KCON/F/NEURO/06

TITLE

Positioning devices and development of the preterm infants in the

NICU- A review.
 RESEARCH QUESTION

• Available Positioning devices used on preterm infants in the NICU and

its effect on development of the preterm infants.
 INTRODUCTION

• Globally every year an estimated 15 million preterm born (born before 37

completed weeks of gestation). That corresponds to 1 in 10 babies(Sathish Y,
et.al 2019).

• In India, 27 million babies are born each year out of which 3.5 million babies
are born prematurely as per the estimates of 2019(Sathish Y, et.al 2019).

• In recent decades advanced technological resources like mechanical

ventilators and cardiorespiratory monitors are available in intensive care unit
which led to the survival of a large number of premature newborns.
• Normally in the womb fetus is constantly in physiologically flexed
posture (arms and legs bent and trunk tucked forward) and surrounded
by the walls of the uterus, which serve as support and reference to the
movements(Toso BR,et.al 2015).

• Once the child born preterm;

They are having posture unlike they develop in the womb and assumes a
hypotonic extension posture.
• Hypotonic extension posture develops because of low postural tone, the
influence of gravity, and the lack of flexor tonus because they are
exposed to gravity before their bodies can deal with it and are forced to
live and cope in an environment different from the protected
environment in the uterus(Nakano Het.al,2010, Tang X, Bei F,2021)
• For preterm infants neurodevelopment care is highly recommended
practice, positional support is part of the neurodevelopment interventions.

• Therapeutic positioning is one of the earliest neuro developmental

interventions in the NICU, The main objectives during the positioning of
the New born are
 providing support and posture to the movement;
 optimizing the development of the skeleton and biomechanical alignment;
 providing controlled exposure to varied proprioceptive, tactile, and visual
stimuli, and promoting calmness and regulating the behavioral state.
(Toso BR,et.al 2015, Tang X, Bei F,2021).
• In NICU therapeutic positioning to preterm infant is usually provided by
traditional aids or with sophisticated devices.

• Common devices like; Snuggle Up (Phillips) ,Bendy Bumper (Phillips)

and, Dandle roo were used for the positioning of preterm infants.

• Many Studies have shown significant improvement development of the

child by using sophisticated devices for positioning, so the need arises
to review all the available literature on devices used for positioning the
preterm infants in the NICU and its effects on the development of the
preterm.
 METHOD

• In this narrative review articles pertaining to the positioning devices and its
effect on the development of preterm infants in NICU were searched using
databases like Pubmed, , CINHAL, PEDro, Google Scholar and web of
science database.

• The criteria for the inclusion of articles were studies that provide data on
different positioning devices and it’s effect on the development of the preterm
infants in NICU.
• All the articles in the English language and irrespective of the year of the
publication were included in the study.

• The selected articles were appraised depending upon the positioning

method, type of study/ research design and based on that review was
formulated.
 RESULT

• Following the removal of duplication and screening of the titles and

abstracts , a total of 08 potentially relevant studies remained. All
the studies were with higher level evidence.
Sr.No Author/Year of Title of the Article Study Design Methodology Results
Publication
1. L. Vaivre-Doureta, Effect of positioning Randomized 60 low risk Regular changes
K. Ennourib et.al on the incidence of clinical trial. preterm infants in posture, and
(2004) abnormalities of of 31–36 weeks correct functional
muscle tone in low- gestational age positions through
risk, preterm infants were enrolled. moldable mattress,
treated group helps in
were lying in a maintenance of
specially normal
designed neuromuscular
moldable and osteo-articular
mattress and the function and
control group permittes the
was placed on development of
their stomachs, spontaneous and
with a standard functional motor
orthopaedic activity in low-
bolster support risk perterm
under their hips. infants
Sr.No Author/Year Title of the Article Study Design Methodology Results
of
Publication

2. Laurence Comparative Effects prospective 30 preterm neonates All preterm neonates

Vaivre-Douret of 2 Positional study born between 28 and 35 significantly better in
et.al Supports on weeks’ gestation were “Coconou” group
(2007) Neurobehavioral and included. than the “Home-
Postural A first group Cocoon” group and
Development in experimented with a “Coconou” group
Preterm Neonates “Home-Cocoon” Preterm neonates
support which was gains good postural
made by rolled sheets, development and it
and a second group promotes optimal
provided a “Coconou” prophylactic
support, made with a neurobehavioral.
specifically designed
support contains a
flexible material.
Sr.No Author/Year of Title of the Study Design Methodology Results
Publication Article

3. Hisako Nakano, Hideki The Influence of 12 low-risk Appropriate

Kihara Positioning on preterm infants positioning of
(2010) Spontaneous were included in preterm infants
Movements of the study. Six of facilitates
Preterm Infants them received a flexion posture
positioning and movement
program from patterns toward
birth to 35-36 the center of the
weeks of age body similar to
while others did fetuses in the
not. uterus.
Sr.No Author/Year of Title of the Article Study Design Methodology Results
Publication
4. Laura Madlinger- The effects of A randomized 100 preterm Infants in the
Lewis a , Lauren alternative positioning clinical trial infants were alternative
Reynolds et.al on preterm infants in the enrolled at positioning
(2013) neonatal intensive care birth. . All group of the
unit: A randomized infants were study
clinical trial randomized to be demonstrated
positioned in the less asymmetry
alternative in reflex and
positioning good motor
device (Dandle response.
Roo) or in
traditional
positioning
methods for their
length of stay in
the neonatal
intensive care
unit
Sr.No Author/Year Title of the Article Study Design Methodology Results
of Publication

5. Aimee Knorr, Use of the Cranial A prospective 23 neonates and infants At discharge
Kimberlee Cup to Correct descriptive with deformational cranial
Gauvreau et.al Positional Head Shape research plagiocephaly who were measurements
(2016) Deformities in born at less than or equal were obtained for
Hospitalized to 35 weeks gestation, each infant. Use of
Premature Infants weighed greater than 1 the cranial cup
kg, and were in the during the
convalescent phase convalescent phase
(stable) of their of hospitalization
hospitalization were is feasible and
included. All participants safe, and it
were positioned on the provides effective
cranial cup for a correction of
minimum of 12 hours per deformational
day with routine position plagiocephaly for
changes at least every 3 premature
to 4 hours. neonates and
infants.
Sr.No Author/Year of Title of the Study Design Methodology Results
Publication Article
6. Yashoda Sathish, Clinical A Randomized A total of 56 preterm Use of snuggle up
Leslie Edward Outcomes of controlled trial infants (27-32 weeks) position increases
Lewis et.al. Snuggle up were enrolled in the stability of
(2017) Position Using study. The snuggle up physiological
Positioning positioning aids were parameters and it
Aids for used for the intervention helps in weight gain
Preterm (27-32 group and the control and reduced duration
Weeks) Infants group preterm infants of NICU stay.
were placed in ordinary
boundaries prepared by
cotton cloth roll and
find out its effects on
heart rate, respiratory
rate, oxygen saturation,
duration of ventilation,
weight gain, and
duration of NICU stay.
Sr.N Author/Year of Title of the Article Study Methodology Results
o Publication Design
7. Yuma Kitasea,b, A new type of swaddling prospective 39 infants, born at a The swaddling
Yoshiaki Sato et.al clothing improved clinical trial gestational age of < clothing had
(2017) development of preterm 36 weeks were enhanced stretch
infants in neonatal included. 27 capacity and
intensive care unit preterm included in improved the
intervention group muscle tone and
(preterm infants increased sleep
wearing bag-shaped time by
clothing, allowing decreasing the
only exposure of state level of
the head and 12 preterm infants.
preterm in the
control
(conventional
swaddling).
Sr.No Author/Year Title of the Article Study Design Methodology Results
of Publication

8. Xiaoli Tang a , The effects of a Quasi- 95 premature infants “New Nesting

Fei Bei et.al postural supporting experimental were randomized to Device” can provide
(2020) “New Nesting study either a “New premature infants a
Device” on early Nesting Device” comfortable posture
neurobehavioral group (n = 49) or support similar to the
development of “Traditional-Nest” flex posture they had
premature infants group (n = 46) after while in the uterus.
admission. All Smooth body
participating movements and non-
premature infants extended extremities
were assessed at 34th can promote early
and 36th weeks of neurobehavioral
gestational age, on development.
posture, body
movements and early
neurobehavioral
status.
 DISCUSSION

• Preterm birth places infants in the high-tech environment of NICU,

posing considerable stress to them. Mimicking the position in utero
supports the infant in a flexed, contained, and midline-oriented position
as it is in utero.

• There were total 08 studies included in this review. All the articles were
used one or the other sophisticated devices for the positioning a preterm
infants during their stay in the NICU.

• All the included studies have used different types of positioning devices
or aids like; moldable mattress, positioning bed, coccon, Dandle Roo,
cranial cup, snuggle up positioning aid, swaddling clothing.
Moldable Mattress: maintenance of normal neuromuscular and osteo-articular
function
development of spontaneous and functional motor activity.

Coconou Position: good postural development

promotes optimal prophylactic neurobehavioral.

Positioning in Bed: facilitates flexion posture

movement toward the center of the body similar to fetuses in the uterus.

Dandle Roo: less asymmetry in posture

good motor response.
Cranial Cup: correction of deformational plagiocephaly for premature infants.

Snuggle up Position : increases stability of physiological parameters

helps in weight gain and reduced duration of NICU stay.

swaddling clothing: improved the muscle tone

increased sleep time

New Nesting Device: Symmetrical Posture

Smooth body movements
 CONCLUSION

• Included studies have suggested that positioning devices help in the

development , it increases stability of physiological parameters and it
helps in weight gain and reduced duration of NICU stay of preterm infants
in the NICU. However, more studies are required on in this area.