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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
MR.MATHEWS.P.JOY
1
NAME OF THE CANDIDATE
AND ADDRESS
NO:5,NOOR BUILDING,RMV 2NDSTAGE
BHOOPASANDRA MAINROAD
BANGALORE– 560 094.
2
NAME OF THE
INSTITUTION
NOOR COLLEGE OF NURSING
NO:5,NOOR BUILDING,RMV 2NDSTAGE
BHOOPASANDRA MAIN ROAD
BANGALORE– 560 094.
3
COURSE OF STUDY AND
SUBJECT
M.Sc. NURSING 1ST YEAR
CHILD HEALTH NURSING
4
DATE OF ADMISSION
TO COURSE
01/06/2010
5
TITLE OF THE TOPIC
A STUDY TO EVALUATE THE
EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON
KNOWLEDGE REGARDING
PREVENTION OF HYPOTHERMIA
AMONG MOTHERS OF NEONATES
ADMITTED IN SELECTED PAEDIATRIC
HOSPITAL AT BANGALORE.
0
6.0 BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“A mother needs her baby just as much as the baby needs the mother.”
Askldjfas
The healthy newborn infant born at term between 38 to 42 weeks, cries immediately
after birth, establishes independent rhythmic respiration quickly adapts with the extra
uterine environment, having an average birth weight and no congenital anomalies. The
transition from intrauterine to extra uterine life is perhaps the greatest challenge any human
being can fall in the curse of lifetime. Approximately 3% to 7% of all newborns require
some form of support.1
The period from birth to 28 days of life is called neonatal period and the infant in
this period is termed as neonate or newborn baby. The neonates are at risk for various health
problems, even though they born with average birth weight. The morbidity and mortality
rates in newborn infant are high.2
Improving newborn survival is a natural priority in child health today. A staggering
of 26 million babies are born in our country every year. Of these 1.2 million babies are
dying in the first 28 days of life accounting for 20% of the global burden of newborn
deaths. The neonates needs optimal care for improved survival, During the intra uterine life
in the womb baby is gently rocked in the warm amniotic fluid and is well protected from
infection and the warm environment effectively shielded against light and sound. The
virtues of the womb, cushioned and comfortable aquatic abode thermal comfort, zero
insensible water loss, shielded from light, protected from sound and isolation.3
1
A newborn is precious not only to his parents but also to community, nation and to
the world. The maintenance of child health is not only desired but also positively valued by
every society and improved level of child health is the accepted goal of all communities. “A
healthy child has a sure future” is one of the themes of WHO. Neonatal care starts in
premarital age and continues from conception through suitable care during pregnancy,
childbirth and childhood.4
If primary neonatal care is inadequate, it leads to unacceptable high neonatal
morbidity and mortality. The important cause of this is, ignorance related to newborn care
and among the major causes, hypothermia is considered as silent killer in neonates.
Hypothermia is a common alteration of thermoregulatory state of the neonates. Neonates
hypothermia occurs when the body temperature drops between 36.5oC or 99.7oF in the
newborn infants.5
Hypothermia is a risk for new born in any climate whether in the tropics or in cool
mountainous areas. An important objective of appropriate care of the newborn is to avoid
hypothermia for the moment of birth by using procedures that will prevent the heat loss and
maintain the body temperature within the normal range thus conserving the infant’s energy
for growth and development.6
Newborn may suffer from hypothermia. They lose heat because of little
subcutaneous fat; poorly developed autonomic thermoregulatory response, body surface
area is more in relation to weight. The main causes of neonatal hypothermia are separation
of baby from mother, cold environment, change of temperature, inadequate warming,
excessive loss of heat, low birth weight and pre term neonates.7
2
The various clinical signs of neonatal hypothermia are skin temperature between
36.5oC, hands, feet, abdomen are cold to touch, weak and lethargy, bluish extremities, slow
heart rate at irregular respiration. The various consequences of neonatal hypothermia are
hypoxia, hypoglycemia, respiratory distress,
neonatal jaundice, sudden infant death
syndrome and impaired cardiac function.8
A study was conducted in Paris on 111 neonates to evaluate the effectiveness of skin
to skin contact in the prevention of hypothermia. The mothers of neonates were instructed
to keep their babies always in touch with their skin. This study shows that the method was
very much successful in the prevention of hypothermia in neonates and the study supports
the importance of Kangaroo care method also.9
According to WHO reports most of the newborns deaths are due to hypothermia that
is about 42% and 3.6 million develop moderate to severe hypothermia. Thermoregulation is
one of the challenging aspects of neonatal care. Mastering the art of maintaining the neutral
thermal environment is one of the most influential interventions the bedside nurse can
perform for the full term and term and pre term infant.10
6.1 NEED FOR THE STUDY
Neonatal period is very crucial. It is accurate to say that during the first few minutes
especially when a risk situation exists prompt and adequate care should be carried out.16
Based on this thermoregulation is an important physiological function that is closely related
to the survival of the infants. An understanding of the physiological function of temperature
control in neonates is essential in helping the mothers to provide an appropriate
environment to promote thermal stability.11
3
Neonatal period encompasses the first four weak of extra- uterine life but it is an
important link in the chain of events from conception to adulthood. The physical and mental
well being of an individual depends on the correct management of events in the parental
period. The morbidity and mortality rate in newborn infants are high and is worse in the
developing countries because of poor antenatal and neonatal care. In India 10 out of 100
infants do not see their first birth day and nearly 60 % of deaths occur in the newborn
period.12
It is also found that hypothermia increases the risk for metabolic acidosis, jaundice,
respiratory distress, hypoglycemia, pulmonary hemorrhage and death, regardless of the
newborn’s weight and gestational age. Neonatal hypothermia is a common and wide spread
problem even in developed counties. WHO reported hypothermia was found as common
cause of death in all the age groups. But most of the health personnel are not aware of it.
There are different health programmes accepted and propagated by different sections of
government at state and central level by voluntary agencies. It is a real challenge to the
health personnel to improve the primary care of the newborn.13
In India and other developing countries approximately 50%of infant’s death occurs
in the neonatal period, 25% of neonatal deaths occur within 24 hours of life. The existing
neonatal mortality rate in India is 76 / 1000 live births in rural areas and 34 / 1000 live
births in urban areas. Out of this 50% neonatal death, 20% neonatal deaths are due to
hypothermic complications.14
A study was conducted in Jaipur to evaluate the knowledge, attitude and practice
about neonatal hypothermia among medical and paramedical staff dealing with newborn
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care. A total of 160 subjects were assessed using a structured questionnaire, the study
reveals that gross lacunae in knowledge regarding various aspects of neonatal hypothermia
among pediatric and obstetric residents and paramedical staff working in labor room.15
A study was conducted in New Jersey to find out the level of knowledge of mothers
of neonates about the prevention of heat loss and the promotion of adequate body heat. It
was conducted on the mothers who were stayed in the maternity centre for a time period of
two weeks with some delivery complications. The study sample consisted of 70 post natal
mothers. This study found that the mothers are still needs more knowledge to prevent the
baby from heat loss.16
The above statistics shows that mothers are not aware about hypothermia, so the
investigator developed and insight to conduct this study to propagate the knowledge for
prevention of hypothermia among mothers of neonates.17
6.2 REVIEW OF LITERATURE
Reviewing relevant literature is to gain a broad background or understanding
of the information that is available related to a problem. Review investigated at the
beginning of the research process and continues throughout the development of the research
proposal, collection and analysis of data and interpretation of findings.18
A study was conducted in Zimbabwe to determine the temperatures of twins
simultaneously kangarooed and the temperature of maternal breasts during shared kangaroo
care. The investigator watched two sets of premature twins receiving shared kangaroo care
for 1.5 hours. The infant temperature were recorded from incubators, breast temperature
were recorded from thermister. The study concluded that twins can be simultaneously held
in kangaroo care without thermal compromise because each breast responds individually to
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the infant’s thermal needs.19
A study was conducted regarding care of premature infants. The study reveals that
when the ambient temperature needed is between 32 0 C to 36 0 C, covering the head of the
baby, wrapping of baby in dry towels and use of low cost heat cradles will help in
maintaining temperature. Hypothermia has several harmful effects and hence should be
prevented.20
A study was conducted in Algeria to find out the methods in prevention of
hypothermia in neonates. This study insisted to keep an infant warm from the moment of
delivery through the first days of life. All newborns should be thoroughly wiped with a dry
towel soon after birth and wrapped immediately in a warm dry cloth. Discourage washing
an infant until he or she is in a stable condition 24 hours old. Make sure the room
temperature is maintained above 250 C. Encourage close physical contact between the
mother and infant as soon as the infant is born.21
A study was conducted in Albania to find out the effectiveness of thermoregulation
and prevention of hypothermia in neonates. This study stated that low birth weight and very
low birth weight infants were placed in polyethylene wrap from the neck down immediately
after delivery to decrease heat loss in infants born at 23 to 27 weeks of gestation. The
interventions reveals and shows the effectiveness by maintaining thermoregulation and
prevented from hypothermia.22
A study was conducted to find out the thermal control of the new born, knowledge
and practice of health professionals in seven countries. Hypothermia is a common problem
in neonates particularly in developing countries where it is an important contributing factor
to neonatal mortality and morbidity. The study involved 28 health faculties and 260 health
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professionals .It included an assessment of thermal control practices carried out in each
health faculty and a questionnaire on knowledge about thermoregulation administered to
health professional. The findings of the evaluation were frequently inadequate in the
following area; ensuring a warm environment at the time of delivery, initiation of breast
feeding and contact with mother, bathing, checking the baby’s temperature, thermal
protection of low birth weight babies and care during transport. Knowledge on thermal
regulation and thermal protection can be easily acquired and on the basic motivation for
improving thermal control practices can be developed. 23
A study was conducted on methods of temperature regulation among the 30
neonates in Ahemedabad.The study reveals that the immature thermoregulatory
mechanisms and small body size means that preterm neonates are prone to temperature
maintenance problems and thermal stress associates with increased morbidity and
mortality.24
A study was conducted to identify the temperature of newborns: What is normal.
The resource of data was from medical records of 203 healthy full term infants’ factors that
affect temperature and nursery management of infants with temperatures outside published
normal ranges. The mean birth temperature was 36.50 C. Temperature was associated with
birth weight and the presence of maternal fever but not with the type of environment of time
of birth. The mean temperature increased with age rising 2 0 C after bathing. Although 17 %
of all temperatures dropped 20 C after bathing and become hypothermic range, the only
response recorded by nursery staff consisted by warming by modifying the environment.
Newborn auxiliary’s temperatures in nursery were considerably lower than what has been
previously described as “normal”.25
7
A study was conducted to findout neonatal hypothermia and associated risk factors
among newborns of Southern Nepal. A cohort of 23,240 babies in rural southern Nepal was
visited at home by field workers who measured axillary temperatures for 28 days. The study
shows that hypothermia are at risk those who weighed < 2000 g compared to those of
normal weight .Preterm babies, those who had not breastfed within 24 hrs are at increased
risk of hyperthermia. Hypothermia was not associated with delayed bathing, hat wearing,
and room warming or skin-to-skin contact. The study suggested for year-round thermal
care, early breastfeeding and maternal thermal care should be emphasized.26
A study was conducted on the importance of physical contact with the mother. The
objective of this study was to determine normal patterns of temperature variation in
newborn babies and influence of external factors. The methodology used for this study was
abdominal and foot skin temperature were continuously recorded in 27 healthy full term
babies during the first 2 days of life and related to the care situation. Ambient temperature
was close to 230 C during the study period. The result showed that mean rectal and
abdominal and foot skin temperature were lower on day 1 than day 2. The foot skin
temperature was directly related care situation; it is significantly higher when the baby was
with the mother. The abdominal skin temperature was much less influenced by external
factors. The study was concluded that, for temperature regulation during the first few days
physical contact with the mothers is essential.27
A study was conducted in Belgium in order to find out the effectiveness of
mummifying neonates to prevent hypothermia. This study was conducted in 300 neonates.
The mothers of neonates and the staff nurses were strictly instructed to mummify the
neonates in a proper and systematic way. The study results has shown that mummifying
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neonates is an effective intervention to prevent hypothermia and the study concludes that
the neonates needs to be mummified when ever their body heat seems to be go down.28
A study was conducted on fifty newborn Iraqi children with hypothermia to
determine causes and incidence of the precipitating factors. The majority of infants more
than three days old had evidence of infection, particularly septicemia. The overall mortality
rate was 26% 42 %in low birth weight infants .Early onset hypothermia in the first three
days of life is due to exposure to cold without evidence of infection and has a good
prognosis. The most common finding in the series was a high incidence of aspiration
pneumonia in late-onset hypothermia. Antibiotics effective against Escherichia, coli, such
as gentamicin, should be given from the outset to all patients with late-onset hypothermia
without waiting for laboratory proof of infection.29
A cross sectional descriptive study of neonatal hypothermia was performed on 300
newborns consecutively recruited day and night during 2 months at a Ugandan per urban
hospital. Parallel tympanic and rectal temperature measurements were made at 10, 30, 60,
and 90 min post partum. Rectal temperatures taken at 10, 30, 60, and 90 min.The results
showed that 29, 82, 83, and 79% of the newborns respectively were hypothermic. The study
observed that delayed contact with the mother and late warming baby developed
hypothermia. From this study it is revealed that a high prevalence of neonatal hypothermia
was confirmed and indicates that more vigorous efforts have to be undertaken, also in a
tropical setting, to overcome problems of non-adherence to appropriate methods for thermo
protection of the newborn.30
9
A Longitudinal cohort study was conducted to quantify incidence, age distribution,
and seasonality of neonatal hypothermia among 240 newborns. Community-based workers
recorded axillary temperature on day 1. Measurements lower than 36.5°C were observed in
210 babies; half had moderate or severe hypothermia, and risk peaked in the first 24 to 72
hours of life. Risk of moderate or severe hypothermia increased by 41.3% for every 5°C
decrease in average ambient temperature. In the hot season, one-fifth of the babies were
observed below the moderate hypothermia cutoff. Mild or moderate hypothermia was nearly
universal, with substantially higher risk in the cold season. However, incidence in the hot
season was also high; thus, year-round thermal care promotion is required. Research on
community, household, and caretaker practices associated with hypothermia can guide
behavioral interventions to reduce risk.31
A study was conducted to assess the effect of using clinical nursing practice
guideline for preventing neonatal hypothermia on body temperature of full-term newborns.
The purpose of this study was to compare body temperature of newborns between the group
using clinical nursing practice guideline for prevention of neonatal hypothermia and the
group receiving usual nursing care. The sample consisted of 60 normal newborns who were
born at the delivery room, Ramathibodi Hospital in October 2007. The sample was assigned
into the control group and the experimental group. The control group consisted of 30
newborns receiving usual nursing care and the experimental group consisted of 30
newborns receiving nursing care based on clinical nursing practice guideline for preventing
neonatal hypothermia. The results showed that the mean body temperature measured by a
10
rectal thermometer in the experimental group at 10, 30, 60, 90, and 120 minutes after birth
were in normal limits and significantly higher than those of the control group. However, the
mean body temperature in each group was significantly different over time. The mean body
temperature of each group slightly decreased at 10 minutes after birth, however, in the
control group, the body temperature was subnormal at 30 and 60 minutes after birth, while
in the experimental group, subnormal temperature at those points of time was not found.
Then, the mean body temperature of each group slightly increased until closed to that at 10
minutes after birth when 120 minutes elapsed. This study suggests that the clinical nursing
practice guideline is helpful for nurse-midwives to prevent hypothermia in newborns.32
6.3 STATEMENT OF THE PROBLEM
A study to evaluate the effectiveness of structured teaching programme on
knowledge regarding prevention of hypothermia among mothers of neonates in
selected hospitals at Bangalore.
6.4 OBJECTIVES OF THE STUDY
1. To assess the level of knowledge of mothers of neonates regarding prevention of
hypothermia.
2. To evaluate the effectiveness of structure teaching programme on knowledge
regarding prevention of hypothermia among mothers of neonates.
3. To associate the knowledge of mothers with the selected demographic variables.
6.5 OPERATIONAL DEFINITION
Evaluate
It refers to gathering the information on knowledge of mothers of neonates
on prevention of hypothermia.
11
Effectiveness
It refers to the out come of structured teaching programme in improving
the knowledge of mothers of neonates regarding prevention of
hypothermia.
Neonates
Neonates are defined as term newborns of 0 – 28 days after birth.
Knowledge
It refers to the response of the mothers of neonates to the question stated in
the structured knowledge questionnaire regarding prevention of
hypothermia.
Prevention
The action which should be taken by the mothers of neonates for the
prevention of hypothermia like early skin to skin contact, early initiation
of breast feeding, mummifying etc.
Hypothermia
Hypothermia is a common regulatory state of the neonates. Neonatal
hypothermia occurs when the body temperature (auxiliary) drops below
36.50 C (97.7OF) in the newborn infants.
Mothers
A mothers of neonates who are admitted in the postnatal ward of
Yelehanka Government Hospital.
12
Structure Teaching Programme
It refers to systematically prepared teaching programme regarding definition,
incidence, causes, signs and symptoms, management and prevention of hypothermia
6.5 ASSUMPTION
1
It is assumed that mother’s knowledge regarding prevention of
hypothermia in neonates should improve after attending the structure
teaching programme.
2
It is assumed that mother’s knowledge is influenced by variables such as
education and source of information.
6.6 HYPOTHESIS
H1: The mean post test knowledge score of subject exposed to structure teaching
programme will be significantly greater than the mean pre test knowledge
scores.
H2: There will be significant association between pre-test knowledge and
selected demographic variables.
6.7 DELIMITATIONS OF THE STUDY
The study is delimited to
 The mothers of neonates admitted in postnatal ward of Yelahanka
Government Hospitals.
 The duration of study will be up to four weeks.
13
7.0 RESEARCH METHODOLOGY
Sources of data
Mothers of neonates admitted in Yalahanka Government Hospital Bangalore.
Research Approach
The Research Approach adopted for this study is an evaluative research.
Research Design
One group pre and post - test design is adopted in this study.
It can be illustrated as below:
Pre-test
Manipulation
O1
Post-test
X
O2
Key:
O1
→
Pre-test
X
→
Structured teaching programme
O2
→
Post-Test
Setting of the Study
Study will be conducted in the Yalahanka Government Hospital Bangalore which is
a distance of 10kms from Noor College of Nursing. Hospital has a 1000 bedded of which
100 bedded is of pediatric ward. The hospital has conducted delivery of about 4 to 5
mothers per day, and 200 mothers per month.
14
7.1 DESCRIPTION OF VARIABLES
Independent Variable
Structured teaching programme regarding prevention of hypothermia will be the
independent variable of the study.
Dependent Variable
Knowledge of mothers of neonates regarding prevention of hypothermia will be the
dependent variable of the study
Attribute Variable:
Consists of Age, Religion, Education, Type of family, Occupation, Income, Number
of parity.
Population
The target population of the present study includes the mothers of neonates in the
Yalahanka Government Hospital Bangalore.
Sample
Sample comprised of 50 mothers of neonates in the Yalahanka Government
hospital Bangalore.
Sampling Technique
In the present study the sample were selected through Non Probability convenient
sampling technique.
Criteria for sample selection
Inclusive criteria
 Mothers of neonates.
 Mothers who are available at the time of data collection.
15
 Mothers who can read and understand the Kannada or English.
Exclusive criteria
 Mother of neonates those who are severely ill at the time of data collection.
 Mother of neonate with associated congenital anomalies.
7.2 DESCRIPTION OF TOOL
Tools consists of
Section A
Demographic data includes of Age, Religion, Education, type of family, Occupation,
Income, Number of parity.
Section B
Structured knowledge questionnaire will be used to assess the level of knowledge of
mothers of neonates.
7.3 METHOD OF DATA COLLECTION
Prior to data collection, written permission will be obtained from the
concerned
authority. Then the investigator will explain the purpose of the study
and informed consent will be obtained. The pre test will be conducted by using
structured knowledge questionnaire followed by structured teaching programme.
After two days, post - test will be done by using the same structured knowledge
questionnaire to evaluate the effectiveness of structured teaching program. Duration
of data of collection will be up to 4 weeks
16
7.4 STATISTICAL ANALYSIS
The Data obtained will be analyzed in terms of objective of the study using
descriptive and inferential statistics.
A. Descriptive statistics
1. Frequencies and percentage distribution will be used to analyze the demographic
variables.
2. Mean and standard deviation will be used to analyzed the level of knowledge
regarding prevention of hypothermia.
B. Inferential statistics
1. Paired ‘t’ test will be use to determine the significant difference between the
mean pre-test and post-test knowledge score.
2. Chi-square will be used to find out the association between the knowledge score
with selected demographic variables.
7.5 DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTION ON CLINTS OR OTHER HUMAN IF SO PLEASE
DESCRIBE BRIEFLY.
Yes, structured teaching programme will be administered and knowledge of mothers
of neonates will be assessed.
7.6 ETHICAL CONSIDERATION TOWARDS SAMPLE RELATED TO
STUDY
Yes, informed consent will be obtained from authorities to conduct the study.
Privacy, Confidentiality and Anonymity will be maintained throughout study.
17
8.0 LIST OF REFERENCES
1. Marilyn.J.Hockenberry, Wong’s, Paediatric nursing, Elsevier publication, 8thedition
New York, 2006, page no, 993 -994.
2. Parul Datta, Pediatric nursing, Jaypee publication, 2nd Edition, Allahabad, 2004,
page no, 222-224.
3. Sachdeb,Panna Choudhary,Principals of pediatric nursing and neonatal
emergencices,Jaypee Publication,2nd edition, New Delhi ,2005,page no,563-564
4. S.Gupta. A short text book of Pediatrics. 8th edition, Mumbai, Jayapee Brothers;
1998, page no, 161-163.
5. Dorothy.R.Marlow, Barbara, A.Radding.The text book of Pediatric nursing. Elsevier
Publication, 6th edition, London, page no, 75-78.
6. Sudindra B K Naj. Newborn care. Indian Pediatrics.volium New Delhi 1994 Jul /
Sep page no . 203 – 297.
7. Ball
Bindler,Paediatric
nursing
,Pearson
education
publicdition,4th
edition,Algeria,page no,1298-1299
8. Carolin Edward. Traditional Birth Attendants Training. The Journal of Midwifery
and Women’s Health. volume 2004 Jul / Aug,page no 49: 4: 298 – 304.
9. WHO. Neonatal care: report of WHO scientific group. Technical report. Series No:
424 Geneva. WHO
10.Chricker.The Newborn. Journal of Obstetrics and Gynecological Nursing. Volume
1 1999 Mar page no 26 – 27
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11.Sankar B, Sindhu B. Learning and Teaching Nursing , Jaypee publication,1st edition
Mangalore 2003.page no 152-153
12.Francis Newman. Health Dialogue. Care of the newborn. volume 1 Belgium1998
page no 111-114
13.Thomas K. North American journal , volume 1,Hoosten, 1994 March. page 15-22
14.WHO. Neona tal care: report of WHO scientific group – Technical report. Series
no. 424 Geneva. WHO.
15.A.K.Dutta , Anupam Sachdeva, Advance in Pediatrics, Jaypee publications ,1st
edition,Nagpur ,1997; page no . 1039 – 1042.
16.Zayeri F, et.al Hypothermia in Iranian newborns. Volume- 1.Iran, 2005 Sep, 26 (9):
1367 – 71.
17.Park K.
Parks Textbook of Preventive and Social Medicine.17th ed. India:
Bannarsidas Bhannot Publishers; Mumbai, 2001.page no 321- 326
18.Choudhary. Prevention of
hypothermia. Essential component of newborn
care.Jaypee publications, Lucknow 1994 ,page no :7-9
19.Gowtham Guptha, Neonatal morbidity and mortality: Report of national neonatal
prenatal database: Indian Pediatrics 1997; New Delhi page no . 1039 – 1042.
20.Hughes, A, Riou, P, Day, C. Full neurological recovery from profound acute
accidental hypothermia: successful resuscitation using active invasive rewarming
techniques. Emerg Medical Journal, 2007; 24:511.
21.Danzl, DF, Pozos, RS. Accidental hypothermia. North England Medical Journal,
1994; 331:1756.
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22. Lundgren, JP, Henriksson, O, Pretorius, T, et al. Field torso-warming modalities: a
comparative study using a human model. Prehosp Emerg Care 2009; 13:371.
23. Polit.DF, Hungler BP. Nursing research.Principles and
methods.6thedition,Philadalphia,Williams and wilkins;2004,pp126-30
24. Gill, BS, Cox CS, Jr. Thermodynamic and logistic considerations for treatment of
hypothermia. Mil Med 2008; 173:743.
25. Kornberger, E, Schwarz, B, Lindner, KH, Mair, P. Forced air surface rewarming in
patients with severe accidental hypothermia. Resuscitation 1999; 41:105.
26. Silfvast, T, Pettilä, V. Outcome from severe accidental hypothermia in Southern
Finland--a 10-year review. Resuscitation 2003; 59:285.
27. Danzl, DF, Pozos, RS, Auerbach, PS, et al. Multicenter hypothermia survey. Ann
Emerg Med 1987; 16:1042.
28. Plaisier, BR. Thoracic lavage in accidental hypothermia with cardiac arrest--report
of a case and review of the literature. Resuscitation 2005; 66:99.
29. De Caen, A. Management of profound hypothermia in children without the use of
extracorporeal life support therapy. Lancet 2002; 360:1394.
30. Scaife, ER, Connors, RC, Morris, SE, et al. An established study to assess the
survival in extreme hypothermia. J Pediatr .Volume 6,Finland;2009.pp238-42
31. Corneli, HM. Accidental hypothermia. J Pediatr ,New Jersy,1992; 120:671.
32. Otto, RJ, Metzler, MH. Rewarming from experimental hypothermia: comparison of
heated aerosol inhalation,Volume 3,Crit Care Med 1988; 16:869.
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9
SIGNATURE OF THE CANDIADATE
10
REMARKS OF THE GUIDE
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NAME AND DESIGNATION
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.5 HEAD OF DEPARTMENT
11.6 SIGNATURE
12
12.1 REMARKS OF THE CHAIRMAN/PRINCIPAL
12.2 SIGNATURE
21