Assessment of Nurse's Practices toward Care of Neonates with Hypoglycemia at Neonatal Intensive Care Unit in Al-Nasiriya City

ABSTRACT


INTRODUCTION
One of the most common causes for neonatal intensive care unit admission is hypoglycemia. Since different amounts of blood glucose were used to describe hypoglycemia, the true occurrence of neonatal hypoglycemia varies greatly across different studies. When BG levels of (47 mg/dL) and (36) mg/dL were used for hypoglycemia diagnosis, the incidences of (51%) and (19%) in infants with risk factors for hypoglycemia were used, respectively (1) .
Hypoglycemia in newborns is significant because it is a common condition linked to brain injury and poor neuron growth. Despite the fact that the concept of neonatal hypoglycemia is debatable, treatment thresholds have been defined and are used throughout clinical practice. Neonatal hypoglycemia affects up to 15% of otherwise healthy infants, and it is common in resource-poor countries (2) .
Hypoglycemia affects approximately 17% of babies admitted to the neonatal intensive care unit (NICU). Hypoglycemia is estimated to be more common in developing countries due to higher rates of low birth weight and intrauterine growth restriction (IUGR), as well as insufficient nutrition and inadequate treatment (3) .
When it comes to neonatal hypoglycemia, nurses are the first line of defense. Careful observation and evaluation, as well as an understanding of which infants are most vulnerable to negative outcomes, are required. As a result, all neonatal nurses are required to follow the algorithm (4) .
In the diagnosis of neonatal hypoglycemia, nurses played an important role. It happens as a result of a general examination of the mothers' and newborns' information and medical histories, as well as the identification of the risk factor for neonatal hypoglycemia. To detect early signs and symptoms of neonatal hypoglycemia, a general examination of the newborn's body systems (neurological, respiratory, cardiovascular, and gastrointestinal) is performed. Send a blood sample for glucose testing, and be responsible for maintaining a normal level of glucose and avoiding hypo and hyperglycemia (5) .    Table 3 shows that there is significant difference between nurses practice about neonatal hypoglycemia and their age and displays that there is significant difference between nurses practice about neonatal hypoglycemia and their educational level. Also, that there is no significant difference between nurses practice about neonatal hypoglycemia and their years of service in nursing. Finally there is no significant difference between nurses' practice about neonatal hypoglycemia and their marital status.

DISCUSSION:
-Discussion of the distribution of the nurses by their demographic characteristics table (1).
Regarding to the nurses' demographic characteristic in table (1). The finding indicated that (52.5%) of nurses at age (26-30) years. this results agree with in a descriptive study carried out in Egypt (6,8) .This finding consisted with our finding. Regarding to nurses gender, all of them are females. Study in Iraq found that all of nurses working in NICU were females. This finding consisted with our finding. This finding due to most of nurses working in gynecology and pediatric hospital were female (7) .
Regarding to educational level, (42.5%) of nurses have nursing bachelor graduated. In interventional study carried out in Sudan (Effect of the training program on nurses' practice regarding premature nursing care in Pediatric Teaching Hospital Wad Medani, Gezira state, Sudan), they found that most of nurses had bachelor graduated in nursing. This result agrees with our finding (9) .
Regarding to the years of service of nurses, (77.5% & 100%) of nurses has (1-5) years of service in nursing and in NICU respectively. Two studies agree with the present study result (12,10) . Regarding to participating in training session related to hypoglycemia in neonate, (17.5% & 2.5%) of nurses have participate in (1-2 &3-4) training session. Study in Mosul city, Iraq was found that most of nurses had participated in training session related care of neonate in NICU (8) .
-Overall assessment of nurses' practice in present study According to the finding of the nurses' practice in table (2), at the pretest the nurses have low level of practice toward neonatal hypoglycemia; study in Iraq was indicated that identification of areas of deficient knowledge among nursing staff represents (13) . Also, study in Sudan was found that nurses had poor level of practice toward care of neonate in NICU at the pretest. This finding supported our finding of study (11) .
In another descriptive study (Nurse's Knowledge and Practice on the Care of Preterm Infants at Khartoum State Hospitals) in Khartoum state hospital. They found that most nurses had relatively poor knowledge and practices about the aspects of neonate care. These findings supported the present study finding about nurses practice related care of neonatal hypoglycemia in present study (12) .
Also, study in Sudan was found that nurses had good level of practice toward care of neonate in NICU in them study. This finding consisted with the present study finding (11) .
Study in Baghdad city in the study (impact of training neonatal resuscitation program upon nurses practices in operation room in Baghdad city) found that (75%) of nurses had poor practice about neonatal resuscitation. This finding consisted with the present study finding (13) .
Study in Iraq was assessed of nursing staff's knowledge and practice regarding care of premature Babies in Mosul teaching Hospitals found that all of the studied nurses (100%) had satisfactory level of practice related to weight, and one quarter (25%) of them had satisfactory level of practice related to skin care. This finding supported the present study (8) .
-Discussion of the difference between nurses practice and demographic characteristics table (3). According to the difference between nurses' practice and age in table (3), the finding indicates that there is significant difference between nurses' practices toward care neonates with hypoglycemia and their age. Study in Kirkuk City Mustafa was found that there was no significant statistical relationship between nurses' level of practices and their age (10) .
According to the difference between nurses' practice and level of education in table (3), the finding indicates that there is significant difference between nurses' practices toward care neonates with hypoglycemia and their educational level. Egyptian study was shown that there was no significant relationship between nurses' practices and level of education (9) .
According to the difference between nurses' practice and years of service in nursing in table (3), the finding indicates that there is no significant difference between nurses' practices toward neonates with hypoglycemia and their years of service in nursing. This finding related to most of nurses had few years of experience in nursing field and in NICU and lack of training sessions and workshops about the neonatal hypoglycemia.
According to the difference between nurses' practices and marital status in table (3), the finding indicates that there is no significant difference between nurses' practices toward neonates with hypoglycemia and their marital status. This result due to the mean score of nurses practice regarding marital status of the single, married and other are in same level, therefore no found any different between them in the mean score at p value (0.05).

CONCLUSION:
3. The importance of fully utilizing continuing medical education to provide neonatal hypoglycemia courses for all NICU nurses.
-Ethical Clearance: All experimental protocol was approved under the College of Nursing, University of Kufa, Iraq and all experiments were carried out in accordance with approved guidelines.