Highlights
- •The comfort of preterm infants was the best in prone position, although the comfort levels were not low enough to require a pain relief intervention in any of the four positions.
- •Four positions (prone, supine, right lateral and left lateral) given to preterm infants treated with NCPAP did not affect the infant's cardiorespiratory stabilization
- •The preterm infant's diagnosis, the time waited for the baby to stabilize after the positioning and the time the infant was kept in the same position were determinant regarding the effect of the position on the heart rate and respiration
Abstract
Purpose
The purpose of the study is to investigate the effect of four body positions (supine,
prone, left lateral, right lateral) on cardiorespiratory stabilization and comfort
in preterm infants receiving Nasal Continuous Positive Airway Pressure (NCPAP).
Design and methods
In the study conducted as a randomized crossover design, the sample was composed of
20 preterm infants receiving NCPAP therapy. At each change of position, the baby was
allowed to stabilize for 15 min, and heart rate and oxygen saturation values were recorded every 10 min for the next 60 min. The comfort levels of the infants
in each position were evaluated at 30th and 60th minutes using the Premature Infant
Comfort Scale.
Results
At the end of the study, it was determined that there was no statistically significant
difference between heart rate (p = .83), respiratory rate (p = .90) and oxygen saturation (p = .15) of the infants in terms of their positions. When the mean comfort scores of
the preterm infants were compared in terms of position, it was found that there was
a difference between the positions (p < .01). According to the scale evaluation, the highest comfort level of the infants
was in the prone position, which was followed by right lateral, supine and left lateral
positions.
Practice implications
Prone position was the most comfortable for preterm infants. However, comfort levels
of preterm infants were also high enough in other positions so that no intervention
is needed. In order to ensure comfort and cardiorespiratory stabilization, any of
the four body positions can be chosen.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric Nursing: Nursing Care of Children and FamiliesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Effects of body position on thermal, cardiorespiratory and metabolic activity in low birth weight infants.Early Human Development. 2009; 85: 497-501https://doi.org/10.1016/j.earlhumdev.2009.04.005
- Fewer spontaneous arousals during prone sleep in preterm infants at 1 and 3 months corrected age.Journal of Perinatology. 2006; 26: 306-312
- Yenidoğan yoğun bakım ünitelerinde bireyselleştirilmiş gelişimsel bakım: Güncel yaklaşımlar [ Individualized developmental care in neonatal intensive care unit: Current approaches: Review].Türkiye Klinikleri. 2017; 9: 245-254https://doi.org/10.5336/nurses.2017-55289
- Yenidoğan yoğun bakım hemşirelerinin preterm yenidoğanlara uygulanacak terapötik pozisyonlar hakkındaki bilgi düzeyi [ neonatal intensive care unit nurses’ levels of information regarding therapeutic positions to be applied to preterm newborns].Güncel Pediatri. 2015; 13: 21-30https://doi.org/10.4274/jcp.26349
- Effect of prone and supine position on sleep, apneas, and arousal in preterm infants.Pediatrics. 2006; 118: 101-107
- Effect of body position on preterm newborns receiving continuous positive airway pressure.Acta Pediatrica. 2014; 103: e101-e105https://doi.org/10.1111/apa.12504
- The effect of prolonged lateral positioning during routine care on regional lung volume changes in preterm infants.Pediatric Pulmonology. 2016; 51: 280-285https://doi.org/10.1002/ppul.23254
- Measurement of pain in premature infants with a gestational age between 28 to 37 weeks: Validation of the adapted COMFORT scale.Journal of Neonatal Nursing. 2007; 13: 13-18https://doi.org/10.1016/j.jnn.2006.11.007
- Influence of prone positioning on premature newborn infant stress assessed by means of salivary cortisol measurement: Pilot study.Revista Brasileira de Terapia Intensiva. 2014; 26: 169-175https://doi.org/10.5935/0103-507X.20140025
- Decreased activity and oxygen desaturation in prone ventilated preterm infants during the first postnatal week.Heart& Lung: The Journal of Acute and Critical Care. 2002; 31: 34-42https://doi.org/10.1067/mhl.2002.120241
- Transparent Reporting of Trials.Consort 2010 key documents.(Accessed 12.12.2019)
- Hammock and nesting in preterm infants: randomized control trial.Revista Brasileira de Enfermagen. 2019; 72: 96-102https://doi.org/10.1590/0034-7167-2018-0099
- Age-appropriate care of the premature and critically I11 hospitalized infant: Guideline for practice.National Association of Neonatal Nurses, Glenview, IL2011
- Effect of prone versus supine position on oxygen saturation in patients with respiratory distress in neonates.Pakistan Journal of Medical Sciences. 2011; 27: 1098-1101
- Mechanical Ventilation.in: Cloherty J.P. Eichenwald E.C. Hansen A.R. Stark A.R. Manual of neonatal care. 7th ed. Lippincott Williams & Wilkins, Philadelphia2012: 377-392
- Comparison of massage and prone position on heart rate and blood oxygen saturation level in preterm neonates hospitalized in neonatal intensive care unit: A randomized controlled trial.Iranian Journal of Nursing and Midwifery Research. 2019; 24: 343-347https://doi.org/10.4103/ijnmr.IJNMR_34_18
- Spontaneous arousals in supine infants while swaddled and unswaddled during rapid eye movement and quiet sleep.Pediatrics. 2002; 110e70https://doi.org/10.1542/peds.110.6.e70
- Comparison the effect of sleep positioning on cardiorespiratory rate in non-invasive ventilated premature infants.Nursing and Midwifery Studies. 2013; 2: 182-187
- Positioning effects on lung function and breathing pattern in premature newborns.The Journal of Pediatrics. 2013; 162: 1133-1137https://doi.org/10.1016/j.jpeds.2012.11.036
- Comparison of motor self-regulatory and stress behaviors of preterm infants across body positions.American Journal of Occupational Therapy. 2003; 57: 289-297https://doi.org/10.5014/ajot.57.3.289
- Prematüre yenidoğanlar için geliştirilmiş bireyselleştirilmiş destekleyici gelişimsel bakım programı [An individualized supportive developmental careprogram developed for premature newborns].Uluslararası Hakemli Kadın Hastalıkları ve Anne Çocuk Sağlığı Dergisi. 2017; 9: 41-61https://doi.org/10.17367/JACSD.2017.1.004
- Continuous distending pressure for respiratory distress in preterm infants. (Review).Cochrane Database of Systematic Reviews. 2015; 7https://doi.org/10.1002/14651858.CD002271.pub2
- Neurobehavioral development.in: Kenner C. Lott J.W. Comprehensive Neonatal Nursing Care (5 th ed.; pp. 705). Springer Publishing Company, New York2014
- Effect of body position on ventilation distribution in preterm infants on continuous positive airway pressure.Pediatric Critical Care Medicine. 2012; 13: 446-451https://doi.org/10.1097/PCC.0b013e31822f18d9
- Effect of time and body position on ventilation in premature infants.Pediatric Research. 2016; 80: 499-504
- Effects of prone and supine positions on sleep state and stress responses in preterm infants.Infant Behavior and Development. 2011; 34: 257-263https://doi.org/10.1016/j.infbeh.2010.12.014
- Supine and prone infant positionin: A winning combination.The Journal of Perinatal Education. 2004; 13: 10-20
Kahraman, A., Başbakkal Z., Yalaz, M. & Sözmen, E.Y (2017) The effect of nesting positions on pain, stress and comfort during heel lance in premature infants. Pediatrics and Neonatology, 59(4), 352–359. doi: https://doi.org/10.1016/j.pedneo.2017.11.010.
- Comfort theory and its application to pediatric nursing.Pediatric Nursing. 2005; 31: 187-194
- Prematüre bebek konfor ölçeği’nin türkçe geçerlilik ve güvenilirliği [The reliability and validity of the premature infant comfort scale’s Turkish].Hemşirelikte Eğitim ve Araştırma Dergisi. 2015; 12: 142-148https://doi.org/10.5222/HEAD.2015.142
- Effect of posture on respiratory function and drive in preterm infants prior todischarge.Pediatric Pulmonology. 2003; 36: 295-300
- The small baby.in: Meeks M. Hallsworth M. Yeo H. Nursing The Neonate (2 nd ed.; pp. 65-78). Blackwell Publishing, Malaysia2010
- The effectiveness of quarter turn from prone in maintaining respiratory function in premature infants.Journal of Paediatrics and Child Health. 2014; 50: 972-977https://doi.org/10.1111/jpc.12689
- A review of non-invasive ventilation support in neonates.Paediatrics and Child Health. 2013; 24: 7-10
- The effect of positioning on preterm infants’ sleep–wake states and stress behaviours during exposure to environmental stressors.Journal of Child Health Care. 2014; 18: 314-325https://doi.org/10.1177/1367493513496665
- Infant position in neonates receiving mechanical ventilation (review).Cochrane Database of Systematic Reviews. 2016; 11https://doi.org/10.1002/14651858. CD003668.pub4
- Physiological and behavioural effects of preterm infant positioning in neonatal intensive care unit.British Journal of Midwifery. 2017; 25: 647-654https://doi.org/10.12968/bjom.2017.25.10.647
- Prone sleeping position in infancy: Implications for cardiovascular and cerebrovascular fuction.Sleep Medicine Reviews. 2017; 39: 174-186
- The effects of flexed (fetal tucking) and extended (free body) postures on the daily sleep quantity of hospitalized premature infants: A randomized clinical trial.Journal of Research in Medical Sciences. 2016; 21: 1-8https://doi.org/10.4103/1735-1995.196606
- Developmental care.in: Meeks M. Hallsworth M. Yeo H. Nursing the Neonate (2 nd ed.; pp. 316-333). Blackwell publishing, Malaysia2010
- Semi-prone position can influence variability in respiratory rate of premature infants using nasal CPAP.Journal of Pediatric Nursing. 2016; 31: e167-e174https://doi.org/10.1016/j.pedn.2015.10.014
- Nursing preterm babies intensive care: Which position is best?.Journal of Neonatal Nursing. 1994; 1: 27-31
Article info
Publication history
Published online: July 15, 2020
Accepted:
June 24,
2020
Received in revised form:
May 24,
2020
Received:
August 15,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
