Effectiveness of Positioning on the Movement and Clinical Physiological Outcomes of Preterm Neonates

Study Protocol

Introduction:

The NICU provides a sensory overload through excessive handling, noisy environment, neglected cry, prolonged sleep state and social interactions of the newborns with the professionals. All these make difficult the internal organization of the preterm neonate (Pereira et al, 2013). Also, when babies are born prematurely, their muscles have not yet acquired the appropriate tone which is normally low compared to the muscle tone of full-term neonates. With the deprivation of their usual space limits (uterus walls) and the action of gravity to which the neonates are exposed after birth, the preterm neonates acquire a posture of extension, which is contrary to the flexion they usually adopt in the uterus. This extension position does not help the flexion of their limbs and makes the hand-mouth activities and meeting the middle line difficult. Further, the deprivation of the physical rhythms of the neonates' usual space creates insecurity, irritability, increased extensive motor activity and difficulties with respiration and alertness-sleep cycle (Toso et al, 2015; Zarem et al, 2013).

There is a randomized controlled trial (RCT) that investigated the effectiveness of positioning on the general condition and ability to be fed of 100 neonates (≤ 32 weeks of gestation). This study compared a positioning using the Dandle Roo (DandleLion Medical) with traditional or other positioning (e.g. rolls of sheets, snuggle up) (Madlinger-Lewis et al, 2013). At term-age, a significant difference was found between the two groups, favoring the Dandle Roo positioning, in the movements symmetry as assessed with the NICU Network Neurobehavioral Scale (mean difference: 0.90, 95% confidence intervals: 0.05 to 1.75). No other significant differences were observed at rest of outcomes. Another RCT including 56 preterm neonates (27-32 weeks of gestation) explored the effects of positioning with the Snuggle up and Bendy Pumpers (Philips, USA) in comparison to traditional positioning (rolls of soft fabric). The results showed a significant difference between the two groups, favoring the intervention group, in respiratory rate, oxygen saturation, score of cardiovascular stability, and weight gain (p<0.5) (Sathish et al, 2017).

However, none of these previous studies has investigated any differences in the patterns of movement of the pre-term neonates after a positioning intervention. For example, no study has assessed the gross motor function of the pre-term neonates using the general movements of Prechtl after a positioning intervention, although this assessment is considered important for the prognosis of the motor development and ability for independence of these children (Einspieler et al, 2016). No previous study has also assessed the effect of positioning in the long-term neuro-developmental progress of pre-term children with scales such as the Denver II scale, which scale is also important for the prognosis of the development of the neonate.