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Effectiveness of Nesting Positioning on Physiological Parameters and Behavioral State, among Preterm Neonates in Neonatal Intensive Care Unit (NICU)
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Introduction: Neonatal respiratory dysfunction is common because the process of lung development is protracted and differentiation of anatomic structures for gas exchanging and surface and surfactant production begins there after survival increases markedly. The risk of an Indian child dying of respiratory problems is 30-75 times more than that of its counterpart in the developed world. In India they account for 14.3% of deaths during infancy. Positions are important to reduce the breathing difficulties by improving lung ventilation because of gravity action in different positions. Methods: A True-Experimental pretest posttest design was adopted for the study. The study was conducted in selected Hospital, Nellore District.60 infants with respiratory problems were selected by simple random technique. Observational check list was used to assess the respiratory parameters. Results: The study shows that in supine position among 30 infants in pretest, 17 (57%) children had mild, 11 (37%) had moderate and 2 (6%) had severe respiratory difficulty whereas in posttest 24 (80%) had mild, 5 (17%) had moderate and 1 (3%) had severe respiratory difficulty. In lateral position group among 30 samples in pretest, 23 (77%) infants had mild, 7 (23%) had moderate respiratory difficulty whereas in posttest, 20 (67%) infants had mild, 8(27%) had moderate and 2(6%) had severe respiratory difficulty. Conclusion: The study reveals that there is no significant difference with supine or lateral position on respiratory parameters in both group-I and group-II among infants with respiratory problems.
Objective:
The objectrve is to compare the analgesic effect of Kangaroo Mother Care (KMC), oral dextrose 50% (D50) and supine nesting position in late preterm neonates (34 week to <37 week Gestation Age) while doing heel prick for blood glucose monitoring.
Materials and methods:
Babies were randomized into three groups; KMC, D50 and supine nesting. Premature infant pain profile (PIPP) score was used to measure pain severity following heel prick. Total crying time was also compared.
Results:
Data of 149 eligible babies were analyzed; significant difference was noted in total PIPP scores (mean; SD) across groups; KMC (8.42 [1.99]), D50 (8.76 [1.84]) and nesting (13.08 [1.70]) (P < 0.001). Post hoc analysis revealed comparable scores among KMC and D50 groups (P = 0.638), significantly less than nesting group (P < 0.001). Significant difference in crying time (median; interquartile range) was also noted amongst three groups (P < 0.001).
Conclusion:
The analgesic effect of KMC and oral D50 is comparable and found to be superior to supine nesting position in reducing pain of heel prick.
Aim: Premature babies are vulnerable to environmental stress factors mostly in the first weeks of life. During this time, supportive positioning, especially used all-around the baby, makes them feel better as if they are in utero. The aim of the study was to evaluate the effect of supportive positioning on weight gain, vital signs, feeding intolerance, duration of ventilation, duration of hospitalization and comfort scale scores of the premature babies in neonatal intensive care unit.
Material and Methods: A total of 50 premature infants were recruited into the study randomly, 25 in the supported group and 25 in the control group. The babies in the supported group were nested with soft blankets and pillows as position material. There was no nesting or swaddling in the control group. Demographic findings, comfort scale scores, heart rate, respiratory rate and oxygen saturation of infants were recorded and compared.
Results: Mean gestational weeks and birth weights of the supported and control groups were 32.9±2.5 (26-36) vs. 32.7±2.8 (26-36) weeks (p=0.791) and 1554±492 (680-2380) vs. 1772±439 (590-2375) g (p=0.105), respectively. Weight gain, ventilator days and days of hospitalization were similar in groups, however mean oxygen saturation and comfort scale scores showing deep sedation were higher in the supported group (p=0,024, p<0,001, respectively) after daily care.
Conclusion: Although supportive positioning does not have an effect on duration of hospitalization, ventilation and weight gain, it has a positive effect on mean oxygen saturation and comfort scale scores of premature infants and recommended in newborn care.
Objective:
To compare the physiological variables and the sleep-wake pattern presented by preterm in nesting and hammock positions after diaper change.
Method:
This is a crossover randomized controlled trial. It was conducted with 20 preterm infants who, after diaper change, were placed in nests or hammocks. These preterm infants were evaluated for physiological variables (heart rate and oxygen saturation) and behavioral variables (sleep and wakefulness).
Results:
There was no statistically significant difference in the studied variables between nesting and hammock positions. However, regarding the categorical variable sleep, the comparison between the research phases for the hammock position showed differences between the baseline phase and the immediate recovery (p=0.00), baseline and late recovery (p=0.00), response and immediate recovery (p=0.00), response and late recovery (p=0.00).
Conclusion:
No differences were identified between the nest and the hammock; however, the use of the hammock favored the sleep of preterm infants compared to its non-use.
Aim:
Prone and kangaroo care positioning of preterm infants during intragastric tube feeding were compared with regard to post prandial gastric residual volume, vital signs and infant comfort.
Methods:
The study sample included 30 28-36-birth-week old preterm infants who were hospitalized at the neonatal intensive care unit. Infants were fed in two positions: prone and kangaroo care. All the infants were placed in the prone position after feeding. Vital signs and comfort scores were recorded 30 min after feeding, and the gastric residual volume was measured 3 h after feeding.
Results:
After 3 h of feeding, the heart rate was lower in the kangaroo care position than in the prone position. After 30 min and 3 h of feeding, the mean comfort scores and the mean distress scores were lower in the kangaroo care position than in the prone position. It was also determined that there was no significant difference between the kangaroo care position and prone position regarding their effects on the residual volume measured 3 h after feeding.
Conclusions:
The infants fed in the kangaroo care position have a lower heart rate, better comfort levels and less distress after feeding. These positive effects ensure that preterm infants experience less stress and consume less energy. What is currently known? It has been determined that kangaroo care reduces the pain response and heart rate of the newborn, increases the duration of sleep, reduces the length of stay in the hospital, facilitates breastfeeding, reduces the risk of hypothermia, decreases the mother's anxiety level by initiating the relationship between the mother and infant, and improves the infant's growth and development. What does this article add? While there were no differences between prone and kangaroo positions during feeding with regard to gastric residual volumes, we found that the heart rate, comfort scores and distress scores were lower in the kangaroo care position than in the prone position.
Background
Nesting positions are commonly used in procedural analgesic administration in premature neonates. The effectiveness of nesting positions is questioned. The aim of the this study was to assess the pain, stress, comfort and salivary cortisol and melatonin values in nesting positions during the heel lance procedure in premature infants at the NICU.
Methods
Experimental research; repeated measurement design. The sample comprised 33 premature neonates with gestational age of 31–35 weeks who had been hospitalized in the NICU. Nesting positions were given using linen or towels. The procedure of heel lance was recorded on camera. The camera recordings were evaluated according to the NIPS and the COMFORTneo scale. Saliva samples were obtained five minutes prior to and 30 minutes after the heel lance procedure. Salivary Cortisol and Melatonin were measured using the Salimetrics Cortisol Elisa Kit and the Salimetrics Melatonin Elisa Kit.
Results
The crying time, the mean NIPS score, the COMFORTneo score, the COMFORTneo NRS-pain scores and the COMFORTneo NRS-distress scores for premature neonates who were in the prone position during the procedure were significantly lower than the scores in the supine position (p<0.000). Furthermore, the level of salivary cortisol five minutes prior to and 30 minutes after the heel lance procedure had significantly decreased in the prone position; however, there were insignificant differences in the mean levels of salivary melatonin between the positions.
Conclusions
Nesting in the prone position has a pain reducing effect, enhancing comfort and reducing stress in premature infants.
Background: Neonatal period is the weakest period of life as it causes high rates of morbidity and mortality due to various diseases, especially in preterm infants and those with low birth weight. Aim of the present study: assessment of the risk factors and incidence of neonatal mortality in neonatal intensive care units in Tanta city. Subjects and Methods: Multi-centric prospective Cohort study that was conduct in Neonatal Intensive Care Units in Tanta city (5 public centers and 10 private centers). The duration was 6 months from August 2017 to January 2018. Results: Incidence of neonatal mortality among the studied sample during a period of six months was 27.7%. The most common cause of neonatal deaths was prematurity (39.4%). Cesarean section was the highest maternal risk factors (64.3%) among the study sample. Positive consanguinity was found in 52% and had statistically significant on neonatal mortality. There was no statistically significant difference between survived and expired neonates, while gestational age and birth weight were statistically significant. Neonatal mortality was higher between lower gestational age and lower birth weight. Conclusion: Neonatal mortality rates were found to be significantly high in prematurity, low gestational age, low birth weight, cesarean section and positive consanguinity. Improvement of health care qualities is needed to control the preventable risk factors and decrease neonatal morality.
Introduction:
Premature infants undergo numerous painful procedures during hospitalization. Some trials have examined the effectiveness and safety of combined nonpharmacological interventions in which two or more non-pharmacological interventions are used simultaneously or continuously to relieve repeated procedural pain via multisensory stimulation in preterm neonates. However, a systematic review of this topic has not yet been carried out.
Objective:
To review the evidence on the efficacy and safety of combined nonpharmacological interventions for repeated procedural pain in preterm neonates.
Method:
Eight databases were searched using keywords to identify peer-reviewed journal articles in English or Chinese. Randomized controlled trials (RCTs) focusing on combined nonpharmacological interventions for repeated procedural pain in preterm neonates published from database inception until May 2019 were included.
Results:
Eight RCTs were retrieved that included ten different combined nonpharmacological interventions. Different study designs were used in the included trials, which did not allow us to carry out a meta-analysis. The findings from the included articles were categorized in terms of efficacy and safety. With respect to efficacy, 1. two trials reported that combined nonpharmacological interventions were more effective than usual care during painful procedures; 2. three trials reported that combined nonpharmacological interventions were more effective than single nonpharmacological interventions; 3. three trials reported the effects of different combinations of nonpharmacological interventions and found that their effect depends on intervention type rather than number of interventions. Only four trials reported on safety, and they found that combined nonpharmacological interventions were safe for repeated procedural pain in preterm neonates.
Conclusion:
According to the literature, combined nonpharmacological interventions may be effective and safe for repeated procedural pain in premature infants. However, due to the diversity of interventions included in this systematic review, the evidence is not strong enough to produce a best practice guideline. Further research is needed with larger sample sizes and less heterogeneity to adequately explore the efficacy and safety of combined nonpharmacological interventions for repeated procedural pain in premature infants.
Low-birth weight (LBW) infants have a major problem of sleep–awake and instability on physiological function. The objective of this study was to identify the effect of nesting with fixation and position on sleep–awake status and physiological function. This study used a crossover design and was conducted in a general hospital in Jakarta, involving 19 LBW infants who met the inclusion criteria. The intervention consisted of: nesting with fixation combined with prone position (NFPP) (A), nesting with fixation combined with quarter prone position (NFQP) (B), nesting with quarter prone position (NQP) (C), and control group (D). The results of this study showed that there was a significant difference between NFPP and NFQP compared to the control group in regard to quiet sleep and oxygen saturation (p < .05). Nesting with fixation combined with prone position was the most effective method to facilitate quiet sleep and the stability of SaO2 followed by nesting with fixation combined with quarter prone position as alternative intervention for LBW infant. Therefore, the application of nesting with fixation is needed.
Quality problem or issue:
Infant positioning may interfere with neuromotor development. Bedside education and Infant Positioning Assessment Tool (IPAT) improve nurses' and doctors' proficiency in applying proper infant positioning.
Initial assessment:
Nursing compliance with proper positioning is suboptimal due to many factors. One factor was the inadequate knowledge and practice of infant positioning, since the baseline mean IPAT score was 3.4.
Choice of solution:
Three experienced neonatal intensive care unit (NICU) nurses were chosen as position champions to help other NICU nurses apply proper positioning and monitor IPAT scores. Education and hands-on demonstration sessions were developed based on the observed baseline practice.
Implementation:
Periodic education with hands-on demonstration was given to NICU nurses and residents. Infants' positions were objectively scored using IPAT. Two Plan, Do, Study and Act cycles were completed and adjustments were made based on each cycle's achieved results.
Evaluation:
Mean IPAT scores increased from 3.4 at baseline and 6.3 in the second cycle to 7.3 in the third cycle of intervention.
Lessons learned:
A systematic approach targeting infants' positioning succeeded in improving nurses' and residents' clinical performance. Not reaching significant change until after 18 months highlights the difficulty and complexity in changing behaviors.
Background: The WHO has defined KMC as early, continuous, and prolonged skin-to-skin contact between the mother and preterm babies. Exclusive breastfeeding is one of the most important essential components of Kangaroo Mother Care in preterm babiesMethods: This a cross sectional study, 265 consecutive premature newborns admitted to neonatal intensive care unit (NICU) between May 2015 and May 2016 in KIMS NICU Hospital in Bengaluru were evaluated. All of candidate mothers were educated for KMC and compared with a CMC group.Results: In this study 159 mothers performed kangaroo mother care (KMC group) versus 106 in conventional method care (CMC group). In KMC group exclusive breast feeding was 99 (65.2%) versus 40 (37.7%), and P = .00 in CMC group, at the time of hospital discharge. Receiving KMC, and gestational age were the only effective factors predicting exclusive breastfeeding. Present result indicated that there was a 2.7 time increase in exclusive breastfeeding by KMC, and also weekly increase in gestational age increased it 0.9 times, but maternal age, birth weight, mode of delivery, and 5-minute Apgar score had no influence.Conclusions: KMC is more effective, and increases exclusive breast feeding successfully. It can be a good substitution for CMC (conventional methods of care). It is a safe, effective, and feasible method of care for LBWI even in the NICU settings.
The Brazelton Neonatal Behavioral Assessment attempts to capture the behaviors of the neonate as he defends himself from intrusive, negative stimuli, and controls interfering motor and autonomic responses in order to attend to important social and nonsocial stimuli. In order to conceptualize the 26 behavioral items and 20 reflex scores, four clusters or typologies have been identified which help to reduce the data for analytic purposes with small numbers of subjects. So far few long-term validation studies have been completed, although the scale is in use in many different areas, such as obstetrical medication, predicting to neurological deficits, cross-cultural differences, and with low birth weight infants.
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