Abstract

Aim. This paper reviews various positions for neonates admitted to Neonatal Intensive Care Unit (NICU), describes benefits and disadvantages of each position and suggests a clinical guideline to improve development.

Background. It has been known that development of active muscle tone begins at 36 weeks gestation, when the baby achieves a postural state known as physiological flexion. Premature babies suffer from low muscle tone because they have missed out on some or all of the substantial stages of muscle tone development in the uterus. Without appropriate intervention these babies may experience head flattening and cranial molding. Without support, gravity causes preterm babies shoulders and hips flatten onto the bed, often called ‘frog leg position’ and ‘W arm position’. This can result in inappropriate or delayed development and mobility challenges including the inability to crawl, stand, walk and problem in fine motor skills such as hand-mouth co-ordination.

Method. In this literature review, papers published during the last 15 years, were searched out through search engines and data bases: Science Direct, Google Scholar, Ebsco, Pub Med, Ovid, Proquest based on which 16 papers about neonatal positioning during nursing care were selected. Also, three neonatal textbook were used.

Result. One of the earliest neurodevelopmental strategies in the NICU is therapeutic positioning. Positioning of premature infant is an essential neonatal nursing care. These positions are supine, prone, side-lying, and head up tilted position. Many studies have shown that a variety of outcomes can be affected by different body positioning of premature infants. Every position has its own advantages and disadvantages, so each infant should be individually assessed and positioned according to condition, preferences and behavioral cues. Position changes should be slow and steady, so that the infant doesn’t become distressed and dislodgement of invasive and monitoring equipment can be avoided. Whenever possible, an infant should be touched gently and talked to before changing their position.

Conclusion. It is necessary to ensure that preterm and sick neonates receive individualized positioning appropriate for their musculoskeletal development in order to minimize complications. Infants receiving developmentally supportive care have been demonstrated better medical outcomes including shorter duration of mechanical ventilation and supplemental oxygen support, earlier oral feeding, and shorter hospitalization.