الفهرس 
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Abstract
Preterm neonates are born before the completion of 37 weeks of gestation. They are
vulnerable to mortality, morbidity, and neuro-developmental delays due to immaturity. The
NICU provides specialized high-technology care to the neonates; however, the environment is
often stressful for the preterm neonates. Intense sensory stimulation from the NICU
environment on immature neurological sensory systems places preterm neonates at risk of
adverse sensory developmental outcomes. Developmental care strategies such as olfactory,
tactile, and auditory stimulation modulate the NICU environment to foster better growth and
development for preterm neonates. Preterm neonates who are exposed to breast milk olfactory
stimulation had stable physiological parameters, better organized behavioral responses, more
mature feeding abilities, and better weight gain in addition they have a shorter duration in
hospitals.
This study was carried out to investigate the effect of breast milk olfactory stimulation
on behavioral responses and feeding progression of preterm neonates. The study was
conducted in the NICU at the Specialized University Hospital for children at Smouha. A
convenient sample of 60 preterm neonates admitted to NICU who comprised the study
subjects. The neonates were randomly assigned into two equal groups, study and control (30
neonates for each). First group was the control group who was received only routine care of
the unit. Whereas the second group received breast milk olfactory stimulation.
Three tools used to collect the necessary data. Tool One: characteristics and
physiological parameters of the Preterm Neonates Assessment Record, It includes two parts:-
part I characteristics and medical data of preterm neonates such as age, sex, gestational age,
current weight and diagnosis. Part II: Physiological parameters of preterm neonates such as,
respiratory rate, heart rate and oxygen saturation (SPO2).Tool Two: Neonatal Behaviors
Assessment Record: - It includes two parts. Part I:- Preterm Neonate’s Orally Directed
Behavioral Responses For Feeding: it includes pre feeding cues such as rooting, hand to
mouth, empty sucking and sucking on hand. Part II: -Behavioral State of Preterm Neonates:
such as quite sleep, alert drowsy and crying. Tool Three: Preterm Neonates Feeding
Progression Assessment Record. It includes feeding progression criteria such as: sucking,
swallowing, and amount of feeding and current weight of preterm neonates. Tools were
developed by the researcher after reviewing the relevant literature. Tools were tested for their
content validity by five experts in the Pediatric Nursing field. The data was collected over a
period of 11 months extended from the beginning of November-2021 to the end of September
2022.
The main results of the current study revealed the following:
More than half of preterm neonates in OSG (56.7%) ranged from 10 to 20 days were
compared to 40% in control group.
More than three quarters of preterm neonates (80.0%) in OSG ranged from 34-35 weeks
of gestation compared to 33% among control group.
Nearly three quarters of preterm neonates in OSG were small for gestational age with a
mean age of 34.90 ± 0.71 compared to 90.0% of preterm neonates in control group with
a mean age of 34.60 ± 0.72.
Two thirds of preterm neonates (66.7 %) in OSG were males compared to 43.3% of
preterm neonates in the control group
The mean weight of preterm neonates on admission in OSG was 1390.57 ± 46.55
compared to 1322.10 ± 66.26 of preterm neonates in the control group
More than one third of preterm neonates (36.7%) in the OSG were diagnosed with
respiratory distress syndrome (RDS) compared to 40.0% of preterm neonates in control
group.
Almost all preterm neonates among both group (93.3%) had normal respiratory rate (30-
60c\m) before feeding on the seventh day.
Almost all of preterm neonates among OSG (96.7%) had normal respiratory rate after
feeding compared to 100% of preterm neonates among control group on the third and the
seventh days.
Less than three quarters of preterm neonates (70.0%) among OSG had normal heart
rates (120-160 b\m) before feeding compared to 93.3% among control group. Statistical
significant difference was found (p=0.033) on the seventh day.
The percentages of preterm neonates who had normal heart rates almost similar among
OSG and control group (80% and 83.3% respectively) after feeding on the seventh day
among preterm neonates of both groups.
Concerning to normal range of oxygen saturation (95-100%), Statistical significant
differences between OSG and control group were found on the third and seventh day
(p=<0.001 for each).
More than three quarters of preterm neonates in OSG (76.7%) exhibited rooting reflex
compared to 66.7% in control group on the third day. Furthermore, this percentage
jumped to 100.0% of preterm neonates in OSG compared to 60.0% of preterm neonates
in control group. Statistical significant difference was found between both groups on the
first day and seventh day (p=<0.001*p=0.035).
Half of preterm neonates in OSG (50.0%) moved their hands to mouth compared to
33.3% of preterm neonates in control group on the third day. On seventh day, these
percentages increased to 63.3% of preterm neonates in OSG compared to only 20% of
preterm neonates among control group. Statistical significant difference was found
between two groups on the seventh day (p=0.001)
More than three quarters of preterm neonates among OSG (76.7%) displayed empty
sucking compared to 40.0 % of preterm neonates among control group on the third day.
Additionally, the percentages of preterm neonates among OSG increased to 83.3%
compared to 50 % among control group on the seventh day. Statistical significant
differences were found between both groups on the third and seventh days (p=<0.004
&p=0.006).
Less than one half of preterm neonates (40.0%) among olfactory stimulation group
displayed hand sucking before feeding compared to only 10.0% of preterm neonates in
control group on the first & seventh day. Statistical significant differences were found
between two groups on the first and seventh day (p=0.007 for each).
More than one third of preterm neonates (36.7%) of OSG and control groups had quite
sleep on the first day after feeding. The percentage of preterm neonates in OSG
increased to70% on the third and seventh days compared to 43.3% of preterm neonates
in the control group. Statistical significant differences were found between the two
groups on the third and seventh days (p=0.037 for each).
Concerning the alert drowsy state, it was found that with no statistical significant
difference between both groups on the three days.
Small proportions of preterm neonates among OSG cried after feeding on the first and
third days (16.7 % & 6.7 % respectively) compared to 26.7%& 20.0% of preterm
neonates in the control group. On the seventh day none of preterm neonates had crying
among OSG compared to 36.7% of preterm neonates among control group. Highly
statistical significant difference was found between the two groups on the seventh day
(p= <0.001).
More than half of preterm neonates 56.7% of OSG had easy beginning of sucking
compared to 73.3% among control group on the first day. On the third day those
percentages showed slight decrease in OSG and control group (53.3% & 63.3%
respectively). While all preterm neonates among both groups (100%) had easy beginning
of sucking on the seventh day.
The majority of preterm neonates among OSG (93.3%) maintained their tongue in the
central groove during feeding compared to 86.7% of preterm neonates on the first day.
These percentages was decreased in both group to 70% on the third day and showed
further increase to 100% in both groups on the seventh day.
More than one third of preterm neonates (36.7%) among OSG had peristaltic tongue
movement during feeding compared to 46.7% in control group on the first day. These
percentages decreased to 33.3% among both groups on the third day. Moreover, the
proportions of preterm neonates were close among both group (60.0% &63.3%
respectively) on the seventh day.
Majority of preterm neonates among OSG (93.3%) had jaw rising and lowering
movement on the first day and this percentages increased to 96.7% on the third day but
returned to decrease to76.7% on the seventh day. For the control group it also had an
increase on the first and third day (86.7% & 100% respectively) and decreased to 80.0%
on the seventh day.
Less than half of preterm neonates among OSG (46.7%) had tongue and jaw
coordination on the first day and this percentage increased to 73.3% on the third and
seventh day. While in the control group the percentages of preterm neonates who had
tongue and jaw coordination were 50% on the first day and increased on the third day to
80.0% and returned to decrease to 70.0% on the seventh day.
The percentages of preterm neonates among OSG who had good sucking strength on the
three days (33.3%, 80.0% & 60.0% respectively) were less than that in the control group
on the three days (46.7%, 83.3% & 66.7% respectively).
Half of the preterm neonate among OSG (50%) had organized sucking rhythm compared
to 36.7% among control group in the first day. On the other hand, these percentages
changed to 36.7% among OSG compared to 46.7% of the control group on the third day.
Additionally, on the seventh day the percentages of preterm neonates were the same
(83.3%) among both groups.
Regarding suction, swallowing and breathing coordination, nearly same percentage of
preterm neonates in both OSG and control group (30% and 33.3% respectively) had
suction, swallowing and breathing coordination. This percentage increased on the third
day to be 76.7% in olfactory stimulation group and 70% in the control group. In the
seventh day, the percentage of preterm neonates in OSG increased again to 83.3%
compared to preterm neonates in the control group who decreased to 56.7 with
statistically significant difference (P= 0.024)
The majority of preterm neonates (90%) in the OSG had orally ejected milk on the first
day. Then, the percentage decreased on the third and seventh days (40% for each). For
the control group, 63.3% of preterm neonates had oral milk ejection on the first day and
the percentage decreased to 26.7% on the third and seventh days. A statistically
significant difference was found between both groups on the first day (P=< 0.015)
The mean total amount of milk received by preterm neonates among the OSG on the first
day was 85.83 ± 13.34 cc compared to 80.17 ± 11.78 cc in the control group. This mean
was increased to 92.70 ± 13.12 cc among the olfactory stimulation group compared to
83.40 ± 11.69 cc among the control group on the third day. On the seventh day the mean
total amount of milk received by preterm neonates in OSG showed an increase to 100.43
± 9.04 cc compared to 86.67 ± 9.97 cc in the control group. Statistical significant
differences were found between both groups on the third and seventh days (p=<0.005 &
p=<0.001 respectively).
The mean body weight of preterm neonates among OSG groups was 1440.83 ± 48.22
grams compared to 1363.03 ± 3476 grams among the control group on the first day. On
the third day, the mean body weight of preterm neonates among OSG increased to
1451.93 ± 46.71 grams compared to 1367.40 ± 36.35 grams of the control group.
Additionally, the mean body weight of preterm neonates among OSG increased to
1482.50 ± 51.81 grams compared to 1374.17 ± 38.36 grams among the control group on
the seventh day. The statistical significant differences were found between the two
groups on the first, third and seventh days (p=<0.001 for each).