الفهرس 
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Abstract
Thermoregulation is a critical function which is closely linked to the survival of preterm infants, sick neonates and infants. Hypothermia has a direct relationship with mortality and morbidity (Baley, 2015). Newborn baby is a homoeothermic, but his ability to stay warm may easily be overwhelmed by extremes of environmental temperatures. Neonatal hypothermia often due to lack of attention by health care providers continues to be a very important cause of neonatal deaths (Lubkowska, Sławomir, and Chudecka, 2019).
Developmental supportive positioning is an intervention that has been proven to improve postural and musculoskeletal outcomes. As well as improve sleep states and physiological outcomes (Ettenberger, 2017). Handling and positioning of the neonates are the major interventions in NICU (Gardner, Goldson and Hernandez, 2015). Positioning of neonate is basic neonatal nursing care and one of the important aspects of developmental care to keep the preterm infants comfortable using supine, prone and side lying position as measured by infant positioning assessment tool (Park and Kim,. 2019).
Aim of the study:This study aimed to assess the relation between developmentally supportive positioning and thermoregulation on neonates at neonatal intensive care units.
Research question:
Is there a relation between developmentally supportive positioning and thermo-regulation on neonates at neonatal intensive care units?
Research Design:
A descriptive comparative design was used to conduct this study.
Study Settings:
The study was carried out at the Neonatal Intensive Care Units at children’s Hospital affiliated to Ain Shams Hospital University.
Subjects:
A convenient sample of 120 neonates attended previously mentioned settings regardless their age. They were divided into two groups study and control group; group I used as study group and group II used as control group and equal number for each (60).
A purposive sample (50 nurses), who work at NICU regardless their age experience, gender…etc.
Tools of data collection:
Four tools were used in this study and classified as the following:
I: Pre –designed Questionnaire Sheet:
It was designed by the researcher after reviewing related literature to collect the required data. It was written in simple Arabic language, and it consists of two parts.
Part (I): Personal information t was be used to assess characteristics of neonates such as chronological age, Gestational age, Gender, Birth weight, Recent weight (total question 5).
Part (II): Clinical information of studied neonates such as Medical Diagnosis, Type of labor, Expose to the health problem during labor, Apgar score (total question 4).
II: Nurse’s questionnaire sheet for assessment of nurse’s knowledge: It composed of two parts:
Part (I): Socio demographic characteristics of nurses such as age, Gender, level of education, marital status, Residence, years of experience and Attendance of training courses (total question 7).
Part (II): Nurse’s knowledge about developmental supportive; it was consisted of open questions such as definition, importance, uses, barriers of developmentally supportive …., etc. (total questions 15).
Scoring system: The total scores of the 15 questions were 30 degrees which equal 100%, each question was assigned a score according to nurses’ knowledge responses were (Complete correct, Incomplete correct& Incorrect) answer scored ( 2, 1& 0) respectively The nurses’ knowledge was checked with a model key answer and accordingly the nurses’ knowledge was categorized into satisfactory and unsatisfactory. These scores were summed and were converted into a percent score. It was classified into 2 categories:
Satisfactory score for knowledge <70%.
Unsatisfactory score for knowledge>70%.
III: Child Positioning Assessment Tool (IPAT):
This tool developed by (Coughlin et al., 2010), it was be used to assess developmental supportive positioning practices in the NICU. It consists of 17 items head (3), neck (2), Shoulder status (3), Hand and arm location (3), Hips/pelvis (3) & Knees/ankles/feet (3).
Scoring system: The IPAT evaluates posture at the head, neck, shoulders, hands, hips, knees/ankles/feet. A two-point scoring system is used with a score of 2 for perfect positioning, a 1 for acceptable alternative positioning and a 0 for unacceptable positioning. It was classified into 3 categories
Perfect positioning = 34
Acceptable 17 <34
Need for repositioning <17
IV: Neonatal Physiological Parameters sheet:
It was be including temperature, heart rate, respiratory rate and blood oxygen saturation.
Scoring system:The neonates evaluated according to the normal ratio of three types:
Body temperature:
No Body Temperature Range
1 Normal 36.5-37.5°C
2 Cold Stress 36.0-36.4°C
3 Moderate Hypothermia 32.0-35.9°C :
4 Severe Hypothermia below 32°C:
Heart rate:
Normal: 120:160 b/m.
Less than 120: Bradycardia.
More than 160: Tachycardia
Respiratory rate:
Normal: 30:60 c/m.
Less than 30: Bradypnea.
More than 60: Tachypnea.
Oxygen saturation:
Normal: 88:97%.
Less than 88%: hypoxia.
More than 97%: hyperoxia.
Results can be summarized as the following:
The mean gestational age of the study group was 36.4 ±3.46 weeks, while it was 37.03±3.73 weeks at control group.
The mean birth weight of the study group was 2.215 g ±345.9 while, it was 2.314±256.8 at control group. In addition, 58.3% of the study group and 61.7% of the control group had low birth weight.
The mean age of the studied nurses was 27.8 with SD ±4.03 years and 62.0% of them were female. Moreover, 40.0% of them were at technical health institute and 28.0% had Nursing Diploma.
Regarding total knowledge of the studied nurses about developmental supportive care, 66.0% of them had unsatisfactory knowledge, while 34.0% of them had satisfactory knowledge.
As regard the studied neonates’ total child positioning, 68.3% of the study group and 48.3% of the control group had perfect positioning.
Also, 25.0% of the study group and 35.0% of the control group had acceptable positioning, while 6.7% of the study group and 16.7% of the control group needed for repositioning with a statistically significance difference between both groups.
There was a highly statistically significant relation between studied nurses’ total knowledge and their education level (X2=7.964, P=0.005) and years of experience (X2=9.242, P=0.002).
There was a highly statistically significant relation between total child positioning and the study group of neonates’ body temperature (X2=13.12, P=0.001), heart rate (X2=13.08, P=0.000), respiratory rate (X2=12.85, P=0.002) and oxygen saturation (X2=12.64, P=0.001).