Abstract
Objective
To improve developmentally supportive positioning practices by 50% in neonates weighing <1800 g, admitted in a neonatal intensive care unit over 6 months.
Methods
Infant Position Assessment Tool (IPAT) scores were used for assessment of the ideal position. Proportion of neonates with IPAT score ≥8 and improvement of average IPAT score were the process and the outcome measures, respectively. At baseline, 16.6% of infants had optimum position. After root cause analysis, interventions were done in multiple Plan-Do-Study-Act (PDSA) cycles of educational sessions, positioning audits, use of low-cost nesting aids, and training of mothers.
Results
Over 21 weeks, 74 neonates were observed at 714 opportunities. Over 6 months, mean (SD) IPAT score improved from 3.4 (1.4) to 9.2 (2.8). Optimum positioning was maintained in 83.3% neonates during sustenance phase.
Conclusions
Low-cost interventions, awareness regarding standards of optimum positioning and involvement of primary caregiver can effectively improve infant positioning practices.
Keywords: Conformational position, Infant Positioning Assessment Tool (IPAT), Nursing care, Posture, Outcome
Footnotes
Ethics clearance
Institutional ethics committee, AIIMS, Rishikesh; AIIMS/IEC/19/698; dated April 12, 2019.
Contributors
JU, PS, SB: conceptualized and designed the study, coordinated and supervised data collection, drafted the initial manuscript; KCD, SS, RG: coordinated and supervised data collection, and reviewed and revised the manuscript. All authors approved the final manuscript.
Funding
None
Competing interests
None stated.
References
- 1.Blackburn S. Environmental impact of the NICU on developmental outcomes. J Podiatry Nurs. 1998;13:279–89. doi: 10.1016/S0882-5963(98)80013-4. [DOI] [PubMed] [Google Scholar]
- 2.Altimier L, Phillips R. The neonatal integrative developmental care model: Advanced clinical applications of the seven core measures for neuroprotective family-centered developmental care. Newborn Infant Nurs Rev. 2016;16:230–44. doi: 10.1053/j.nainr.2016.09.030. [DOI] [Google Scholar]
- 3.Madlinger-Lewis L, Reynolds L, Zarem C, Crapnell T, Inder T, Pineda R. The effects of alternative positioning on preterm infants in the neonatal intensive care unit: A randomized clinical trial. Res Dev Disabil. 2014;35:490–7. doi: 10.1016/j.ridd.2013.11.019. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Vaivre-Douret L, Ennouri K, Jrad I, Garrec C, Papiernik E. Effect of positioning on the incidence of abnormalities of muscle tone in low-risk, preterm infants. Eur J Paediatr Neurol. 2004;8:21–34. doi: 10.1016/j.ejpn.2003.10.001. [DOI] [PubMed] [Google Scholar]
- 5.Hughes AJ, Redsell SA, Glazebrook C. Motor development interventions for preterm infants: A systematic review and meta-analysis. Pediatrics. 2016;138:e20160147. doi: 10.1542/peds.2016-0147. [DOI] [PubMed] [Google Scholar]
- 6.Ferrari F, Bertoncelli N, Gallo C, et al. Posture and movement in healthy preterm infants in supine position in and outside the nest. Arch Dis Child Fetal Neonatal Ed. 2007;92:F386–90. doi: 10.1136/adc.2006.101154. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Visscher MO, Lacina L, Casper T, et al. Conformational positioning improves sleep in premature infants with feedingdifficulties. J Pediatr. 2015;166:44–8. doi: 10.1016/j.jpeds.2014.09.012. [DOI] [PubMed] [Google Scholar]
- 8.Jeanson E. One-to-one bedside nurse education as a means to improve positioning consistency. Newborn Infant Nurs Rev. 2013;13:27–30. doi: 10.1053/j.nainr.2012.12.004. [DOI] [Google Scholar]
- 9.Zarem C, Crapnell T, Tiltges L, et al. Neonatal nurses’ and therapists’ perceptions of positioning for preterm infants in the neonatal intensive care unit. Neonatal Netw J Neonatal Nurs. 2013;32:110–6. doi: 10.1891/0730-0832.32.2.110. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.POCQI-Learner-Manual.pdf [Internet]. Accessed September 25, 2020. Available from: https://www.newbornwhocc.org/POCQI-Learner-Manual.pdf
- 11.Coughlin M, Lohman MB, Gibbins S. Reliability and effectiveness of an infant positioning assessment tool to standardize developmentally supportive positioning practices in the neonatal intensive care unit. Newborn Infant Nurs Rev. 2010;10:104–6. doi: 10.1053/j.nainr.2010.03.003. [DOI] [Google Scholar]
- 12.Masri S, Ibrahim P, Badin D, Khalil S, Charafeddine L. Structured educational intervention leads to better infant positioning in the NICU. Neonatal Netw. 2018;37:70–7. doi: 10.1891/0730-0832.37.2.70. [DOI] [PubMed] [Google Scholar]
- 13.Spilker A, Hill C, Rosenblum R. The effectiveness of a standardized positioning tools and bedside education on the developmental positioning proficiency of NICU nurses. Intensive Crit Care Nurs. 2016;35:490–7. doi: 10.1016/j.iccn.2016.01.004. [DOI] [PubMed] [Google Scholar]
- 14.Charafeddine L, Masri S, Ibrahim P, Badin D, Cheayto S, Tamim H. Targeted educational program improves infant positioning practice in the NICU. Int J Qual Health Care. 2018;30:642–8. doi: 10.1093/intqhc/mzy123. [DOI] [PubMed] [Google Scholar]