الفهرس 
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Abstract
However, advances in medical research have improved birth outcomes, preterm birth
outcomes remain issues of public health concern, particularly in low- and middle-income
countries, as significant contributors to morbidity and mortality during neonatal, infancy, and
childhood stages. The transition from intra- to extrauterine life requires rapid, complex and
well-orchestrated steps to ensure neonatal survival. Preterm neonates, especially late preterm
ones are physiologically and metabolically immature at birth, and can be lacking of the selfregulatory
ability to appropriately adapt to the extra-uterine environment that takes several
weeks to many months.
Cardiorespiratory and behavioral assessment are a corner stone in the management of
preterm neonates. Neonatal nurses are in a unique position to safeguard the preterm neonate
from environmental stressors, such as noise to support their neurobehavioral capacities,
promoting physiological and motor development, and improve sleep efficiency of preterm
neonates through appropriate therapeutic touch method. Yakson’s touch method regulates the
sleep-wakefulness pattern by providing relaxation to infants and creating positive behaviors.
Early application of Yakson’s therapeutic touch is advocated to increase growth, improve
physiological and motor development, improve sleep efficiency, reducing behavioral stress,
and prevent the occurrence of neurodevelopmental disorders later in life.
The aim of the current study was to investigate the effect of Yakson’s therapeutic touch
on vital signs, growth measurements and behavioral state of preterm neonates.
The study was conducted in Neonatal Intensive Care Units of the Maternity University
Hospital at El-Shatby and the Specialized University Hospital at Smouha in Alexandria. A
convenience sampling of 60 preterm neonates comprised the subjects. Infants were being
randomly assigned to two equal groups: study groups and control (each group consisted of 30
preterm neonates). Study Group: Thirty premature neonates who received Yakson’s
therapeutic touch in addition to the routine care of the unit. Control Group: Thirty preterm
neonates who received only the routine care of the unit.
Three tools were used to collect data of the present study, namely: preterm neonate’s
perinatal and admission data assessment sheet, preterm neonates’ vital signs and growth
measurements record and Anderson Behavioral State Scale (ABSS). They were developed by
the researcher after reviewing the relevant literature.
The main results of the present study were as follows:
The gestational age of 53.3% of preterm neonates in the study group ranged from 34-36
wks. Whereas, gestational age of 60% of those in the control group ranged from 32 to 33
weeks.
The majority of preterm neonates in both study and control group (90% and 93.3%
respectively) had RDS and VLBW as the final diagnosis.
The mean birth weight and admission weight of preterm neonates in study group was the
same value as it was 1400.27±181.24 gm, while was 1401.17±206.84 gm in those in the
control group.
The total mean scores of preterm neonates’ body temperature in study group in morning
and evening shifts before and after intervention were 37.05±0.214 oc and 37.08±0.219 oc respectively, as well as in control group were 36.97±0.064 oc and 36.99±0.145 oc
respectively with statistically significant differences between study and control groups
before and after intervention.
The differences in the mean scores of preterm neonates’ body temperature in the study
group across the 5 days in the morning and evening shift before and after intervention were
statistically significant, while significant differences were found in the morning shift only
across the 5 days in the control group before and after routine care.
The mean scores of preterm neonates’ heart rate in the study group had decreased after
intervention than before throughout the study period, contrariwise in the control group. In
addition, there were statistically significant differences between study and control group
before and after intervention except in the morning and evening 1st day and morning 2nd
day before intervention.
The mean scores of preterm neonates’ respiratory rate in the study group decreased after
intervention than before through the study period, compared to those in the control group
which increased after routine care.
As well as, the total mean scores of preterm neonates’ respiratory rate in morning and
evening in the study group before and after intervention were 43.89±4.572 c/m and
41.79±4.558 c/m respectively, related to in the control group were 50.48±5.768 c/m and
53.86±5.751 c/m respectively with statistically significant differences (p=0.000).
Furthermore, the differences in the mean scores of preterm neonates’ respiratory rate
between the study and control groups were found before and after intervention across the
study period except in the morning 1st day before intervention. Moreover, the differences in
the study group before and after intervention were found in the morning and evening shift
across the study period (p=0.000), but there were no statistically significant differences in
the control group in the morning and evening shift before and after the routine care across
the study phases.
The mean scores of preterm neonates’ systolic blood pressure in study group were better
after intervention throughout the study period than those who were in the control group. As
well as, the total mean scores in morning and evening shifts of systolic blood pressure of
preterm neonates in the study group was 59.05±2.802 mmhg after intervention, but was
57.20±2.623 mmhg after routine care in the control group.
The total mean scores in morning and evening shifts of preterm neonates’ systolic blood
pressure showed statistically significant differences between study and control groups
before and after intervention, as well as in the study and in the control group before and
after intervention.
The mean scores of preterm neonates’ diastolic blood pressure in the study group were
improved after intervention than those in the control group throughout the study period. As
well as, the total mean scores in morning and evening shifts of diastolic blood pressure of
preterm neonates in the study group was 32.02±2.274 mmhg after intervention, compared
to 30.23±1.352 mmhg after routine care in the control group with statistically significant
differences between the study and control group before and after intervention (p=0.009 and
p=0.001 respectively).
The mean scores of preterm neonates’ oxygen saturation in the study group throughout the
study period were higher after intervention other than those in the control group as oxygen
saturation decreased after the routine care.
Statistically significant differences were not found in the mean scores of preterm neonates’
oxygen saturation between the study and the control group before intervention except in
the 1st and 4th day, while there were statistically significant differences between study and
control groups after intervention.
The increase in weight of preterm neonates in the study group throughout the study period
was somewhat higher than those in the control group.
However, there were no statistically significant differences in the mean scores of preterm
neonates’ weight between the study and control groups, a statistically significant difference
was found in the weight means scores of preterm neonates in the study group throughout
the study period (p=0.047) other than those in the control group (p=0.861).
The total mean scores of preterm neonates’ length in the study group were slightly higher
than those in the control group as it was 41.31±1.661 cm and 40.71±1.801 cm respectively.
Although, there were no statistically significant differences in the mean scores of preterm
neonates’ length between the study and the control group, a statistically significant
difference was found in the study group across the study days (p=0.009) other than in the
control group (p=0.106).
Even though, there were no statistically significant differences shown between the study
and the control group in the mean scores of preterm neonates’ head circumference
throughout the study period, the mean scores of preterm neonates’ head circumference in
the study group at the 5th day was to some extent higher than those in the control group as
they were 31.15±1.481 cm and 30.63±1.326 cm respectively.
Slight raise was shown in the mean scores of preterm neonates’ chest circumference in the
study group than those in the control group throughout the study period without
statistically significant differences between both groups.
On the other side, the difference was statistically significant in the total mean scores of
preterm neonates’ chest circumference between the study and the control group (p=0.012),
with a total mean score were 28.03±1.417 cm and 27.71±1.143 cm respectively.
Even though, no statistically significant differences were found in the mean scores of
preterm neonates’ mid-upper arm circumference between study and control groups across
the study phases, the total mean scores of mid-upper arm circumference of preterm
neonates in the study group was slightly higher than those in the control group as it was
7.40±0.683 cm and 7.21±0.768 cm respectively.
The mean scores of preterm neonates’ behavioral state in the study group decrease after
intervention, inverses to what occurred in the control group where the mean scores of
preterm neonates’ behavioral state in the control group increase after the routine care
throughout the study phases.
Statistically significant differences of the mean scores of preterm neonates’ behavioral
state were found between study and control groups before intervention except in the
morning 2nd, 4th, 5th day and evening 3rd and 5th day, even though there were statistically
significant differences between both groups after intervention in all days across the study
(p=0.000).
The total morning and the total evening body temperature, systolic and diastolic blood
pressure of preterm neonates in the study group slightly raised after intervention than those
in the control group after the routine care with statistically significant differences were shown between both groups except in the total morning body temperature mean scores.
The total morning and the total evening heart and respiratory rate mean scores of preterm
neonates in the study group decreased after intervention opposites to those in the control
group which increased after the routine care with statistically significant differences
between both groups before and after intervention (p=0.000).
The total morning and the total evening oxygen saturation mean scores of preterm neonates
raised after intervention in the study group, on the contrary to those in the control group as
they lowered after the routine care with statistically significant differences between both
groups after intervention only (p=0.000).
The total morning and the total evening behavioral state mean scores of preterm neonates
in the study group decreased after intervention (4.280±1.11 and 3.866±1.09 respectively),
inverse to those in the control group which increased after the routine care (10.17±0.686
and 10.41±0.897 respectively).
Thus, illustrates that the preterm neonates in the study group became calm, quiet and
sleepy after Yakson’s therapeutic touch, other than those in the control group which
became restless, agitated and crying after the routine care.
The differences in means of preterm neonates’ vital signs, growth measurements and
behavioral state scores before and after the routine care were statistically significant except
in preterm neonates’ weight which had a small size effect.
Furthermore, the routine care’s effect size regarding preterm neonates’ oxygen saturation,
length and head circumference was medium (Cohen’s D=0.59, Cohen’s D=0.63, and
Cohen’s D=0.76 respectively). While large effect size was found regarding preterm
neonates’ body temperature, chest circumference, heart and respiratory rate(Cohen’s
D=0.93, Cohen’s D=0.98, Cohen’s D=0.94, Cohen’s D=0.86 respectively).
On the other side, the routine care’s effect size of preterm neonates in the control group
regarding behavioral state, mid-upper arm circumference, systolic and diastolic blood
pressure was very large effect (Cohen’s D=2.51, Cohen’s D=1.31, Cohen’s D= 6.83, and Cohen’s D= 3.45 respectively).