengking, perubahan warna kulit serta
apnoe
4) Setelah melakukan tindakan berikan sentuhan positif seperti
mengelus ataupun menggendong bayi
5) Setelah bayi dalam kondisi tenang kemudian letakkan dalam
nesting yang sudah dibuat
6) Cara membuat nesting: Buat gulungan dari 3 bedongan
kemudian ikat kedua ujungnya sehingga didapatkan 2
26
gulungan bedongan dari 6 bedongan yang dipersiapkan.
Gunakan selotip untuk merekatkan sisi gulungan bedongan,
1 gulungan bedong tersebut dibuat setengah lingkaran, jadi
dari 2 gulungan bedongan tersebut terlihat seperti lingkaran,
kemudian bayi diletakkan didalam nest dengan posisi fleksi
diatas kaki dibuat seperti penyangga dengan menggunakan
kain bedongan
7)
3. Evaluasi
Setelah melakukan tindakan yang dapat membuat stress pada bayi,
bayi yang
terpasang nest tersebut tampak tenang tidak rewel, dan nyaman
didalam nest
tersebut
27
D. HEEL LANCE PROCEDURE (HEEL STICK)
1. DEFINISI
Heel stick adalah cara pengambilan sampel darah pada neonatus dan
bayi di bawah usia 6 bulan karena jari mereka terlalu kecil.
Lokasi pengambilan darah
Tumit adalah lokasi yang direkomendasikan untuk pengambilan
spesimen dengan cara menusuk kulit pada bayi kurang dari12 bulan.
Lokasi daerah tusukan harus di permukaan (tunggal) plantar kaki
posterior dari tengah kaki besar untuk tumit, atau lateral untuk garis
yang ditarik dari antara jari kaki keempat dan kelima untuk tumit. Di
hampir semua tulang bayi, pembuluh darah, dan saraf tidak dekat
dengan daerah-daerah tersebut. Pada bagian dalam (jempol kaki) dari
tumit adalah arteri tibialis posterior.
2. INDIKASI
Pengambilan sampel darah Heel Stick diindikasikan pada kondisi
sampel yang dibutuhkan relatif kecil atau sumber diterima darah yang
28
lain (misalnya, pusat vena kateter, kateter umbilikalis, garis arteri)
belum tersedia.
Sampel heelstick dapat digunakan untuk kimia rutin dan tes fungsi hati,
jumlah darah lengkap (CBCS), toksikologi, skrining bayi yang baru
lahir, pemantauan samping tempat tidur glukosa, dan analisis gas darah .
3. KONTRA INDIKASI
Tidak boleh dilakukan jika di tumit terdapat luka, infeksi, anomali, atau
edema hadir pada daerah tumit sampling. Saat ini, studi koagulasi
mungkin tidak dilakukan dengan sampel kapiler. Tes darah yang
membutuhkan volume sampel yang relatif besar mungkin tidak
dipergunakan cara pengambilan sampel metode heel stick ini. Kultur
darah memerlukan teknik sempurna steril dan, karenanya, tidak dapat
dilakukan dengan sampel yang diperoleh melalui heel stick. Beberapa
tes canggih lainnya juga mungkin tidak dilakukan pada sampel heel
stick (misalnya, analisis kromosom dan imunoglobulin tertentu dan
titer).
Ketika uji laboratorium yang dikirim ke fasilitas lain atau luar biasa,
periksa dengan laboratorium untuk menentukan jenis sampel darah
diperlukan.
4. PERALATAN DAN REAGEN
1. Heelstick Lancet.
2. Handscoon
3. Alkohol 70 %
4. Darah Koleksi Container (slide, tabung, atau strip uji, dll)
5. kasa steril 2x2
6. Pemanasan Perangkat (jika diperlukan)
5. PROSEDUR
1. Pilih lokasi gunakan bagian paling medial atau lateral
permukaan plantar tumit.
2. Bersihkandaerah tusukan dengan alkohol 70%, kering anginkan.
29
3. Pegang tumit tegas, tapi lembut dengan jari telunjuk kaki melilit,
mendukung lengkungan, dan ibu jari melilit pergelangan kaki, di
bawah daerah tusukan.
4. Posisi tusukan perangkat di bagian paling medial atau lateral
permukaan plantar tumit.
5. Lakukan tusukan tegak lurus terhadap garis tapak.
6. Perangkat pemanas dapat digunakan sebelum tusukan, untuk
meningkatkan aliran darah.
7. Pemanasan dapat dilakukan dengan mengompres menggunakan
air hangat hingga 41°C. Spesimen darah harus dikumpulkan
segera setelah 3 menit pemanasan, karena mencuci kain cepat
akan mendinginkan tumit karena cools dan ini benar-benar akan
memperlambat aliran darah
8. Tekan lokasi dengan ibu jari untuk mengaktifkan lanset.
9. Usap jauh penurunan pertama darah dan lembut menerapkan
tekanan intermiten ke jaringan sekitarnya sampai volume darah
yang diperlukan diperoleh
10. Jangan meremas atau menerapkan tekanan berulang yang kuat
(memerah) ke daerah tusuk, hal ini dapat menyebabkan
hemolisis atau jaringan-cairan kontaminasi spesimen.
11. Ketika mengumpulkan sampel untuk pengujian laboratorium,
spesimen harus diambil secepat mungkin: slide pertama,
spesimen EDTA, spesimen aditif lainnya, dan serum terakhir.
Label spesimen.
12. Setelah koleksi, tekan sponge bersih kasa 2x2 di situs tusukan
sampai perdarahan telah berhenti.
13. Buang dalam wadah benda tajam.
6. HAL YANG PERLU DIPERHATIKAN

1. Jangan memilih daerah yang dingin, sianosis atau
pembengkakan.
2. Jangan menusuk daerah antara batas-batas imajiner.
30
3. Jangan menusuk kelengkungan posterior tumit.
4. Jangan menusuk area kaki selain tumit.
5. Jangan melakukan tusukan di pusat lengkungan kaki. Tusukan di
daerah ini dapat mengakibatkan kerusakan pada saraf, tendon,
dan tulang rawan dan tidak menawarkan keuntungan lebih dari
tusukan tumit.
6. Jangan menusukan lebih dari 2,0 mm pada bayi dan 2.4mm pada
orang dewasa atau anak.
7. Jangan menusuk melalui daerah tusukan sebelumnya karena
akan menyebabkan infeksi.
8. Jangan menusukan jari-jari bayi kurang dari satu tahun
7. KOMPLIKASI
1. Rasa Nyeri
Rasa nyeri berlangsung tidak lama sehingga tidak memerlukan
penanganan khusus. Nyeri bisa timbul alibat alkohol yang belum
kering atau akibat penarikan jarum yang terlalu kuat.
Cara pencegahan:
1. Setelah disinfeksi kulit, yakin dulu bahwa alcohol sudah
mongering sebelum pengambilan darah dilakukan
2. Penarikan jarum tidak terlalu kuat
3. Penjelasan / Menggambarkan sifat nyeri yang sebenarnya
(memberi contoh )
2. Alergi
Alergi bisa terjadi terhadap bahan- bahan yang dipakai dalam
flebotom, misalnya terhadap zat antiseptic/ desinfektan, latex
yang adapada sarung tangan, turniket atau plester. Gejala alergi
bisa ringan atau berat, berupa kemerahan, rhinitis,radang selaput
mata; kadang-kadang bahkan bisa (shock).
Cara pencegahan :
1. Wawancara terhadap orang tua apa ada riwayat allergi.
31
2. Memakai plester atau sarung-tangan yang tidak
mengandung latex.
3. Trombosis
Terjadi karena pengambilan darah yang berulang kali
ditempatyang sama sehingga menimbulkan kerusaka dan
peradangan setempatdan berakibat dengan penutupan
( occlusion ) pembuluh darah. Hal ini juga terlihat pada
kelompok pengguna obat ( narcotics ) yang memakai pembuluh
darah vena.
Cara pencegahan : hindari pengambilan berulang ditempat yang
sama
4. Radang Tulang
Penyakit ini sering terjadi pada bayi karena jarak kulit-tulang
yangs empit dan pemakaian lanset yang berukuran panjang.
Cara mengatasi : Mengatasi peradangan tulang
Cara Pencegahan :Menggunakan lanset yang ukurannya sesuai.
Saat ini sudah dipasarkan lanset dalam berbagai ukuran
disesuaikan dengan kelompok usia. Setiap kejadian komplikasi
Phlebotomi harus dilaporkan kepada dokter dan dicatat dalam
buku catatan tersendiri dengan mencantumkan identitas pasien
selengkapnya, tanggal dan jam kejadian,dan tindakan yang
diberikan.
5. Anemia
Pada bayi, terutama bayi baru lahir dimana volume darah sedikit,
pengambilan darah berulang dapat menyebabkan anemia. Selain
itu pengambilan darah kapiler pada bayi terutama yang bertulang
dapat menyebabkan selulitis, abses, osteomielitis, jaringan parut
dan nodul klasifikasi. Nodul klasifikasi tersebut mula-mula
tampak seperti lekukan yang 4-12 bulan kemudian akan menjadi
nodul dan menghilang dalam 18-20 bulan.
6. Komplikasi Neurologis
32
Komplikasi neurologist dapat bersifat local karena tertusuknya
syaraf dilokasi penusukan, dan menimbulkan keluhan nyeri atau
kesemutan yang menjalar ke lengan. Walaupun jarang, serangan
kejang ( seizures ) dapat pula terjadi.
Cara Penanganan:
1. Pasien yang mengalami serangan saat pengambilan darah
harus dilindungi dari perlukaan.
2. Hentikan pengambilan darah
3. Baringkan pasien dengan kepala dimiringkan ke satu sisi
4. Bebaskan jalan nafas
5. Usahakan lidah tidak tergigit
6. Lakukan penekanan secukupnya pada daerah penusukan
sambil membatasi gerak pasien
33
BAB IV
PENUTUP
A. KESIMPULAN
Dari perbandingan ketiga jurnal diatas dapat disimpulkan bahwa,
nesting sangat berpengaruh terhadap tingkat suplai oksigenasi pada balita
premature serta dapat menurunkan frekuensi nafas sehingga
memungkinkan adekuatnya oksigen yang dihirup oleh bayi tersebut serta
dalam perlakuan nesting dapat meningkat berat badan pada bayi premature
dalam dua perlakuan yaitu selama 5 hari dan 7 hari.
Dalam jurnal pendukung disebutkan bahwa posisi nesting juga
dapat mereduksi tingkat stress dan rasa nyeri serta memberikan rasa
nyaman terhadap bayi yang dilakukan Tindakan Heel Lance.
Akan tetapi hasil yang berbeda di dapatkan pada kadar saturasi dan
detak jantung balita premature yang hanya dilakuan perubahan posisi
tengkurap, miring kiri tidak dilakukan perlakuan nesting , dari hasil
penelitian didapatkan hasil yang tidak significan atau belum bermanfaat
untuk bayi premature tersebut.
B. SARAN
Untuk penatalaksanaan nesting pada bayi pematur sangat dianjurkan oleh
karena, dapat memberikan manfaat yang baik terhadap bayi tersebut,
seperti mempertahankan saturasi oksigen , menurunka frekuensi
pernafasan , menurunkan detak jantung, memberikan rasa nyaman,
menurunkan tingkat stress pada bayi dan mengurangi tingkat nyeri.
34
BAB V
DAFTAR PUSTAKA
Melson, Kathryn A & Marie S. Jaffe, Maternal Infant Health Care Planning,
Second Edition, Springhouse Corporation, Springhouse Pennsylvania,
1994
Wong, Donna L., Wong & Whaley’s Clinical Manual of Pediatric Nursing,
Fourth Edition, Mosby-Year Book Inc., St. Louis Missouri, 1990
Doenges, Marilyn E., Maternal/Newborn Care Plans : Guidelines for Client Care,
F.A. Davis Company, Philadelphia, 1988
Bayuningsih, R. (2011). Tesis : Efektivitas penggunaan nesting dan posisi

prone terhadap saturasi oksign dan frekuensi nadi pada bayi
prematur di RSUD Bekasi. Tidak dipublikasikan. Depok :
Universitas Indonesia
Byers, et al. (2016). A Quasi-Experimental Trial On Individualized,

Developmentally Suportif Family Centered Care, diakses pada
tanggal 5 Maret 2019
Darmanto, Djojodibroto. (2017). Respirologi. Jakarta : EGC
Depkes RI. (2016). Pedoman Pelaksanaan Stimulasi: Deteksi, dan Intervensi

Dini Tumbuh Kembang Anak Di Tingkat Pelayanan Kesehatan
Dasar. Jakarta: Dirjen Bina Kesehatan Masyarakat, Depkes RI
Fleisher, B. (2016). Individualized developmental care for very low-birth-

weight premature infants. USA : Diakses tanggal 7 Maret 2019
Goldsmith, J., & Karotkin., E., H, (2013). Assistedd ventilation of the neonatal.
Philadelphia : Saunders Inc
Grenier, I.R., Bigsby, R., Vergara, E, R., & Lester, B. M. Comparasion of

mootor self – regulatory and stress behaviors of preterm infants
across body positions. American Journal of Occupational Therapy,
57, 289-297. diundu pada tanggal 11 Maret 2019.
35
Guyton, A.C. (2015). Fisiologi Manusia dan Mekanisme Penyakit (edisi
3.) Jakarta: EGC Hidayat, A. (2015). Asuhan neonatus bayi dan
balita :
36
STRADA Jurnal Ilmiah Kesehatan
DOI: 10.30994/sjik.v9i1.275
ISSN: 2252-3847 (print); 2614-350X (online) Vol.9 No.1. May 2020. Page.119-128
Effectiveness Of Use Of Nesting On Body Weight,

Oxygen Saturation Stability, And Breath Frequency In
Prematures In Nicu Room Gambiran Hospital
Kediri City
Miftakhur rohmah1*, Nurwinda Saputri2, Justitia Bahari1

1,
IIK STRADA Indonesia, Kediri, East Java, indonesia
2
University of Muhamadiyah Pringsewu
miftakh@iik-strada.ac.id
ABSTRACT
Premature births are responsible for two-thirds of infant deaths due to lack of good
adaptability to extrauterine life so that the prospects for the survival and health of infants
are greatly threatened. Nesting is an innovation used in the NICU room made of baby
swaddling cloth that is rolled up in such a way that is then positioned around the baby's
body like a condition in the mother's womb. This study aims to determine the effectiveness
of the use of nesting 5 and 7 days in maintaining the stability of oxygen saturation,
breathing frequency and body weight in premature infants in the NICU Room at Gambiran
City Hospital in Kediri. This study used aapproach quasi- experimental with pre-post test
group design in the NICU Room at Gambiran City Hospital in Kediri for the period 1 May
2019 to 31 July 2019. The population was 30 preterm infants. With purposive sampling
technique, there were 14 samples of preterm infants. Group 1 consisted of 7 infants
performed nesting for 5 days and group 2 consisted of 7 infants performed nesting for 7
days. Data normality test uses the Kolmogoro-Smirnov Test. Independent t test is used to
test the effectiveness of using nesting on oxygen saturation, respiratory frequency stability
and premature baby's weight. The results of the study in both groups p <α (0.05), then H0 is
rejected and H1 accepted. So it can be concluded that the use of nesting in premature
babies is effective in stabilizing body weight, oxygen saturation, the frequency of
breathing of premature babies.
Keywords: Premature, Nesting on body weight, Oxygen saturation, Breath frequency.
Received December, 25, 2019; Revised January 24, 2020; Accepted February 15, 2020
STRADA Jurnal Ilmiah Kesehatan, its website, and the articles published there in are licensed under a Creative Commons Attribution-ShareAlike
4.0 International License.
Website: https://sjik.org/index.php/sjik | Email: publikasistrada@gmail.com 11

9
DOI: 10.30994/sjik.v9i1.275
BACKGROUND
Preterm birth is responsible for two-thirds of infant deaths. Preterm or premature is
defined as birth before 37 weeks' gestation, regardless of body weight (Bobak, 2015).
Premature babies do not have the ability to adjust well to extrauterine life and the prospect
of babies to have good survival or health can be severely threatened. The World Health
Organization (WHO) states that babies born weighing less than 2500 grams and born after
37 weeks' gestation have better prospects for life than those born prematurely. LBW
mortality is less than 5% if the pregnancy lasts until the age of term (Bobak, 2015).
Problems that often occur in premature babies include being born with a low birth weight
of less than 2500 grams, as compensation for the lack of fat reserves. Babies who are born
full term will experience a weight loss of around 5−10% in the first 7 days. Peak weight
loss occurs on the second day after birth. Research conducted by Davanzo et al explains
that weight loss of 8% is the top safe limit for newborn weight loss. If weight loss is ≥8%,
it can increase the risk of mortality and morbidity in infants, such as hyperbilirubinemia
and dehydration due to hypernatremia.
Based on East Java's health profile in 2016, 20,836 babies were born with a body weight
<2500 g out of 580,153 baby births, or around 3.6%. In Kediri City, 127 babies were born
with low birth weight from 4,324 babies born that year.
The number of low birth weight babies treated during the last three months in the
Neonatus room at Gambiran City Hospital in Kediri (September - November 2018)
obtained 98 data, with birth weight <2500 grams, 36 of them were treated in the NICU
room and 15 of them died due to various complications ( Medical Record, 2019).
Premature babies are also very susceptible to hypothermia due to thin fat reserves under
the skin and immature heat control centers in the brain (Zaviera, 2012). The hypothermic
condition causes permanent central nervous system changes which eventually lead to
mortality. Chilled babies spend calories to warm the body and vice versa make an effort to
stabilize body temperature to normal. Hypothermia conditions cause increased oxygen
consumption and if not fulfilled causes a hypoxic situation and causes tachycardia or
bradycardia in response to decreased oxygenation. In premature neonates, the quantity of
fluid loss through evaporation of the skin and respiratory tract is higher than in neonates
born at term. In addition, neonates born prematurely have a greater extracellular
component, leading to greater diuresis in premature neonates. This is what causes
neonates born prematurely to experience a higher weight loss than neonates born at term.
Whereas in neonates born less months, the decline can occur up to 15%. Physiological
weight loss does not occur after neonates aged 5-7 days and body weight increases at 12-
14 days (Rahardina, 2015).
Respiratory problems are one of the causes of death in babies born prematurely.
Respiratory problems in infants are often associated with the condition of Respiratory
Distress Syndrome (RDS), also called hyaline membrane disease (HMD), is the most
common cause of morbidity and mortality in low birth weight infants that is often caused
by prematurity. RDS incidence of about 5-10% is found in infants less than 50 months,
50% in babies weighing 500-1500 grams (Nur, 2010).
Interview with nurses from the NICU Room at Gambiran City Hospital in Kediri,
obtained information that the use of nesting was done prematurely. Nesting is the use of
tools shaped like a condition in the mother's womb made of linen and can be adjusted to
the length of the baby's body. This tool is placed as a protector of the baby's position,
maintaining changes in the baby's position caused by gravity. Nesting is one of the nursing

DOI: 10.30994/sjik.v9i1.275
interventions in giving the right position for neonates. Nesting can facilitate the
development of premature babies in the form of physiological and neurological conditions.
Nesting is a buffer in the sleeping position of the baby so that it stays in a position of
flexion, this is intended to prevent drastic changes in the position of the baby that can
result in loss of energy from the neonate's body.
Based on the above phenomenon, researchers are interested in conducting further research
on "Effectiveness of Nesting Use on body weight, oxygen saturation stability, and
breathing frequency in premature infants in the NICU room at Gambiran City Hospital in
Kediri".
OBJECTIVE
This study aimed to determine Effectiveness of Nesting Use on body weight, oxygen
saturation stability, and breathing frequency in premature infants in the NICU room
METHODS
Methods Themethod used is quasi- experimental withapproach one group pretest posttest.
The sample in this study was a portion of premature infants who were in the NICU room
at Gambiran City Hospital in Kediri for 1 month that met the criteria of premature babies
with birth weight> 1500-2500 grams, who did not have respiratory disorders, babies who
did not undergo surgery, were treated in incubator, premature babies who do not have
central nervous system damage and do not experience congenital abnormalities. Sampling
uses a purposive sampling technique. The implementation time is on May 1 to July 31,
2019. The instrument used to take the Oxygen Saturation variable is oximetry with a
normal SPOindicator2 88-95%, the breath frequency variable uses a stethoscope with a
normal RR indicator: 30-60x / min, the Weight variable Agency uses Infant scale digital
instruments. Nesting was given for 30 minutes per day for 5 days in groups 1 and 7 days
in group 2.
RESULTS
Characteristics of Respondents
This study sampled 14 premature infants treated in the NICU Room at Gambiran City
Hospital in Kediri during the period of May 1 2019 to 31 July 2019. The characteristics of
the respondents are then presented in the form of the following table.
Table 1 Characteristics of Respondents by Age of Pregnancy
Age of Pregnancy Grup
(weeks) n %
29 - 31 Group 1 2 14.23
Group 2 3 21.47
32 - 36 Group 1 5 35.71
Group 2 4 28.57
Total 14 100
Source: Primary Data, 2019
Based on the above table, most respondents were born with 32-36 weeks' gestation.
Namely 35.71% in group 1 and 28.57% in group 2.

DOI: 10.30994/sjik.v9i1.275
Table 2 Characteristics of Respondents by Birth

Weight Birth Grup Total
(grams) n %
1500 - 1999 Group 1 2 14.23
Group 2 4 28.57
2000 - 2500 Group 1 5 35.71
Group 2 3 21.49
Total 14 100
Source: Primary data, 2019.
Based on table 2 above, most respondents were born with a body weight of 2000-2500
grams. Namely 57.2%., Where group 1 contributed 35.71% and group 2 contributed
21.49%.
Table 3 Characteristics of Respondents by Gender

Variable Men % Women %
Gender Group 1 3 42.86 4 57.14
Group 2 2 28.57 5 71.43
In table 3 it can be seen that the number there were more female respondents in each
group than male respondents, which was 57.14% in group 1. While in group 2 there
were 71.43% respondents were female.
Table 4 Equality of Research Respondents by Pregnancy Age

Characteristics n Mean Median SD Min-max P-value
Variable (%)
Pregnancy Group 1 7 (50) 33 33 1.88 29-35 0.272
Age
Group 2 7 (50) 33 33 2.03 29-35
Based on table 4, the mean gestational age in group 1 and group 2 was 33 weeks. The
results of the normality test data using the Kolmogorov-Shmirov Test, obtained
gestational age is equivalent to p value > 0.05 which means there is equality at the
gestational age of the two groups. The mean and median in the two groups were the
same, ie 33 weeks, which means the data distribution is normal.
Based on these data the researchers concluded that there was equality in group 1 and
group 2. Where group 1 was the baby to be nested for 5 days and group 2 was nested
for 7 days.
Characteristics of Variables
Characteristics of each variable studied are oxygen saturation, respiratory frequency and
body weight measured values include mean, median and mode aimed at determining the
normality of the data. The data normality test uses the Kolmogorov-Smirnov Test.

DOI: 10.30994/sjik.v9i1.275
Table 5 Analysis of Oxygen Saturation Data, Respiratory Frequency and Weight

of Premature Babies Before Using Nesting
Variables Mean Median Mode SD P value
Oxygen Group 1 91.14 90 90 1.96 0.755

Saturation Group 2 91 90 90 1.51
Respiratory Group 1 64 , 43 65 65 2.38 0.85

Frequency Group 2 64 64 64 1.6
Body Group 1 1977.14 2010 2010 206.31 0.177

Weight Group 2 1968.57 1950 1950 203.73
In the table 4.5 found the average oxygen saturation prior to the installation of nesting in
group 1 was 91.14% and group 2 was 91%. Equivalence test results found that the oxygen
saturation of the two groups is equivalent to p value > 0.05. Thevalues are modethe and
median same meaning the data distribution is normal.
The mean respiratory frequency before nesting in group 1 was 64.43x / min and was 64x
group 2/ min. Both groups have the same mean and median mean the data distribution is
normal. Equivalence test results p value > 0.05.
The mean weight before nesting in group 1 was 1977.14 grams and group 2 was 1968.57
grams. Both groups have the samevalues mode and median meaning the data distribution is
normal. Equivalence test results found that the weight of the two groups is equivalent to p
value > 0.05.
Table 6 Analysis of Oxygen Saturation Data, Respiratory Frequency and Weight

of Premature Babies After Using Nesting
Variable Mean Median Mode SD
Oxygen Group 1 93.42 93 93 1.29

Saturation Group 2 95.71 96 97 1.27
Respiratory Group 1 58, 14 59 59 2.59

Frequency Group 2 53.43 52 52 2.06
Group 1 1992.86 2020 2020 206.72
weight
Group 2 1997.14 1970 1970 203.88
In table 6 was found to mean oxygen saturation after the installation of nesting on group 1
was 93.42% and group 2 was 95.71% ,. The difference in mean increase in both groups
was 2.29%, whereas in group 2 the increase in saturation was more significant than in
group 1. The mean respiratory frequency after nesting in group 1 was 58.14 x / minute and

DOI: 10.30994/sjik.v9i1.275
group 2 was 53.43x / minute. In group 2 there was a better respiratory deceleration with a
difference of 4.71 x / min from group 1. The mean weight after nesting in group 1 was
1992.86 grams and group 2 was 1997.14 grams. Group 2 experienced an increase in the
mean more than group 1 by 4.28 grams.
Statistical
Tests Testing the normality of the data in this study using the Kolmogorov-Smirnov test,
where the normality test is a requirement or assumption of the parametric test.
This study uses an independent test, which is a comparative test to find out whether there
are significant differences in mean or average between two free groups that have interval
or ratio data scales where the source of data comes from different subjects. In this study an
independent t test was used to test the effectiveness of using nesting on oxygen saturation,
respiratory frequency stability and body weight of premature infants. This test is used to
determine the p value (probability value) of each variable tested.
Table 7 Effectiveness ofUse Nesting on Oxygen Saturation in Premature Babies

Oxygen Saturation Variables Mean SD P value
Group 1 Before 91.14 1.96 0.001
After 93.42 1.29
Group 2 Before 91 1.51 0.001
After 95.71 1.27
In table 7 it appears that in both groups there was a significant increase in mean oxygen
saturation. In group 1 before the average oxygen saturation action 91.14% to 93.42%.
Group 2 before the average oxygen saturation action 91% to 95.71%. In both groups the
results count p (0.001) <α (0.05), then H0 is rejected and H1 accepted. So it can be concluded
that the use of nesting effectively maintains oxygen saturation in premature babies.
Table 8 Effectiveness ofUse Nesting on Respiratory Frequency in Premature

Babies
Breathing Frequency Variables Mean SD P value
Group 1 Before 64.43 2.38 0.002
After 58.14 2.59
Group 2 Before 64 1.6 0.000
After 53.43 2.06
In table 8 it appears that in both groups there was a significant decrease in the average
respiratory frequency. In group 1 prior to the mean respiratory frequency 64.43 x / minute
decreased to 58.14 x / minute with p value 0.002. Group 2 before the average respiratory
frequency of 64 x / min fell to 53.43 x / min, with a p value of 0,000. In both groups the
results count p (0.002) <α (0.05), then H0 is rejected and

DOI: 10.30994/sjik.v9i1.275
H1 accepted. So it can be concluded that the use of nesting is effective in reducing respiratory
frequency in premature babies.
Table 9 Effectiveness ofUse on Nesting Premature Baby Body Weight
Variable Weight Mean SD P value
Group 1 Before 1977.14 206.31 0.001
After 1992.86 206.72
Group 2 Before 1968.57 203.73 0.000
After 1997.14 203, 8
Table 9 shows that in both groups there was a significant increase in body weight.
Where group 1 before the average weight of 1977.14 grams increased to 1992.86 grams
with a p value of 0.001. Whereas Group 2 before the mean weight action of 1968.57 grams
increased by 28.57 grams to 1997.14 grams, with a p value of 0,000. In both groups the
results count p (0.001) <α (0.05), then H0 is rejected and H1 accepted. So it can be concluded
that the use of nesting in premature babies is effective in increasing body weight.
DISCUSSION
Effect ofUse Nesting 5 and 7 Days Against Oxygen Saturation in Premature Babies
Based on table 7 an increase in the average oxygen saturation after the use of nesting.
In the group performed nesting for 5 days there was an increase in the average of 2.28%
and in the group carried out nesting for 7 days the mean increased by 4.71%.
This is in accordance with the theory that states that the exact position and
anatomical is an important component in the care of the development of premature babies
(Bowden, et al. 2000). Nesting functions as a support for the baby's body so that there is no
drastic change in position in the baby that can result in a lot of energy loss. Can also
prevent the incidence of hypoxia due to hypothermia or due to incorrect position which
results in difficulty breathing (Zubaidah, 2012). So that oxygen saturation can be
maintained within the normal range.
Stress is closely related to cortisol production which can reduce oxytocin production
which affects parasympathetic control in the cardiorespiratory system (Zahra, et. Al.,
2018). Babies use nesting as a support for sleep to stay in a flexed position. This position
facilitates the baby to feel relaxed and not stressed due to changes in conditions outside the
uterus, thereby reducing the frequency of breathing and increasing oxygen saturation.
In this study thegroup nesting for 7 days showed better oxygen saturation results
than thegroup nesting for 5 days. This can be realized, with increasing age of the baby, the
baby's ability to adapt to the environment also improves. Nevertheless, nesting facilitates
the development of premature babies in suppressing stress byan environment based on
developingdevelopmental care that supports the development of physiological conditions.
Effect ofUse Nesting 5 and 7 Days Against Respiratory Frequency in Premature

Babies
Based on table 8 there was a decrease in the average respiratory frequency in both
groups after nesting. In the group that wasnesting for 5 days there was a decrease in the
average respiratory frequency by 3.71 x / minute, whereas in thegroup nesting for 7 days
there was a decrease in the average respiratory frequency which was more by 10.57 x /
minute.

DOI: 10.30994/sjik.v9i1.275
The results of this study are consistent with the theory that the baby's position affects
the amount of energy expended by the body. The best position for premature babies is to
do a flexion position because it will reduce metabolism in the body (Bowden, et. Al, 2000).
The use of nesting facilitates the baby in maintaining a flexion position, namely by
supporting the baby's body so that it is in the right and comfortable position. In babies with
oxygen support, nesting helps maintain a position so as to maximize therapeutic delivery.
Premature babies have a very thin layer of subcutaneous fat, so hypothermia is easy
and oxygen demand will be greater (Wong, et. Al., 2009). This is consistent with research
conducted by Bayuningsih (2011), that nesting is able to maintain a warm body
temperature so as to prevent respiratory stress due to hypothermia. Nesting is an
environmental management method similar to KMC (kangaroo mother care) in infants
whose conditions do not meet the KMC requirements.
The decrease in respiratory frequency is because the baby is calmer and increases
sleep when nesting. It also shows a decrease in the stress level of infants due to
deceleration of the body's cortisol level. Mooncey et al's research indicates that cortisol
levels decrease by as much as ± 60% affecting the limbic area of the insular cortex in the
brain, then resulting in the production of oxytocin which can calm and stabilize the
cardiorespiratory system. When nesting, the baby is altered in a position so that it is not
always in the supine position which can increase diaphragm compression. Infants are
positioned flexibly so as to optimize the functioning of the baby's respiratory system
(Zahra, et. Al., 2018).
The results showed that preterm infants undergoing nesting showed a more
significant respiratory frequency deceleration than the first group. This can be influenced
by the maturity of premature baby organs which is increasing. Nesting in this case helps to
condition the baby's environment so that it remains conducive so that the energy it has can
be maximized to support the development of premature babies so that it is faster in
achieving optimal health conditions.
Effect of Nesting Use 5 and 7 Days Against Premature Baby Weight

Based on the results of the analysis in table 9 there was an increase in the average
weight in both groups after nesting. In the nesting group for 5 days there was an average
increase of 15.72 grams. In the nesting group for 7 days the average was 28.57 grams.
The baby's weight carried out by nesting longer showed better results, this is because
the nesting method has a positive effect on maintaining the baby's weight (Anderson et al,
2003). The use of nesting intervention is done with the hope to maintain the energy
released by the baby's body so that it is used optimally for growth and development. The
researchers analyzed a number of studies, including concluding that nesting can reduce
energy expenditure, accelerate emptying of stomach contents, increase nutrient absorption
thereby reducing the incidence of significant weight loss.
Nesting is able to keep body temperature warm so as to prevent hypothermia
(Bayuningsih, 2011). Warm ambient temperature in premature babies is needed for the
efficiency of metabolism or the conservation of body energy as measured by calorie
measurement (Zahra, et. Al., 2018).
Researchers also analyzed that the increase in baby's weight was influenced by
several factors one of which was the baby's ability to absorb nutrients given both orally
and parenterally. In premature babies who are cared for separately from their mothers, this

DOI: 10.30994/sjik.v9i1.275
nesting treatment is expected to be able to control stress that is exposed due to differences
in extrauterine conditions.
Physiologically, infant weight gain is also influenced by the age of the baby, where
babies tend to lose significant weight. Babies do not lose more than 10% of weight on the
5th day of birth. In neonates born less months, a decrease can occur up to 15% (Rahardina,
2015).
The use of this nesting can help the baby in stabilizing the physiological functions of
the body's metabolism by preventing stress, the baby in a pleasant position like conditions
in the womb. As explained in previous research by Bayuningsih (2011), although in the
study the changes that occurred were not significantly explained.
CONCLUSION
An increase in mean oxygen saturation significantly in both groups after nesting. Increased
oxygen saturation was higher in the nesting treatment group for 7 days (4.71%) compared
to the nesting treatment group for 5 days (2.28%).
There was a decrease in the average respiratory rate in both groups after nesting. The
group that was placed nesting for 7 days (10.57 x / min) showed a mean deceleration of
respiratory frequency that was more significant than the nesting group 5 days (3.71 x /
min).
There was an increase in the weight average in both groups. The 7-day nesting treatment
group experienced an increase in body weight more than 15.72 grams compared to the
nesting treatment group for 5 days, which was 28.57 grams.
In both groups the results of the p value (p value) variable oxygen saturationbefore and
after the action obtained (0.001) <α (0.05), then H0 is rejected and H1 is accepted. So it
can be concluded that the use of nesting effectively maintains oxygen saturation in
premature babies.
In both groups the results of calculating the p value (p value) variabel respiratory
frequency before and after the action obtained p (0.002) <α (0.05), then H0 is rejected and
H1 is accepted. So it can be concluded that the use of nesting is effective in reducing the
frequency of breathing in premature babies.
In both groups the resultl calculated the value of p (p value) weight variable before and
after the action obtained p (0.001) <α (0.05), then H0 is rejected and H1 is accepted. So it
can be concluded that the use of nesting in premature babies is effective in increasing body
weight.
The nesting treatment group for 7 gave more significant results than the nesting treatment
group for 5 days.
REFERENCES
Alimul. (2017). Pengantar Ilmu Kesehatan anak Untuk Pendidikan Kebidanan. Jakarta :
Salemba medika
Arifah, Siti. (2010). Jurnal : Pengaruh Kangaroo Mothercare (KMC) Dua Jam Dan Empat
Jam Perhari Terhadap Kenaikan Berat Badan Lahir Rendah Bayi Preterm Di RS
PKU Muhammadiyah Surakarta. Surakarta : Prosiding Seminar Ilmiah Nasional
Kesehatan

DOI: 10.30994/sjik.v9i1.275
Bayuningsih, R. (2011). Tesis : Efektivitas penggunaan nesting dan posisi prone terhadap
saturasi oksign dan frekuensi nadi pada bayi prematur di RSUD Bekasi. Tidak
dipublikasikan. Depok : Universitas Indonesia
Byers, et al. (2016). A Quasi-Experimental Trial On Individualized, Developmentally
Suportif Family Centered Care, diakses pada tanggal 5 Maret 2019
Darmanto, Djojodibroto. (2017). Respirologi. Jakarta : EGC
Depkes RI. (2016). Pedoman Pelaksanaan Stimulasi: Deteksi, dan Intervensi Dini Tumbuh
Kembang Anak Di Tingkat Pelayanan Kesehatan Dasar. Jakarta: Dirjen Bina
Kesehatan Masyarakat, Depkes RI
Fleisher, B. (2016). Individualized developmental care for very low-birth-weight
premature infants. USA : Diakses tanggal 7 Maret 2019
Goldsmith, J., & Karotkin., E., H, (2013). Assistedd ventilation of the neonatal.
Philadelphia : Saunders Inc
Grenier, I.R., Bigsby, R., Vergara, E, R., & Lester, B. M. Comparasion of mootor self –
regulatory and stress behaviors of preterm infants across body positions. American
Journal of Occupational Therapy, 57, 289-297. diundu pada tanggal 11 Maret 2019.
Guyton, A.C. (2015). Fisiologi Manusia dan Mekanisme Penyakit (edisi 3.) Jakarta: EGC
Hidayat, A. (2015). Asuhan neonatus bayi dan balita : Buku praktikum mahasiswa
keidanan. Jakarta : EGC
Hockenberry, M.J, & Wilson , D. (2017). Wong’s : Nursing Care of Infants and Children.
St; Louis : Mosby. Diakses tanggal 7 Maret 2019
Kenner, C., & Mc. Grath., J.M. (2014). Developmental Care Of New Borns & Infants: A
guide For HealthProfessionalis. St. Louis: Mosby Inc
Kosim, M.S. (2011). Buku Ajar Neonatologi. Jakarta: Ikatan Dokter Anak Indonesia
Lissauer, T., Fanarrof, A. (2015). At a glance : Neonatology. USA : Mosby
MacGregor, J. (2018). Introduction to the anonimity and phisiology of children: A guide
for students of nursing. child care and health (2nd edition). New York : Routledge
Merenstein, Gerald B. (2012). Neonatal Intensive Care. USA : Mosby
Nelson, B. (2011). Ilmu kesehatan anak Vol 2. Jakarta : EGC
Nursalam. (2012). Konsep Penerapan Metodologi Penelitian Ilmu Keperawatan Pedoman
Skripsi, Tresis Dan Instrumen Penelitian Keperawatan. Jakarta : Salemba Medika
Pantiawati, Ika. (2015). Bayi dengan Berat Badan Lahir Rendah. Yogyakarta : Nuha
Medika
Surasmi, A., Handayani, S., & Kusuma, H.N. (2012). Perawatan Bayi Resiko Tinggi.
Jakarta: EGC
Syahreni, E. (2012). Tesis : Pengaturan pengaruh stimulus sensori terhadap respon
fisiologis dan perilaku BBLR di RSUPN Dr. Cipto Mangunkusumo. Depok :
Universitas Indonesia
Tomey, A.M., & Alligood, M.R. (2016). Nursing theory. Missouri : Mosby, Inc.
Widyani. (2010). Panduan Perkembangan Anak. Jakarta : Puspawarsa
Wong, Schhwartz P. (2011). Buku Ajar Keperawatan Pediatrik. (Edisi 6). Jakarta : EGC
Zubaidah. (2012). Tesis : Pengaruh Pemberian Informasi Tentang Developmental Care
Terhadap Pengetahuan, Sikap dan Tindakan Perawat dalam Merawat BBLR di
RSUP dr. Kariadi Semarang. Depok : FIK UI

The effect of position on oxygen saturation and heart rate
[ DOI: 10.22088/acadpub.BUMS.2.2.153 ]
in very low birth weight neonates
Abstract:
Background: Optimal oxygenation in preterm neonates is very important,
therefore different measures are recommended to improve their oxygenation.
One of these measures is the position of these infants. The studies on the
effects of prone and left lateral positions showed conflicting results. So, the
Original Article aim of this study was to determine the effect of position on arterial oxygen
saturation (SaO2) and heart rate (HR) in very low birth weight (VLBW)
neonates.
Zahra Akbarian Rad (MD) 1 Methods: This non-randomized simple convenient interventional study was
Mohsen Haghshenas Mojaveri conducted on 40 VLBW 7-28-day infants with 29-35-weeks gestational age
(MD) 1 using in 2014-2015. The infants were hospitalized in the neonatal intensive
care unit of Rouhani Hospital in Babol. Based on the inclusion criteria, each
Downloaded from caspianjp.ir at 17:35 +0330 on Wednesday October 7th 2020
Mahmoud Hajiahmadi (PhD) 1

Azita Ghanbarpour (MD) 2 of them was initially kept in supine position for 120 minutes and then in
Samaneh Mirshahi (MSc) *1 prone and finally left lateral position for 120-min after 10-min rest. During
this period, SaO2 and HR parameters were recorded every 15-min and data
were analyzed.
1. Non-Communicable Pediatric Diseases
Results: The mean of SaO2 was 97.41±1.91%, 96.74±2.09% and
Research Center, Health Research
96.14±2.36% in prone, supine and left lateral positions, respectively and this
Institute, Babol University of Medical
difference was statistically significant (P=0.032). The mean of HR was
Sciences, Babol, IR Iran.
146.09±9.65, 148.15±11.46 and 146.02±10.54 (beat/min) in prone, supine
2. Infertility and Reproductive Health
and left lateral positions, respectively. HR was normal in all three positions
Research Center, Health Research
but the HR variability in prone position was slightly less than other positions
Institute, Babol University of Medical
(P=0.596).
Sciences, Babol, Iran.
Conclusions: The results of the current study indicated that in preterm
newborns, the prone position made more desirable oxygenation and HR
variability compared to the supine and left lateral positions
 Correspondence: Keywords: Arterial Oxygen Saturation, Preterm Neonate, Heart Rate,
Samaneh Mirshahi,
Position Change
Non-Communicable Pediatric Diseases
Research Center, No 19, Amirkola Citation:
Children’s Hospital, Amirkola, Babol, Akbarian Rad Z, Haghshenas Mojaveri M, Hajiahmadi M, et al. The effect of
Mazandaran Province, 47317-41151, position on oxygen saturation and heart rate in very low birth weight neonates.
IR Iran. Caspian J Pediatr Sep 2016; 2(2): 153-7.
Introduction:
E-mail: s.mirshahi63@yahoo.com The number of very low birth weight (VLBW) and premature neonates
Tel: +98 1132346963 has increased due to the enhance of artificial insemination methods and
Fax: +98 1132346963 multiple births [1].Thus, the optimal oxygenation is very important in preterm
infants so that both hypoxia and hyperoxia cause damage to infants,
especially premature ones. Therefore, it is important to maintain proper
oxygen range according to the gestational age and age of the infants in
Received: 22 June 2016
neonatal medicine. There are various methods including pharmacotherapy
Revised: 18 July 2016
and respiratory cares for improving and maintaining the optimal oxygenation
Accepted: 11 Aug 2016
and heart rate within desirable ranges. The selection of proper positioning of
the infants on a hospital bed is one of the methods, which is important for
researchers [2]. Two studies mentioned that the prone position was
successfully used for lung disease by Bryan for the first time [2, 3].
Similarly, Douglas published an article about the impairment of blood circulation to the lungs [10].
[ DOI: 10.22088/acadpub.BUMS.2.2.153 ]
impact of increased oxygenation in the prone position However, there are many conflicting results so that no
on patients with respiratory failures [4]. These neonates difference was found between prone, supine and left
may often be hospitalized a long time in neonatal lateral positions in terms of oxygenation and
intensive care unit (NICU). Physiological flexibility in hypoxia [11] while in another study, it was observed that
the areas of trunk, waist and hip in preterm infants and the arterial CO2 pressure was greater in prone position
inadequate muscular tonicity caused by prematurity in than supine position [12]. On the other hand, there are
neuromuscular system cause these neonates to have many reports of reducing the gastro esophageal reflux
abnormal changes of this system when they encounter in left lateral position [4, 9, 13]. There are few studies
the prolonged immobility [3]. In addition, the about the effect of position change on the heart rate. In
immobilization is associated with the risk of skin a study, it was observed that the heart rate increased
damage so it is necessary to change the positions of 8.5% half an hour after changing position than that
these infants every 2-3 hours [4]. time before this change [10].
There are few researches about the positive effects Mostly, the supine position is used for neonates in
of prone position on the oxygenation in neonates and NICU. Although the lateral positions are important for
comparing it with the supine position [2, 5]. Improved premature infants to improve their developmental
oxygenation in the prone position cannot be justified skills [14], health care staff are reluctant to place the
with the increased respiratory muscle strength in neonates in this position .
preterm infants because it seems that the respiratory Hence, the aim of this study was to evaluate the
muscle strength does not increase in prone position [6]. effect of prone, supine and lateral positions on oxygen
Therefore, higher levels of arterial oxygen saturation and heart rate in VLBW infants, considering
saturation in premature infants with prone position can the conflicting results about the effects of position
be due to the improved mechanical activity of lungs, change on oxygen saturation and heart rate.
increased lung volume, decreased mismatch between
ventilation and pulmonary circulation [7]. However, one
study suggested that the prone position led to decreased Methods:
lung volume and the oxygenation was getting worse in This non-randomized simple convenient
this position due to the increased pressure of intra- interventional study was conducted on very low birth
abdominal content on the diaphragm and they believed weight (VLBW) infants in 2014-2015. These newborns
that the supine position was a suitable position in were non-randomly selected and entered into the study
VLBW infants [7]. on the seventh day of birth after the stability of vital
On the other hand, one research indicated that signs. Sample size was 40 preterm VLBW infants
unlike the supine position, the prone position could whose gestational age and birth weight was less than
increase the risk of sudden infant death syndrome 37 weeks and 1500 g, respectively.
(SIDS) [8]. Another one showed the effects of right and These neonates were fed by their mothers and using
left lateral positions and it was concluded that these gastric gavage and did not have any respiratory disease.
positions had no effect on arterial oxygen while the The exclusion criteria were congenital anomaly,
prone and left lateral positions could decrease the apparent and significant cardiovascular disease,
gastro esophageal reflux [9]. One study indicated that pulmonary disease, digestive problems, seizure and
the speed of motor skills and muscle tonicity increased neurological problems and neonates who need
among infants nursed in a lateral position; therefore, respiratory support, umbilical catheter and chest tube,
this position can be paid more attention for neonates as well as infants with new clinical problem.
admitted in NICU except those who have no stable Infants who met the inclusion criteria were placed
respiratory condition. in supine position at first for 2 hours after the approval
The other one illustrated that the arterial oxygen of ethics committee and consent of parents then their
saturation and required oxygen concentration enhanced position was changed into prone position. The first ten
and reduced at the time of switching from supine to minutes were considered as the resting phase and
prone position [1]. Considering the hypothesis that position change. After that time, the prone position was
rotating the neonates to prone position improves followed for 2 hours and finally they were placed in the
perfusion to ventilation, thus it is concluded that the left lateral position and after 10 minutes of rest, they
patients may suffer from supine position because of were fallowed in this position for 2 hours.
154 | P a g e Caspian Journal of Pediatrics, Sep 2016; Vol 2(No 2), Pp: 153-7
During this period except the rest phase, parameters females. The minimum and maximum gestational ages
[ DOI: 10.22088/acadpub.BUMS.2.2.153 ]
of arterial blood oxygen and heart rate were recorded in were 27 and 35 weeks, respectively (30.10±2.158). The
a questionnaire with demographic characteristics of minimum and maximum weights of the newborns were
infants every 15 minutes and its mean was determined. 754 g and 1490 g respectively (1180.38±205.318).
Then the mean of above cases were compared with The mean of oxygen saturation and heart rate in
each other in terms of the effect on parameters of blood supine, prone and left lateral positions is illustrated in
oxygen saturation and heart rate in three positions. The table 1. Arterial oxygen saturation was significantly
information was recorded by a neonatal nurse. None of different in the supine, prone and left lateral positions
the neonates required therapeutic intervention during during 120 minutes (P=0.023). Moreover, the study of
the intervention and recording the changes in oxygen arterial oxygen saturation between two positions of left
saturation and heart rate. lateral and prone showed that there was no significant
The collected data were statistically analyzed using difference between these two positions (P= 0.392).
SPSS 21 and descriptive statistics (mean variance The maximum and minimum of heart rate were
criterion relative frequency distribution). Paired sample 123.44 and 175.33, 124 and 165.78, and 164.56 and
test and repeated measurement test were used to 124.11 (beat/min) in the supine, prone and left lateral
determine the significance of oxygen saturation and position, respectively. Heart rate variability was
heart rate mean at different times in any position. slightly lower in the prone position than the other two
P<0.05 was statistically considered significant. positions but this difference was not significant
(P=0.596). The results also showed that the mean of
heart rate was not significant between the supine and
Results: left lateral positions (P=0.233) (table 1).
In this study, 40 neonates 7-28-day (30.17±79.50)
were studied. They were 12 (45%) males and 18 (55%)
Table 1: Comparison the mean of arterial oxygen saturation and heart rate in three studied positions of supine,
prone and left lateral
Position Supine Prone Lateral P -value
variables
Oxygen saturation 96.74±2.09 97.41±1.91 96.14±2.36 0 . 032
( percent)
( mean± SD)
Heart rate 148.15±11.46 146.09±9.65 146.02±10.54 0.596
( beat/ min)
( mean± SD)
Saadati et al. conducted a study on 40 low birth

Discussion: weight infants with respiratory distress and each infant
This study represented that the mean of oxygen was placed in the prone and supine positions for 2
saturation was higher in prone than lateral position. hours then the ABG was individually measured in each
There was no significant difference among these three position. The mean of arterial oxygen saturation in the
positions in terms of the mean of heart rate during two supine and prone positions was 87.65% and 96.04%,
hours. respectively (p<0.05). On the other hand, the mean of
Riani et al. reported the effect of prone position on arterial pressure of CO2 suggested significant
oxygenation in 40 preterm infants weaned from difference between the supine and prone positions.
mechanical ventilation and they concluded that the Although the invasive ABG was used in mentioned
mean of arterial oxygen saturation was higher in prone study, its result was the same as our study [12].
than supine position, which is similar to the current Yao et al. performed a study on 30 weaned infants
study [15]. Balaguer et al. demonstrated the percentage from the ventilator, it was indicated that the infants had
of oxygen saturation was higher in the prone than better oxygenation in the prone than supine position
supine position [5]. during the first 9 hours of weaning from mechanical
ventilator [16]. Despite the different conditions of
infants in their study, the results are consistent with the Acknowledgment:
[ DOI: 10.22088/acadpub.BUMS.2.2.153 ]
findings of the present study. The authors would like to appreciate the Clinical
A study was done on 32 ventilated premature Research Development Committee of Amirkola
infants by Abdeyazdan et al. in 2013 and they Children's Hospital, Health Research Institute, Non-
concluded that the SPO2 difference was not significant Communicable Pediatric Diseases Research Center of
between the lateral position and other positions during Babol University of Medical Sciences, Mrs. Faeze
120 minutes of neonates' positioning. In fact, the Aghajanpour, also the staff of NICU in Ayatollah
preterm infants receiving mechanical ventilation could Rouhani Hospital of Babol for their contribution to this
well tolerate the lateral position [17]. study and we hereby acknowledge the clinical research
Other study was conducted on 52 infants to development unit of the Rouhani Hospital and the
compare their oxygenation in different positions and it parents of infants participated in the study.
was found that there was no difference between prone,
supine and left lateral positions in terms of oxygenation Funding: This study was supported by a research grant
and hypoxia attacks [18]. and Master of Science Nursing NICU (Neonatal
Guana et al. in 2012 carried out a study on 19 Intensive Care Unit) thesis of Samaneh Mirshahi from
newborns with mean gestational age of 27 weeks and the Non-Communicable Pediatric Diseases Research
mean age of 17 day. They investigated the effect of Center of Babol University of Medical Sciences (Grant
different positions on premature infants with mild Number: 9339012).
respiratory failure receiving NCPAP and their Conflict of interest: The authors declare that they have
breathing pattern was evaluated by plethysmography. It no conflict of interests.
was seen that the arterial oxygen was higher in both
prone and left lateral positions than supine position.
Because left lateral position had no effect on the References:
arterial oxygen saturation in this study, which may be 1. Ghorbani F, Valizadeh S, Asadollahi M. Comparison
due to the difference in respiratory disease among of Prone and Supine Positions on Oxygenation of
infants in these two studies [19]. Premature Infants with Respiratory Distress Syndrome
In one study, 88 healthy preterm infants who were Treated with Nasal CPAP in Tabriz Alzahra Hospital,
fed by mouth and ready for discharge were placed in 2010, Tabriz, Iran. Qom Univ Med Sci J. 2012; 6(4):
the prone position for 30 minutes and then in the 57-63. [Text in Persian]
supine position for 30 minutes. Unlike the current 2. Eghbalian F, Moeinipour A. Effect of neonatal position
study, they suggested that the arterial oxygenation was on oxygen saturation in Hospitalized premature infants
the same in the prone and supine positions and this with respiratory distress syndrome. Annali Military
difference may be owing to the short duration of the Health Sci Res 2008; 6(1): 9-13. [Text in Persian]
intervention (30 min) [20]. 3. Farhat A, Mohammadzadeh A, Alizadeh E, Amiri M.
In the study of Elder et al., the arterial oxygen Effect of care positions on oxygen saturation in healthy
saturation of 7 infants with chronic lung disease (CLD) low birth weight infants. Med J Mashhad Uni Med Sci
and mean gestational age of 27 weeks and of 8 infants 2005; 48(87): 85-8. [Text in Persian]
without CLD was evaluated and no significant 4. Douglas WW, Rehder K, Beynen FM, et al. Improved
difference was found [21]. The difference between the oxygenation in patients with acute respiratory failure:
results of Elder and those of us can be due to the need the prone position. Am Rev Respir Dis 1977; 115(4):
of oxygen because the infants participating in Elder’s 559-66.
study were different in terms of oxygen need, while in 5. Balaguer A, Escribano J, Roque i Figuls M, Rivas-
the present study, all infants had the same conditions Fernandez M. Infant position in neonates receiving
and did not have any need for oxygen. mechanical ventilation. Cochrane Database of
The result of the current study showed that the Systematic Reviews 2013; (3): Art. No.: CD003668.
arterial oxygen saturation in VLBW infants was DOI: 10.1002/14651858.CD003668.pub3:3.
increased in the prone position than the supine and left 6. Dimitriou G, Greenough A, Pink L, et al. Effect of
lateral positions while the heart rate was not posture on oxygenation and respiratory muscle strength
significantly different in all these three positions. in convalescent infants. Arch Dis Childhood-Fetal
Neonatal Edition 2002; 86(3): F147-F50.
7. Bhat RY, Leipala JA, Singh NR-P, et al. Effect of carbon dioxide. American J Dis Child 1988; 142(2):
[ DOI: 10.22088/acadpub.BUMS.2.2.153 ]
posture on oxygenation, lung volume, and respiratory 200-2.

mechanics in premature infants studied before 15. Rezaeian M, Sheikh Fathollahi F, Abdolkarimi M, et al.
discharge. Pediatr 2003; 112(1): 29-32. Comparison of Supine and Prone Positions on Oxygen
8. Mirian M. Sudden Infant Death syndrome. J hayat Saturation in Preterm Neonates after Weaning from
2002; 8(2): 43-52. Mechanical Ventilation in NICU of Afzalipour
9. Ewer A, James M, Tobin J. Prone and left lateral Hospital of Kerman in 2014. J Rafsanjan Uni Med Sci
positioning reduce gastro-oesophageal reflux in 2015; 13(9): 885-96. [Text in Persian]
preterm infants. Arch Disease in Childhood-Fetal and 16. Yao WX, Xue XD, Fu JH. Effect of position on
Neonatal Edition. 1999; 81(3): F201-F5. oxygenation in neonates after weaning from
10. Emami S, Amiri M. The effect of prone position on the mechanical ventilation. Chin J Contemporary Pediatr
arterial blood oxygenation in patients with respiratory 2008; 10(2): 121-4.
failure. Iran J Anaesthesiology Critical Care 2006; 17. Abdeyazdan Z, Nematollahi M, Ghazavi Z,
28(55): 19-25. Mohamadizadeh M. Investigation of oxygenation in
11. Bredemeyer SL, Foster JP. Body positioning for premature infants under mechanical ventilation in
spontaneously breathing preterm infants with apnoea. supine position compare to side lying. Holistic Nurs
Cochrane Database System Rev 2012; (6). Art. No.: Midwifer J 2015; 25(1): 18-25.
CD004951. DOI: 10.1002/14651858.CD004951.pub2. 18. Gillies D, Wells D. Positioning for acute respiratory
12. Saadati A, Foroutan R. Comparison of prone and distress in hospitalized infants and children. Cochrane
supine positions on the blood oxygen saturation in low Database of Systematic Reviews 2005, (2). Art. No.:
birth weight newborns under mechanical ventilation. J CD003645. DOI: 10.1002/14651858.CD003645.pub2.
Sabzevar Uni Med Sci 2011; 18(1): 21-5. [Text in 19. Gouna G, Rakza T, Kuissi E, et al. Positioning effects
Persian] on lung function and breathing pattern in premature
13. Van Wijk MP, Benninga MA, Dent J, et al. Effect of newborns. J Pediatr 2013; 162(6): 1133-7. e1.
body position changes on postprandial 20. Torabi Z, Ghaheri V, Aflaki BF. The Effect of Body
gastroesophageal reflux and gastric emptying in the Position on the Arterial Oxygen Saturation of Healthy
healthy premature neonate. J pediatr 2007; 151(6): 585- Premature Neonates: A Clinical Trial. J Mazand Univ
90. e2. Med Sci 2012; 22(86): 234-42.
14. Bozynski MEA, Naglie RA, Nicks JJ, et al. Lateral 21. Elder DE, Campbell AJ, Doherty DA. Prone or supine
positioning of the stable ventilated very-low-birth- for infants with chronic lung disease at neonatal
weight infant: Effect on transcutaneous oxygen and discharge? J Paediatr child health 2005; 41(4): 180-5.
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/321033426
The Effect of Nesting Positions On Pain, Stress And Comfort During Heel
Lance In Premature İnfants
Article in Pediatrics & Neonatology · November 2017

DOI: 10.1016/j.pedneo.2017.11.010
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Original Article
The effect of nesting positions on pain,

stress and comfort during heel lance in
premature infants
Ays‚e Kahraman a,*, Zümrüt Bas‚bakkal a, Mehmet Yalaz b,
Eser Y. Sözmen c
a
Ege University Faculty of Nursing, Bornova, I_zmir, Turkey
b
Ege University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bornova,
_Izmir, Turkey
c
Ege University Faculty of Medicine, Department of Medical Biochemistry, Bornova, I_zmir, Turkey
Received Oct 6, 2016; received in revised form Aug 21, 2017; accepted Nov 10, 2017
Available online 13 November 2017
Key Words Abstract Background: Nesting positions are commonly used in procedural analgesic adminis-
nesting positions; tration in premature neonates. The effectiveness of nesting positions is questioned. The aim of
pain; the this study was to assess the pain, stress, comfort and salivary cortisol and melatonin values
comfort; in nesting positions during the heel lance procedure in premature infants at the NICU.
stress; Methods: Experimental research; repeated measurement design. The sample comprised 33
cortisol level premature neonates with gestational age of 31e35 weeks who had been hospitalized in the
NICU. Nesting positions were given using linen or towels. The procedure of heel lance was re-
corded on camera. The camera recordings were evaluated according to the NIPS and the COM-
FORTneo scale. Saliva samples were obtained five minutes prior to and 30 min after the heel
lance procedure. Salivary Cortisol and Melatonin were measured using the Salimetrics Cortisol
Elisa Kit and the Salimetrics Melatonin Elisa Kit.
Results: The crying time, the mean NIPS score, the COMFORTneo score, the COMFORTneo NRS-
pain scores and the COMFORTneo NRS-distress scores for premature neonates who were in the
prone position during the procedure were significantly lower than the scores in the supine po-
sition (p < 0.000). Furthermore, the level of salivary cortisol five minutes prior to and 30 min
after the heel lance procedure had significantly decreased in the prone position; however,
there were insignificant differences in the mean levels of salivary melatonin between the po-
sitions.
* Corresponding author. Ege University Faculty of Nursing, 35100, Bornova, I_zmir, Turkey. Fax: þ90 232 388 63 74.
E-mail addresses: ayse.ersun@gmail.com, ayse.kahraman@ege.edu.tr (A. Kahraman), zumrut.basbakkal@gmail.com (Z. Bas‚bakkal),
mehmetyalaz35@gmail.com (M. Yalaz), eser.sozmen@ege.edu.tr (E.Y. Sözmen).
https://doi.org/10.1016/j.pedneo.2017.11.010
1875-9572/Copyright ª 2017, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-
NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Nesting positions and pain 353
Conclusions: Nesting in the prone position has a pain reducing effect, enhancing comfort and
reducing stress in premature infants.
Copyright ª 2017, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. This is an
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/
by-nc-nd/4.0/).
1. Introduction ages of 31e35 weeks who had been hospitalized at the

NICU. The data for the research were collected between
The survival rates of premature babies have increased with September 2013 and October 2014. All premature infants
technological developments and the duration of stay at the had been born through cesarean section and had oral
Neonatal Intensive Care Unit (NICU) has increased.1 During feeding. Infants who had received sedatives, muscle re-
their stay at the NICU, premature infants are repeatedly laxants, corticosteroids or analgesics, those who had major
exposed to painful procedures as a result of routine care.2 congenital malformations, those with apgar scores of lower
In the long term, painful and stressful procedures may lead than 6 at the first minute and lower than 8 at the fifth
to physiological, psychological and behavioral sequelae in minute after birth, those with severe respiratory distress
premature infants.3 Within the scope of developmental requiring mechanical ventilation or NCAP, and those with
supportive care attempts, some of the applications pre- neurological, gastro-intestinal, cardiac and metabolic dis-
formed during painful and stressful procedures include eases were excluded from the study. The inclusion and the
positioning and swaddling,4e6 massage,7 kangaroo care,8,9 exclusion from participation in the study are presented in
oral glucose and sucrose solutions,10,11 non-nutritive suck- Fig. 1.
ing,12,13 breastfeeding10,14 and topical anesthetics.15 To determine the sample size, a pilot study with 10
Positioning lies within the scope of developmental sup- premature infants was performed and the sample size was
portive care attempts, and it is one of the most important calculated using the power analysis by G*power. Consid-
interventions used during painful and stressful proced- ering a confidence level of 95% and a power of 80%, we
ures.4,6 There are some studies on developmental sup- estimated that 33 infants were required to determine the
portive positions in preterm infants. These studies have effect of positions on pain, stress and comfort response
emphasized that developmental supportive positions help during the heel lance procedure in premature infants. We
avoid energy expenditure caused by unnecessary move- included 48 infants in the study, taking into account the loss
ments of the infant16e19 and reduce unnecessary and excess of sample. Fifteen infants were excluded from the study
sedation, and help wean from analgesia.20 (Fig. 1). Thirty-three premature infants submitted for heel
Positions that are given to premature infants should be lance were evaluated.
comfortable, safe, should enhance physiological stability, Supine and prone positions by nesting were given to the
and help keep all extremities at the midline, while main- infants in the study. A nest maintains the preterm infant
taining the flexion posture and support optimal neuromotor with limits (similar to that in the womb); thus the preterm
development.3,20e23 To support infants keeping their hands infant has a surface to touch. Nesting maintains the flexion
together, to facilitate sleep and to support development of posture, while maintaining intrauterine position and pos-
sensory systems, infants can be positioned by nesting.16,20 tures. The nesting positions were given using sheets or
Nesting positions maintain the flexion posture while main- towels on the infants. The study was applied to the heel
taining intrauterine position and postures.5,16,20 As a basic lance procedure that is performed routinely in order to
responsibility of the nurse and as one of the most important determine bilirubin and hematocrit levels. After having
nursing strategies, positioning by nesting uses a non- waited for 30 min for gastric emptying and stabilization
pharmacological approach in order to reduce pain and following feeding, the supine positioning was applied on the
stress and improve comfort. No study has examined the 3rd postnatal day and prone positioning was applied on the
effect of the nesting positions on pain, stress and comfort, 4th postnatal day. Having monitored the infant in the given
salivary cortisol and melatonin values. This study aims to position for 30 min, the heel lance procedure was per-
examine the effects of nesting supine and prone positions formed. Salivary samples were obtained 5 min before and
on the infant’s pain, stress and comfort during the heel 30 min after the procedure. Four salivary samples were
lance procedure in premature infants hospitalized in the obtained from each infant. The heel lance procedure was
NICU. recorded on camera. Camera recording was begun prior to
the procedure and continued until the infant’s crying was
over. After the end of the data collection process, the re-
2. Methods cordings were evaluated by two scientists (observers), in-
dependent from each other; the observers were
This experimental study is a repeated measurement design experienced in premature infants, newborn nursing and
research. The reason for carrying out the study in thesame pain assessment. The observers assessed the pain, distress,
group is that pain is experimental (depending on experi- and the comfort levels of the infants according to the
ence) and every infant’s response to pain is specific. The Neonatal Infant Pain Scale (NIPS) and the COMFORTneo
sample comprised 48 premature infants with gestational scale. To evaluate the inter-observer agreement, intra-
354 A. Kahraman et al
Figure 1 Selection of the study participants.
class correlation coefficients for the NIPS total score, the of 0 and 1. Crying has three descriptors for a possible
COMFORTneo scale total score, the COMFORTneo NRS-pain maximum score of 2. The total score is 0e7. A score of 0e2
scores and the COMFORTneo NRS-distress scores were means no pain/mild pain, a score of 3e4 means mild pain/
determined between the positions. Oxygen saturation and moderate pain and scores of >4 indicate severe pain. The
the heart rate were monitored using the Nellcor Pulse Ox- Cronbach’s alpha coefficient was 0.95 before the proced-
imetry device and recorded on the camera. Oxygen satu- ure, 0.87 during the procedure and 0.88 after the
ration, heart rate and crying time were determined from procedure.24
video recordings.
2.2. COMFORTneo scale
2.1. NIPS
The COMFORTneo scale consists of 7 items including alert-
The NIPS is composed of five behavioral and physiological ness, calmness/agitation, respiratory response and crying,
parameters intended to assess infant pain. Behavioral pa- body movement, facial tension and muscle tone. The
rameters include facial expression, crying, arm move- lowest score in the scale is 6 and the highest is 30. High
ments, leg movements, state of arousal and physiological scores indicate that the infant is uncomfortable. Further-
parameters including breathing patterns. Each behavior more, the COMFORTneo scale has a Numerical Rating Scale
(except crying) has descriptors for the two possible scores for pain and distress. NRS pain and NRS distress are scored
after the COMFORTneo score by the caregiving nurse rep- used in order to verify that the data were normally
resenting expert opinion. The rating is on a scale of 0e10, distributed, the Paired t test was used for parameters with
with 0 representing no pain or distress, and 10 representing normal distribution, and the Wilcoxon test was used for the
the worst imaginable pain or distress. A score of 4e6 in- parameters with abnormal distribution. For analysis of NIPS
dicates moderate pain and distress, and a score of 7e10 and COMFORTneo scale items according to positions, the
indicates severe pain and distress.25 The reliability and the McNemar Test was used for the scale items with two eval-
validity of the Turkish version of the COMFORTneo scale uation criteria, and the McNemareBowker Test was used
were investigated. The Cronbach Alpha coefficient was for the scale items with more than two evaluation criteria.
determined as 0.85 for the primary observer and 0.82 for The KruskaleWallis Test was used to determine the corre-
the assistant observer before care, and as 0.92 and 0.85, lation between gestational age and crying time. The Man-
respectively, after care.26 neWhitney U Test was used to determine the correlation
between gender and crying time. The Intraclass Correlation
2.3. Saliva sampling and analysis Coefficient (ICC) was used to evaluate the consistency be-
tween the two observers.
Heel lancing was performed in the morning at the NICU
where the study took place. The study data were gathered
during the heel lancing in the morning, since it would not be
3. Results
ethical for the baby to take an extra heel lance procedure
for the study. Furthermore, the transition from low light to All 33 participants were premature infants, with an average
bright light in the morning results in a increase in cortisol gestational age of 33.03 T1.31 weeks (min: 31 weeks, max:
levels.27,28 After a review of the literature, it was deter- 35 weeks). The mean birth weight of the infants was
mined that the morning hours were preferred for intake of 1757 g T316 (min: 1230 g, max: 2450 g). 57.6% of the ne-
salivary cortisol sample.18,29,30 For these reasons, the saliva onates were female. The mean fifth minute Apgar score
sample collection was done between 9:00 and 11:00 in the was 8.96 T 0.58 (min: 8, max: 10) (Table 1).
morning. Saliva was obtained using Salimetrics Infant’s The infants’ mean oxygen saturation (SatO2) was
Swab (SIS). The SIS was introduced under the tongue and 94.30 T 5.63 in the prone position during the heel lance,
moved around in the mouth and lip area. The sample and 86.63 T 7.05 in the supine position during the heel
collection time ranged from 60 to 90 s per sample. The SIS lance. The mean SatO2 significantly increased during prone
was then placed into an empty Salimetrics Swab Storage positioning (p Z 0.000) (Table 2). Furthermore, the mean
Tube. The saliva samples were centrifuged at SatO2 significantly increased during the prone positioning
five minutes prior to the heel lance, 30 min prior to the heel
3000e3500 rpm for 15 min and stored at —80 ○C for longer
than 3 months. After the end of the data collection process, lance and 30 min after the heel lance (p < 0.05). The mean
cortisol was measured using the Salimetrics Salivary heart rate (HR) was 146.09 T 15.82 during the prone posi-
Cortisol Elisa Kit (Kit numbers: 1e3002) and melatonin was tioning and 145.48 T 11.69 during supine positioning, with
measured using the Salimetrics Melatonin Elisa Kit (Kit
numbers: 1e3402). Twenty-five mL and 100 mL of saliva,
respectively, were required for the analyses of cortisol and Table 1 Preterm infants characteristics and health status
melatonin. The salivas were collected from 33 infants. (n Z 33).
However, 32 (96.96%) samples were used for cortisol anal-
Premature infant characteristics
ysis. One sample was not used due to the inadequate
amount of saliva. Ten (30.30%) samples were used for Sex (female/male; %) 57.6/42.4%
melatonin analysis. Twenty-three samples were not used Gestational age (weeks), 33.03 T 1.31
due to inadequate amount of saliva. mean (min: 31.0, max: 35.0)
Birth weight (grams), mean 1757 g T 316 g
(min: 1230, max: 2450 g)
2.4. Ethical approval
Birth length (cm), mean 42.5 cm T 2.58 cm
(min: 38, max: 47 cm)
The study was approved by the Clinical Research Ethics One minute 7.69 T 0.88 (min: 6, max: 9)
Committee of Faculty of Medicine (No. 13e6.1/5), Scien- Apgar score, mean
tific Ethics Committee of Faculty of Nursing (No. 2013/30), Five minutes Apgar 8.96 T 0.58 (min: 8, max: 10)
and informed consent was obtained from all parents prior score, mean
to participation. Health status of premature infant (%)
Prematurity only 27.3
2.5. Data analysis PROM 21.2
Multiple pregnancy 21.2
The Statistical Package for the Social Sciences (SPSS version TTN 9.1
16.0) was used for the data analysis and a p value of <0.05 IUGR 15.2
was considered statistically significant. The G*Power pro- Hyperbilirubinemia 6.1
gram was used for the Power analysis. The prevalence TTN: Transient tachypnea of the newborn.
criteria (average, distribution of numbers and percentages, IUGR: Intrauterine growth retardation.
standard deviation, standard error) were used for evalua- PROM: Premature Rupture of Membranes.
tion of the descriptive data. The ShapiroeWilk test was
Table 2 Behavioral and physiological responses of the premature infants during heel lance.
Premature infant responses (n Z 33) Supine Prone z Value/t Value p Value
SpO2 (mean) 86.63 T 7.05 94.30 T 5.63 —3.901
a
0.000
Heart rate (mean) 145.48 T 11.69 146.09 T 15.82 1.417b 0.166
a
Crying time (sec) 49.66 T 36.43 22.24 T 25.52 —2.949 0.003
(Median: 55) (Median: 10)
NIPS (mean)
First Observer 5.12 T 2.50 2.63 T 2.65 3.489a 0.000
Second Observer 4.69 T 1.96 2.39 T 2.35 4.013a 0.000
COMFORTneo score (mean)
COMFORTneo NRS-distress scores (mean)
COMFORTneo NRS-pain scores (mean)
*Salivary Cortisol Value
(mg/dl) 5 min prior to heel 1.19 T 1.33 0.62 T 0.72 —2.744
a
0.006
a
1.08 T 1.19 0.49 T 0.67 —3.459 0.001
lance
30 min after heel lance a
42.75 T 41.02 46.13 T 26.81 —0.459a 0.646
**Salivary Melatonin Value (pg/mL)
44.29 T 53.46 54.40 T 32.79 —0.764 0.445
5 min prior to heel lance
*30The
minsaliva
aftersamples were adequate in 32 neonates for cortisol levels.
heel lance
**The saliva samples were adequate in 10 neonates for melatonin levels.
a
t Value (Paired Samples Test).
b
z Value (Wilcoxon Test).
no significant difference between the positions (p Z 0.166) pain scores and the COMFORTneo NRS-distress scores was
(Table 2). found to be significant, and the agreement level was
Premature infants in the supine position cried for a determined to be moderate and good (p Z 0.000) (Table 3).
longer time during the heel lance than those in the prone
position (p Z 0.003). The crying time did not significantly
differ in terms of weight, gender and gestational age 4. Discussion
(p > 0.05) (Table 2).
Comparison of the NIPS scores showed a significantly The effects of painful stimuli on premature infants are
lower score in the prone position compared to the supine known. We obtained results in this study to contribute to
position (p Z 0.000) (Table 2). the literature examining the effects of nesting positions on
The COMFORTneo scores showed a significantly lower premature infant’s pain, comfort and stress. In the present
score in the prone position compared to supine position study, 33 premature infants submitted for heel lance were
(p Z 0.000). The COMFORTneo NRS-pain scores showed a evaluated. Heel lance was chosen as the painful stimulus
significantly lower score in the prone position compared to for premature infants at the NICU. The nesting prone po-
the supine position (p Z 0.000). The COMFORTneo NRS- sition increased the variation in partial oxygen saturation,
distress scores showed a significantly lower score in the but no significant difference in heart rate was observed.
prone position compared to the supine position (p Z 0.000) Other investigators who evaluated the physiological re-
(Table 2). sponses of premature infants to positions found that the
The median salivary cortisol level during the prone prone position increased the oxygen saturation.31e33 Simi-
positioning five minutes prior to the heel lance was signif- larly, Grunau et al. (2004) found no significant difference in
icantly lower compared to the supine positioning the heart rate parameter between the prone and the su-
(p Z 0.006). Thirty minutes after the heel lance, the me- pine positions.4 Oxygen consumption increases and oxygen
dian salivary cortisol level during the prone positioning was saturation decreases in stressful and painful procedures.
significantly lower compared to the supine position Furthermore, an increase or decrease in heart rate may be
(p Z 0.001) (Table 2) (Fig. 2). expected. While prone position increased the respiratory
Five minutes prior to and 30 min after the heel lance, function and oxygenation, it did not affect the heart rate in
the median salivary melatonin level during the prone this study.
positioning showed no significant difference compared to In this study, nesting prone position resulted in a better
the supine positioning (p Z 0.445) (Table 2). analgesic effect than nesting supine position, as assessed
The inter-observer agreement regarding the NIPS total by Neonatal Infant Pain Scores. In contrast, in a study using
score, the COMFORTneo total score, the COMFORTneo NRS- FLACC, no significant difference was observed between the
Figure 2 Salivary cortisol values (mg/dl) prior to and after the heel lance.
COMFORTneo NRS-pain scores and the COMFORTneo NRS-

Table 3 Intraclass compliance (variability). distress scores were determined to be over 4.25 In contrast,
Positions Variables ICC p another study determined a Comfort-neo score of between
Supine NIPS 0.734 0.000 9 and 14 in 86% of all painful procedures.34 The results of
COMFORTneo score 0.566 0.000 this study demonstrated that the infants were comfortable
COMFORTneo NRS-pain scores 0.687 0.000 in the majority of pain procedures, because several at-
COMFORTneo NRS-distress scores 0.602 0.000 tempts were being implemented to reduce pain and
Prone NIPS 0.608 0.000 improve comfort.
COMFORTneo score 0.736 0.000 Neonatal pain and stress were conducted using saliva
COMFORTneo NRS-pain scores 0.656 0.000 collection for measurement of the cortisol concentra-
COMFORTneo NRS-distress scores 0.656 0.000 tion.18,30,35,36 Cortisol, which is one of the manifestations of
physiological and hormonal changes caused by stress, is
ICC: Intraclass Correlation Coefficient. commonly measured in newborn infants, to demonstrate
stress.18,37 Saliva samples are suitable for assessment of
salivary cortisol in the newborn and premature infants.30,38
prone and supine positions in premature neonates submit- Salivary cortisol and melatonin could be used as a reliable,
ted for heel lance.4 In another study, the prone position non-invasive, non-stress, pain-free alternative to serum
was compared with kangaroo care and oral sucrose. Kan- cortisol.18,30,39e41
garoo care resulted in a better analgesic effect than the The level of salivary cortisol pre and post the heel lance
prone position and oral sucrose.8 Morrow et al. (2010) significantly decreased in the prone position. Candia et al.
determined that newborns, whom heel lance was per- (2014) determined the effect of positions on salivary
formed while in the nurse’s arms, had significantly lower cortisol values without any procedure. They explained that
NIPS scores compared to newborns in supine position.6 the level of salivary cortisol significantly decreased in the
The COMFORTneo scores, the COMFORTneo NRS-pain prone position compared to the lateral position and the
scores and the COMFORTneo NRS-distress scores showed supine position.18 The results were similar to those our
significantly lower scores in the prone position compared to study.
the supine position by both observers during the procedure. The best indicator of circadian rhythm and activity of
The COMFORTneo scores determined scores of over 19, the sleep in neonates is the level of melatonin. Obtaining saliva
COMFORTneo NRS-pain scores determined scores of over 6 samples for measurement of melatonin value is non-
and the COMFORTneo NRS-distress scores determined stressful for premature neonates.40 In this study, insignifi-
scores between 4 and 6, and these scores showed that cant mean differences were observed in the level of sali-
premature infants were uncomfortable in the supine posi- vary melatonin between positions. We think that the saliva
tion. Few studies evaluated the comfort of premature in- samples were adequate in 10 neonates from whom saliva
fants in painful procedures. Van dijk et al. (2009) studied samples were obtained for melatonin levels. Therefore,
286 premature neonates submitted for acute procedural there was no significance. We recommend obtaining more
pain. The Comfort-neo scores determined prior to the saliva for melatonin analysis.
procedure showed a mean of 19.8 T 3.8 and after the In our study, prone positioning by nesting during the heel
procedure, they showed a mean of 12.0 T 3.4. The lance procedure in premature infants decreased the crying
time significantly when compared to supine positioning. family-centered developmental care. Newborn Infant Nurs Rev
Studies related to developmental care applications during 2013;13:9e22.
the heel lance procedure in premature infants have yielded 2. Johnston CC, Fernandes AM, Campbell-Yeo M. Pain in neonates
similar results, which show that developmental care ap- is different. Pain 2011;152:S65e73.
3. Coughlin M. Age-appropriate care of the prematures and
plications reduce the crying times of infants during invasive
critically ill hospitalized infant: NANN guideline for practice.
procedures. Bueno et al. (2012) compared the efficacy of Glenview, IL: National Association of Neonatal Nurses; 2011.
expressed breast milk versus 25% glucose on pain responses 4. Grunau RE, Linhares M, Holsti L, Oberlander TF, Whitfield MF.
during the heel lance. The result of the study demonstrated Does prone or supine position influence pain responses in
that a shorter duration of crying was observed in those with preterm infants at 32 weeks gestational age? Clin J Pain 2004;
25% glucose, in comparison to breast milk.10 Kostandy et al. 20:76e82.
(2008) demonstrated decreases in the duration of crying in 5. Huang CM, Tung WS, Kuo LL, Ying-Ju C. Comparison of pain
kangaroo care during the heel lance.9 Another study found responses of premature infants to the heelstick between
that the duration of the first cry was significantly shorter in containment and swaddling. J Nurs Res 2004;12:31e40.
the glucose group compared to the water group and the 6. Morrow C, Hidinger A, Wilkinson-Faulk D. Reducing neonatal
pain during routine heel lance procedures. MCN Am J Matern
expressed breast milk group.42 Prolonged crying increases
Child Nurs 2010;35:346e54.
the heart rate and oxygen consumption. For this reason, 7. Jain S, Kumar P, McMillan DD. Prior leg massage decreases pain
crying should be reduced by prone positions or other responses to heel stick in premature babies. J Paediatr Child
developmental supportive care attempts. Health 2006;42:505e8.
8. Freire NB, Garcia JB, Lamy ZC. Evaluation of analgesic effect
of skin-to-skin contact compared to oral glucose in preterm
5. Limitations neonates. Pain 2008;139:28e33.
9. Kostandy RR, Ludington-Hoe SM, Cong X, Abouelfettoh A,
Due to the time of use after opening the kit being short, Bronson C, Stankus A, et al. Kangaroo Care (skin contact) re-
saliva samples were frozen and analyzed at the end of the duces crying response to pain in preterm neonates: pilot re-
data collection process. Researchers could not be sure how sults. Pain Manag Nurs 2008;9:55e65.
much saliva was obtained during the study. One neonate’s 10. Bueno M, Stevens B, de Camargo PP, Toma E, Krebs VL,
saliva samples were insufficient for salivary cortisol anal- Kimura AF. Breast milk and glucose for pain relief in preterm
ysis. Twenty-three neonates’ saliva samples were insuffi- infants: a noninferiority randomized controlled trial. Pediat-
cient for salivary melatonin analysis. We recommend rics 2012;129:664e70.
11. Beken S, Hirfanoğlu IM, Gücüyener K, Ergenekon E, Turan O,
obtaining more saliva for measuring cortisol and melatonin
Unal S, et al. Cerebral hemodynamic changes and pain
levels in premature infants. perception during venipuncture: is glucose really effective? J
Child Neurol 2014;29:617e22.
6. Conclusion 12. Liaw JJ, Yang L, Ti Y, Blackburn ST, Chang YC, Sun LW. Non-
nutritive sucking relieves pain for preterm infants during heel
stick procedures in Taiwan. J Clin Nurs 2010;19:2741e51.
This study determined that nesting prone position reduced 13. Losacco V, Cuttini M, Greisen G, Haumont D, Pallás-Alonso CR,
pain, stress, crying time and salivary cortisol level in pre- Pierrat V, et al. Heel blood sampling in European neonatal
mature infants at 31e35 weeks’ gestation age. This study intensive care units: compliance with pain management
emphasized that the nesting prone position had pain- guidelines. Arch Dis Child Fetal Neonatal Ed 2011;96:F65e8.
reducing, comforting and stress-relieving effects in pre- 14. Marı́n Gabriel MÁ, del Rey Hurtado de Mendoza B, Jiménez
mature infants at the NICU during heel lance procedures. It Figueroa L, Medina V, Iglesias Fernández B, Vázquez
is recommended that studies be carried out in smaller Rodrı́guez M, et al. Analgesia with breastfeeding in addition to
skin-to-skin contact during heel prick. Arch Dis Child Fetal
premature infants using different invasive procedures in
Neonatal Ed 2013;98:F499e503.
future studies.
15. Biran V, Gourrier E, Cimerman P, Walter-Nicolet E,
Mitanchez D, Carbajal R. Analgesic effects of EMLA cream and
Conflict of interest oral sucrose during venipuncture in preterm infants. Pediatrics
2011;128:e63e70.
16. Vergara ER, Bigsby R. Elements of neonatal positioning:
Authors have reported no relevant financial and personal
developmental and therapeutic interventions in the NICU.
relationships with other individuals or organizations that Baltimore: Brookes: Paul H. Publishing co; 2004. p. 177e203.
could inappropriately affect their work. 17. Chang YJ, Anderson GC, Dowling D, Lin CH. Decreased activity
and oxygen desaturation in prone ventilated premature infants
during the first postnatal week. Heart Lung 2002;31:34e42.
Acknowledgements 18. Cândia MF, Osaku EF, Leite MA, Toccolini B, Costa NL, Teixeira SN,
et al. Influence of prone positioning on premature newborn infant
We acknowledge the financial support of the Ege University stress assessed by means of salivary cortisol measurement: pilot
Scientific Research Projects Directorate (Project Grant study. Rev Bras Ter Intensiva2014;26:169e75.
Number: 2013/HYO/005). 19. Carrier CT. Developmental support. In: Verklan MT, Walden M,
editors. Core curriculum for neonatal intensive care nursing.
4th ed. Philadelphia: Saunders Elsevier; 2010. p. 213.
References 20. Hunter J. Therapeutic positioning: neuromotor, physiologic
and sleep implications. In: Kenner C, McGrath JM, editors.
1. Altimier L, Phillips RM. The neonatal integrative develop- Developmental care of newborns and infants: a guide for
mental care model: seven neuroprotective core measures for health professionals; 2010. p.285e312. Glenview: NANN.
21. Hunter J. Positioning. In: Kenner C, McGrath JM, editors. Devel- positioning on cardiorespiratory parameters and thermoregu-
opmental care of the newborns and infants: a guide for health lation in premature infants. Neonatology 2010;97:311e7.
care professionals. St. Louis, MO: Mosby; 2004. 33. Gouna G, Rakza T, Kuissi E, Pennaforte T, Mur S, Storme L.
22. Coughlin M, Lohman M, Gıbbıns S. Reliability and effectiveness Positioning effects on lung function and breathing pattern in
of an infant positioning assessment tool to standardize devel- premature newborns. J Pediatr 2013;162:1133e7.
opmentally supportive positioning practices in the neonatal 34. Aukes DI, Roofthooft DWE, Simons SHP, Tibboe D, van Dijk M.
ıntensive care unit. Newborn Infant Nurs Rev 2010;10:104e6. Pain management in neonatal intensive care: evaluation of the
23. Coughlin M. Transformative nursing in the NICU: trauma-informed compliance with guidelines. Clin J Pain 2015;31:830e5.
age appropriate care. New York: Springer; 2014. p. 93e102. 35. Antonini SR, Jorge SM, Moreira AC. The emergence of salivary
24. Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, cortisol circadian rhythm and its relationship to sleep activity
Dulberg C. The development of a tool to assess neonatal pain. in preterm infants. Clin Endocrinol (Oxf) 2000;52:423e6.
Neonatal Netw 1993;12:59e66. 36. Takahashi Y, Tamakoshi K, Matsushima M, Kawabe T. Compar-
25. Van Dijk M, Roofthooft DW, Anand KJ, Guldemond F, de ison of salivary cortisol, heart rate, and oxygen saturation
Graaf J, Simons S, et al. Taking up the challenge of measuring between early skin-to-skin contact with different initiation and
prolonged pain in (premature) neonates: the COMFORTneo duration times in healthy, full-term infants. Early Hum Dev
scale seems promising. Clin J Pain 2009;25:607e16. 2011;87:151e7.
26. Kahraman A, Bas‚bakkal Z, Yalaz M. Turkish validity and reli- 37. Franck LS, Miaskowski C. Measurement of neonatal responses
ability of comfortneo scale. Int Refereed J Nurs Res 2014;1: to painful stimuli: a research review. J Pain Symptom Manage
1e11. 1997;14:343e78.
27. Premkumar M, Sable T, Dhanwal D, Dewan R. Circadian levels 38. Herrington CJ, Olomu IN, Geller SM. Salivary cortisol as in-
of serum melatonin and cortisol in relation to changes in mood, dicators of pain in preterm infants: a pilot study. Clin Nurs Res
sleep, and neurocognitive performance, spanning a year of 2004;13:53e68.
residence in Antarctica. Neurosci J 2013;2013:254090. 39. Bagci S, Mueller A, Reinsberg J, Heep A, Bartmann P,
28. Leproult R, Colecchia EF, L’Hermite-Balériaux M, Van Cauter E. Franz AR. Saliva as a valid alternative in monitoring melatonin
Transition from dim to bright light in the morning induces an concentrations in newborn infants. Early Hum Dev 2009;85:
immediate elevation of cortisol levels. J Clin Endocrinol Metab 595e8.
2001;86:151e7. 40. Bagci S, Mueller A, Reinsberg J, Heep A, Bartmann P, Franz AR.
29. Neu M, Hazel NA, Robinson J, Schmiege SJ, Laudenslager M. Utility of salivary melatonin measurements in the assessment
Effect of holding on co-regulation in preterm infants: a ran- of the pineal physiology in newborn infants. Clin Biochem
domized controlled trial. Early Hum Dev 2014;90:141e7. 2010;43:868e72.
30. Cabral DM, Antonini SR, Custódio RJ, Martinelli Jr CE, da 41. Maas C, Ringwald C, Weber K, Engel C, Poets CF, Binder G,
Silva CA. Measurement of salivary cortisol as a marker of stress et al. Relationship of salivary and plasma cortisol levels in
in newborns in a neonatal intensive care unit. Horm Res Pae- preterm infants: results of a prospective observational study
diatr 2013;79:373e8. and systematic review of the literature. Neonatology 2014;
31. Goto K, Maeda T, Mirmiran M, Ariagno R. Effects of prone and 105:312e8.
supine position on sleep characteristics in preterm infants. 42. Ou-Yang MC, Chen IL, Chen CC, Chung MY, Chen FS, Huang HC.
Psychiatry Clin Neurosci 1999;53:315e7. Expressed breast milk for procedural pain in preterm neonates:
32. Heimann K, Vaessen P, Peschgens T, Stanzel S, Wenzl TG, a randomized, double-blind, placebo-controlled trial. Acta
Orlikowsky T. Impact of skin to skin care, prone and supine Paediatr 2013;102:15e21.
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Effectiveness Of Use Of Nesting On Body Weight, Oxygen Saturation

Stability And Breath Frequency In Prematures In Nicu Room

Gambiran Hospital Kediri City

PROGRAM STUDI S-1 KEPERAWATAN NON REGULER

SEKOLAH TINGGI ILMU KESEHATAN PERTAMEDIKA

Sekian penulis sampaikan terimakasih kepada semua pihak yng

Jakarta, Oktober 2020

Penelitian ini bertujuan untuk mengetahui Efektivitas Penggunaan Nesting

Dengan demikian, persalinan premature dapat terdiri dari :

1. Persalinan premature dengan usia kehamilan kurang dari 37 minggu

2. Persalinan premature dengan usia kehamilan kurang dari 37 minggu

Nama lainnya dari golongan ini adalah

a. Small for gestational age (SGA)

b. Intra uteri grouth retardation (IUGRat)

c. Inta uteri grout restriction (IUGRst)

Menurut WHO, persalinan premature murni dapat digolongkan menurut

Prematuritas dan berat lahir rendah biasanya terjadi secara

1) Persalinan prematur murni sesuai dengan definisi WHO

Batasan Kriteria Keterangan

1. Usia kehamilan 24-30 minggu BB bayi 1000-1500 g

2. Sangat sulit untuk hidup, kecuali dengan inkubator canggih

3. Dampak sisanya menonjol,terutama pada IQ nerologis dan

3. Dengan perawatan cangih masih mungkin hidup tanpa dampak

2. Berat bayi 200-2499 gr

5. Panjang badan sekitar 45cm

Masih sangat mungkin hidup tampa dampak sisa yang berat

2. Daya isap lemah

3. tdak tahan terhadap hipotermia

4. mudah terjadi infeksi

2) Persalinan prematur berdasarkan pengolangan faktor penyebab

Penggolongan Kriteria Keterangan

1) Dapat terjadi prematur teratur tidak menimbulkan proses

6) Kejadian persalinan prematur sangat jarang berulang dengan

1) Merokok ketagihan obat

2) Kebiasaan kerja keras ,kurang tdur dan istirahat

2. Keadaan sosial ekonomi yang menyebabkan konsumsi gizi

Toksenia, hipertensi, malnutrisi /penyakit kronik, misalnya diabetes

Kelainan Kromosomal (misalnya trisomi antosomal), fetus multi

Faktor yang berhubungan dengan kelahiran premature :

3. TI. Servik Inkompeten

6. Riwayat kelahiran premature

1) Kondisi yang menimbulkan partus preterm

Tekanan darah tinggi menyebabkan penolong cenderung

b. Perkembangan janin terhambat

Perkembangan janin terhambat (Intrauterine growth

Terlepasnya plasenta akan merangsang untuk terjadi

Plasenta previa sering kali berhubungan dengan

Sebelum ditemukan anti D imunoglobulin maka kejadian

Pada kehamilan dengan diabetes yang tidak terkendali

2) Kondisi yang menimbulkan kontraksi

a. Kelainan bawaan uterus

Meskipun jarang tetapi dapat dipertimbangkan hubungan

b. Ketuban pecah dini

Ketuban pecah mungkin mengawali terjadinya kontraksi

Riwayat tindakan terhadap serviks dapat dihubungkan

– Tidak melakukan perawatan prenatal

– Status sosial ekonomi rendah

3) Status sosio ekonomi rendah

5) Tingkat pendidikan rendah

1) Persalinan dan kelahiran premature sebelumnya

2) Abortus trimester kedua (lebih dari 2x abortus spontan atau

4) Penyakit-penyakit medis (diabetes, hipertensi)

5) Resiko kehamilan saat ini :Kehamilan multi janin,