Impact of cyclical positioning on total duration of ventilation in pretrem neonates (less than 34 weeks) -a randomised controlled trial

In my study, in the preinitiation phase, all healthcare professionals will be trained for positioning maneuvers in intubated neonates and those on non invasive ventilation and trained to identify and tackle any adversities associated. We will include neonates less than 34 weeks of gestation and ventilated at inborn or outborn unit for atleast 3 days. Exluded babies will have extreme prematurity (less than 28 weeks of gestation, Persistant pulmonary hypertension of newborn, Babies operated or to be operated on for any surgical cause, Fragile bone disease like osteogenesis imperfecta, Intracranial hemorrhage , birth trauma like fracture bone. We will take consent from parents in the next stage followed by Randomization by computer generated block of size 4 and allocation concealment will be done by serially numbered opaque envelope. We will determine baseline characteristics of enrolled babies and then start the intervention that is protocolised cyclical positioning after 3 days of ventilation. Primary outcome will be total invasive and noninvasive ventilator days and in secondary outcome we will see total number of babies with ventilator associated pneumonia, extubation failure, Duration of nicu stay in days, Duration of only oxygen therapy post weaning, sepsis defined as use of antibiotics post enrollment, intraventricular hemorrhage, pneumothorax and mortality. Then we will do the intention to treat analysis and per protocol analysis.

Our total sample size is 64 and 32 babies in each arm. Aim of my study is to prove that efficacy of protocolised change in position of ventilated neonate will reduce ventilator days significantly . My total study duration is one year and will be conducted in both inborn and outborn unit of LNJP hospital associated with Maulana Azad Medical College.

In previous studies done on preterm neonates, full chest physiotherapy was performed including percussion, vibration along with position change which reduced ventilator days by 7 days. As full physiotherapy is not feasible for every preterm babies we want to do only cyclical position change every 6 hourly that is from supine to right lateral then prone positioning then left lateral and back to supine till baby is off ventilator. We want to show that only this maneuver should reduce ventilator dats by 33 percent of 7 days that is atleast 3 days. Which has not been done in prior studies in literature, hence fulfilling the purpose of my study .