Re: VLBW infants and positioning

SteveRN21, I would be very interested as well. The past two years I have worked in two different NICUs and never was this mentioned by anyone regarding the positioning of infants midline for the first 72 hours. But considering that most bleeds occur in that time period, it really makes sense. Any articles or specific references would be greatly appreciated. Thanks!

Re: VLBW infants and positioning

Hi SteverRN- I'm in the process of starting my thesis, which involves choosing one intervention for my unit to initiate in order to decrease our incidence of IVH. I would love to see your policy, and some of the articles that you researched... Would there be any way to share the wealth of knowledge?

Re: VLBW infants and positioning

Hi there This is what our NICU practices as well. It is a NAAN recommendation to decrease the incidence of IVH in preterm infants. Our practice is <28 weeks midline x 7 days and no holding by parents until the 7 day HUS is obtained. Midline does not mean supine!!! As long as the baby's nose is in line with their umbilicus, this is midline. So they can be positioned right side, midline for example. The reason for this is that if the infant's head is turned to one side or the other, this increases the pressure in the cerebral vessels increasing the incidence of IVH. This is still developmentally appropriate positioning!!!

In terms of supporting literature I do not know off the top of my head, but I will ask our unit's educator. She's all about supporting literature.

Hope this helps

Re: VLBW infants and positioning

Originally Posted by dawngloves

I've never heard of the corrilation between postioning and IVH. I'm curious to see how babies's heads are postioned midline while on an oscillator.

We practice <28 weeks midline x7days. I've taken care of MANY infants that fit this criteria that are on oscillators and have no had any issues keeping them midline. The circuit tubing is very rigid, but in the last year we have a new circuit connector that is corregated and therefore more pliable. When repositioning an oscillated baby I have an RT or another RN available to help me move the oscillator and I keep the kid positioned and watch the tube.

Re: VLBW infants and positioning

Originally Posted by dawngloves

Our director would have a cow if he saw oscillating babies on anything but their backs.

What is her indication for keeping them supine? I cannot imagine keeping a kid in the same position for the entire time they are on the oscillator........

Re: VLBW infants and positioning

Originally Posted by Gompers

Now, that's something we do have a policy on, and we don't turn oscillator kids very much because they're usually unstable. They need to have their heads facing the vent because of how stiff the tubing is - it's up to us if we have them on their backs, side with head midline facing vent, or on their abdomen (rare). When they first go on HFOV, we don't turn their heads for 24 hours. Then after that, it's Q12H for turning. It just takes so much to turn the whole baby around in the bed (the vent always stays on the same side of the bed) and many of them don't tolerate the turn well at all. So instead we use gel pillows and things like that to keep pressure off the skin for those long hours spent in the same position. We rarely see skin breakdown on these babies' scalps unless they're extremely edematous.

Our frequency of repositioning and cares depends on the acuity of the baby. We used to use oscillators as "last-ditch-effort" vents... but lately our neos are down to put a kid up on the oscillator on admit as its more gentle to the lungs so they are not generally as unstable as the osc. babies used to be. I personally think that there is a correlation with HFOV and IVH within the first week, no definate supporting literature yet. Still too much of a coincidence that there have been 4 kids in our unit in the past few months, born <28wks, on HFOV within the first few DOL and all have atleast a Gr. III bleed? Anyway......

Re: VLBW infants and positioning

In my Level 3 NICU, we keep all babies under 30 weeks on vents or CPAP midline for 72 hours or until their first head US, whichever is first. Many time we are not even allowed to go side to side, just supine/midline.