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Vented, oxygen-enriched and oh so comfortable: premature baby placement
Cochrane UK Fellow Rufaro Ndokera, pediatrician and Cochrane UK Fellow, looks at the Cochrane findings on optimum position in the first of two posts on the maintenance of the newborn infant, and Stephanie Wiseman, sister of the pediatrician, reflects on her work. The new and delicate life we encounter when working in a newborn ward is one in which every little choice and every little aspect of nursing can have a useful impact on the results, both in the short and long run.
Good mediocre baby home placement has been well investigated. For premature infants, the location was also taken into account in terms of evolution, convenience and distress, but also in terms of aeration and oxygen supply. There is a large number of possible baby locations and a list of them may sound a little like the text to the hooky coy.
In this recently revised Cochrane Review, the effects of different baby postures on the improvement of short-term airway outcome in people who receive ventilatory treatment are investigated. Secundary results were more broadly based, encompassing NET results, morbidity and other preterm birth complications. However, the reviewed paper found poor qualitative proof that the tendency for placement improves short-term airway outcome, encompassing pO2 and saturation.
Infants ventilating with CPAP and conventionally were considered, but the improvements for those on CPAP were not statistically significant. Unfortunately, many of the trials have not addressed longer-term results or side affects that are of major importance in critical illness units with fragility and variability.
Even though the placement of an infant in the abdominal area seems to increase his/her saturation in those who are vented with mechanical ventilation in the shorter run, the degree of enhancement is very small. Make a reasonable distinction for the baby, but is there a good point in not doing it? Neonatologist Stephanie Wiseman reflects on the subject of Neonatatal positioning on the basis of her experience in clinics.
"Neonatological surgeons are often advised on how to position themselves by many members of the multi-disciplinary staff, such as physicians, ergotherapists and physical therapists. Often, they are also advised on how to position themselves. Empirical evidence has shown that position is the keys, but it is not always clear to what extent it has an effect when so many different elements are implicated in the delivery of a ventilated person.
Even though every baby is different, in my own personal history, the vast majority who need airway assistance will profit from being susceptible to breastfeeding. I think it has as much to do with the breast as it does with the baby's placement to make them look safer and safer - much simpler when they're vulnerable because you can put their feet up to bend their waists in a posture much nearer to the foetal posture than possible when they're lying down.
It would also make good sense to put the baby on its side, but this is not always an ideal place to support breathability. Newborns with extreme illnesses, who require regular intervention and are close by with corded umbilicals, are often cared for in the back to facilitate easy accessibility and security of the pipes.
Vented infants are easy to handle with aspiration or changes in ventilator setting if they have desaturation. I have learned from the many instances in which I have been kind to a baby and have sat down in the stomach down, and a physician comes by to check them - the physical effect of tipping over is often much more severe than if they had been breastfed in the back.
It takes these infants longer to recuperate from a shift in posture, so it is better to let them lie when they need several and common procedures. The nurse should always keep an eye on the development-policy stance when breastfeeding a baby in the dorsal lying posture, as it is sometimes on the priority list when it comes to a very ill baby.
Always trying to offer my patient the convenience of a high wall cavity that sets some limits, no mind in which positions they need to be cared for. Infants who receive long-term ventilation but are still strong, or infants who receive high blood pressure or CPAP, often profit from the fact that they are susceptible to breastfeeding and need a lower level of oxygen than if they were breastfed on their back or side.
My own personal experiment has also shown that it helps these infants to place a "surfboard" under them, no broader than their shoulder and the length of the jaw to the hip, to help them keep a development-friendly posture while supporting their breathability. Good old neo-monthly hooky coke will no doubt be continued for other reason in NICU's around the globe.
The need to optimize all aspects of neo-natal treatment for this small and delicate life should prompt us to investigate this particular area further, and perhaps it is not a good thing to have some abdominal uptime. Remote Rivas M, Roqué i Figuls M, Diez-Izquierdo A, Escribano J, Balaguer A. Infant posture in newborns with mechanic respiration.