“EFFECT OF CLING WRAP ON BODY TEMPERATURE AND WEIGHT AMONG LOW BIRTH WEIGHT NEONATES ADMITTED IN SICK NEWBORN CARE UNIT OF SELECTED MEDICAL COLLEGES OF

Background: Low birth weight (LBW) is a major challenging public health problem in developing countries. LBW neonates are more susceptible to evaporative heat loss and develop hypothermia immediately after birth that may lead to morbidity and mortality. An experimental study was undertaken among low birth weight neonates in selected medical colleges of West Bengal, with the objectives of effect of cling wrap on body weight and temperature among LBW neonates. Methods: 60 (E =30 & C= 30) subjects were recruited by simple random sampling technique (along with neonatal characteristics). Data were collected through record analysis proforma, digital baby weighing scale and digital thermometer. All tools were tested for validity and reliability and instruments were calibrated before data collection. Permission obtained from Ethics committee before data collection. Results: The findings revealed that most of the subjects (76.67%) findings of the present study are consistent with the findings of the study conducted by Thakur S, Kumar Y, Chand S et al 11 which revealed that t value of axillary temperature of neonates were statistically significant at 0.05 level of significance for all five days. This present study also exhibits that the difference in the mean score of body temperature between the control and experimental groups is statistically significant in post-test (t=6.95, p<0.000). This is supported by the study conducted by Thakur S, Kumar Y, Chand S et al 11 in which they revealed the significant difference between the axillary temperature of non- cling wrap group and cling wrap group at 0.05 level of significance. of also show that there is no significant difference in pre-test and post-test score of body weight in control group and experimental group. This is supported by the study conducted by Thakur S, Kumar Y, Chand S et al 11 which revealed that no significant difference was found in non- cling wrap group and cling wrap group at 0.05 level of significance.

Shaojun L, Pengfei G, Zou Q et al 4 reported that Plastic wrap can be considered as an effective method to prevent hypothermia in preterm infants. However, its cost-effectiveness and long-term effect on mortality needs to be ascertained by conducting more well-designed studies.
Thermal care practices have very much importance in neonatal care. Concept of thermoregulation for newborn has evolved over the years from the use of incubators in the 1800s to various combinations of technologies including radiant warmers, heated mattresses and family-led practices such as delayed bathing, wrapping the neonate, hats and skin-to-skin care, kangaroo mother care etc.
There are very limited number of studies conducted on effect of cling wrap on body weight and temperature among LBW neonates. During our experiences we have seen the use of cling wrap in a few SNCU. So investigators felt need to conduct a study on this area.
Objectives of the study:- 1. To assess the body temperature of LBW neonates in cling wrap and non-cling wrap group. 2. To determine the effectiveness of cling wrap in terms of body temperature before and after the use of cling wrap in control and experimental group of LBW neonates. 3. To assess the weight of LBW neonates in cling wrap and non-cling wrap group. 4. To determine the effectiveness of cling wrap in terms of body weight before and after the use of cling wrap in control and experimental group of LBW neonates. 5. To find out the association between the level of thermoregulation and selected neonatal characteristics before and after the use of cling wrap in control and experimental group of LBW neonates.

Hypotheses
1. H 1 -There is a significant difference in mean score of body temperature between experimental and control group after the application of cling wrap at 0.05 level of significance. 2. H 2 -There is a significant difference in mean score of body weight between experimental and control group after the application of cling wrap at 0.05 level of significance. delivery, APGAR score at 10 minutes and types of feeding were collected. Reliability of the record analysis performa was established by interrater reliability by two observers simultaneously. The value of r was 1, calibrated weighing machine and calibrated digital thermometer was used. Inclusion criteria were low birth weight babies who were hemodynamically stable, nursed under radiant warmer and whose parents are willing to give their consent for participation in this study. Exclusion criteria were low birth weight babies who were with congenital malformation, critically ill, under phototherapy, undergone surgery and having infection. In the present study low birth weight babies refers to those babies who was having birth weight less than2500 grams irrespective of gestational age and normothermia was 36.5-37.5ºc and hypothermia is below 36.5ºc. Pilot study was done before conducting final study. Final data collected from 60subjects (E=30 & C =30) from a SNCU of selected medical college of West Bengal during 01.01.2021 to 31.01.2021. Informed consent was taken from parents and institutional Ethics committee permission taken.

Intervention protocol:
Data related to neonatal variables were collected from babies" bed head ticket and case record sheet. The study carried out for six consecutive days for each neonate. On first day of observation body weight and axillaries temperature were measured for all neonates in both experimental and control group. After that cling wrap was applied to the bassinet of radiant warmer for neonates of experimental group and daily body weight was measured by digital baby weighing scale once in the morning and axillary temperature was measured by digital thermometer every 2 hourly from 8 am to 6 pm for all neonates in both experimental and control group for five consecutive days. Same weighing scale and same digital thermometer was used, same brand and material of cling wrap was applied to all babies in experimental group. Control group received only routine care in SNCU as per hospital protocol. Cling wrap was changed every morning and when it was torn.

Plan for data analysis:
Data related to neonatal variables are represented by frequency and percentage distribution table and data related to body temperature and body weight are represented through bar diagram, t test, line diagram. Chi square and Modified Fisher"s exact test (Freeman-Halton extension) 5 for those 2*3 contingency tables where more than 20% cells have expected frequency less than 5 because categories also cannot be merged to determine the association between level of thermoregulation and selected neonatal characteristics.           (Modified Fisher"s exact p value) Oro-gastric feeding 1 8

Discussion:-
The results of the present study reflected that most of the subjects (83.33%) had hypothermia before use of cling wrap whereas 100% subjects are normothermic after application of cling wrap in experimental group. The findings of the present study are congruent with the findings of some studies 6,7 in which they reported that no subjects had hypothermia in cling wrap group. In addition, Oatley H K,Blencowe H, and Lawn J E 8 concluded that plastic wraps were associated with reduction in hypothermia.
On the other hand, the study conducted byMcCall E M,Alderdice F, Halliday H L et al 9 and Reilly M C, Rac VE, Zayack D et al 10 in which they concluded that fewer neonates in wrap group had hypothermia and this inconsistency may be due to differences in settings (temperature control) or neonatal characteristics.
The results of present study reveal that there is statistically significant difference present in body temperature between control and experimental group in day1,2,3,4 and5 at 0.05 level of significance which is evident from "t" value. The findings of the present study are consistent with the findings of the study conducted by Thakur S, Kumar Y, Chand S et al 11 which revealed that t value of axillary temperature of neonates were statistically significant at 0.05 level of significance for all five days.
This present study also exhibits that the difference in the mean score of body temperature between the control and experimental groups is statistically significant in post-test (t=6.95, p<0.000). This is supported by the study conducted by Thakur S, Kumar Y, Chand S et al 11 in which they revealed the significant difference between the axillary temperature of non-cling wrap group and cling wrap group at 0.05 level of significance. The findings of the present study also show that there is no significant difference in pre-test and post-test score of body weight in control group and experimental group. This is supported by the study conducted by Thakur S, Kumar Y, Chand S et al 11 which revealed that no significant difference was found in non-cling wrap group and cling wrap group at 0.05 level of significance.
The findings of present study reflect that there is no significant association between pre-test level of thermoregulation and selected neonatal characteristics in control and experimental group of neonates. The findings are consistent with the study conducted by Thakur S, Kumar Y, Chand S et al 11 which revealed that the computed chi square value was found to be non-significant. On the other hands, Amirtha J 12 reported that there is significant association between gestational age and APGAR score in pre-test level of thermoregulation. This inconsistency might be due to differences in neonatal characteristics.
In this study there is significant association between post-test level of thermoregulation and weight at birth in control group of neonates. The findings are not supported by other studies may be due to some differences in neonatal characteristics.
In addition, the present study also reveals that there is significant difference in weight loss between experimental group and control group. The findings are supported by the study conducted by Deorari A K, Kaushal M, Singal Aet al 3 where they found significant difference in cumulative weight loss between the Cling Wrap group and the Non Cling Wrap group. On the other hand, the study also found that weight loss in different days were less in experimental group than control group but it is not statistically significant. These findings are congruent with the other study conducted by Thakur S, Kumar Y, Chand S et al 11 which revealed that decrease in weight was less in cling wrap group as compared to non-cling wrap group.
This study has limitation too. Firstly, the study was limited to assessment of body temperature and weight only and other physiological parameters were not assessed. Secondly, axillary temperature was measured from 8 am to 6pm, not measured at night. Thirdly, subjects in both control and experimental group did not receive kangaroo mother care due to restriction of mother in COVID19 pandemic. So comparison could not be attempted to see whether cling wrap is more effective than kangaroo mother care or not. Fourthly, cling wrap might have effect on body weight if subjects were observed for extended period of time.

Conclusion:-
The study concluded that cling wrap is effective in reducing hypothermia and maintenance of body temperature whereas not effective in maintenance of body weight but it prevents weight loss to some extent among LBW neonates. Use of cling wrap might be an innovative intervention and a simple method for maintaining body temperature and preventing weight loss to some extent among LBW neonates and it requires minimal efforts for application.