Developmental positioning in Giraffe beds

Specialties NICU

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Specializes in NICU.

This question is directed to all nurses who are now using Giraffe Omnibeds or incubators in your NICU's: As you know the company promotes their mattress by stating that it "may help relieve pressure points and preserve skin integrity" and the company recommends a single layer sheet over the mattress. Of course, by the time you properly contain a micro-preemie or ELBW infant in a Snugli which may have a cloth diaper under him to prevent soiling AND you have him nested, you may have 3-4 layers between him and this mattress. In my unit, we are being encouraged to alter our nesting practices so the mattress can provide the most benefit to the infant. Fewer infants are being placed in Snuglis or lightly swaddled in lightweight jersey blankets to contain them. We are told not to dress infants till they reach 1500 grams. Have any of you changed your developmental practice to enhance the benefits of these mattresses? Have you changed how you make your beds?

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Specializes in NICU.

I had no idea those mattresses were supposed to do that. Sometimes we'll layer it so we have a bottom sheet, a sheepskin, then a blanket that the baby lays on, but we don't always have the sheepskin. Then we started using these cool jelly like pads called Z-Flo that mold and conform to the baby. We also start wearing clothes when stable and/or ~1500 grams. Then out to open crib ~1800 grams, but each baby varies on that.

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The gel type matresses I think are an option. We only have a couple.They still supply pressure relief, more so than the conventional matresses, regardless of the blanket barrierer.

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Specializes in NICU, Post-partum.

We have a physical therapy employee that has special training in the positioning and development of the neonate.

Here is what we do:

1. We have a single blanket over the mattress

2. We place a folded pillow case for the infant's head...because the "nap" of the fabric is smoother than the blanket and will cause fewer abrasions.

3. If the infant is prone, we sometimes put a diaper under the tummy for support.

4. We use a circular gel pillow, place under the blanket and the pillow case, for the infant.

5. Folded washclothes can be used to assist in lateral positioning.

6. Our PT emphasizes the importance of snugglies...this is more of a critical issue that you think....

When babies are in the womb, they build up muscle tone from the resistance of the walls of the uterus from turning, punching, kicking, whatever movement they have...as they grow bigger in Mommy's tummy...this resistance is increased, along with the contractions that happen throughout pregnancy and during labor.

Therefore, it is theorized that to NOT "snuggle" the baby puts them in a disorganized state that is not natural to them..in other words, they need the boundaries around them...if they are permitted to "flail" it causes stress to the neonate because they need that security not only for brain development but muscular.

We use the same isolettes...HOB is also kept slightly tilted for all infants.

So, when you think about it..other than the baby's head, there is never more than 1 layer separating the infant from the mattress.

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Specializes in NICU.

very good info!! the "folded pillowcase"..is that a regular size or baby size?

Can you further explain about the 'folded diaper under the tummy' ?

What is a 'circular gel pillow? Is it like a donut??

We make nests out of rolled blankets, which puts 2 layers of blanket between mattress and baby. When prone, we use a 'prone roll' usually made from sheepskin, with the baby elevated on it with shoulders down. The only part of baby to touch mattress would be forearms and shins.

I would be interested in more information...can you share???????

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Specializes in NICU.

:yeah:Thanks, Baby Lady, for your detailed reply! I fully appreciate and understand your responses, but have a couple questions. When you mention 'snugglies', do you have a homemade version or do you use Children's Medical Ventures purchased ones? If either one is used, and I also highly support the use for all the reasons you mentioned, then that is at least an additional layer between the baby and the bed. I, too like using a silky pillow case under the infant's head, as the head is heaviest part of the infant and therefore the most likely to develop pressure sores. But when it is folded and utilized then that is more layers between the infant and mattress. And when the infant is prone, there would be the blanket covering the mattress, the Snuggli material, the pillowcase at the head, and the layer of diaper his chest is resting on . . . so 4 layers. Our unit trialed Children's Medical Ventures new sponge-like prone positioners last year, they come in 4 sizes, and we loved them and now use them when we place an infant prone.

I have written Giraffe for more research on their mattresses to determine if they have enough data to even be concerned about how many layers we have between the baby and the mattress. My nursing goals for these wee ones are very simple: deep boundaries with feet inside the boundary to brace against, some manner of containment, whether lightweight blanket or Snuggli, head cover, isolette cover, a scented wash cloth near face to sniff mom's familar scent, a CD of her voice, a clean and properly sized pacifier, and Kangaroo care as often as possible. I'm hoping for the day when we do most of our cares while baby is nestled on mom's or dad's chest, since private room NICU's with beds and recliners are becoming more common. Kangaroo Mother Care is what babies want and now it is possible. Think of the money we could save on $40,000 incubators and then we wouldn't have to worry about mattresses or bedding. We could feed and care for the parents and THEY could provide the environment for the baby for as much of the time as they could be present in the unit. Maybe I'll get to see this happen before I retire in the next 10 years! :saint:

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Specializes in NICU, Post-partum.
very good info!! the "folded pillowcase"..is that a regular size or baby size?

Can you further explain about the 'folded diaper under the tummy' ?

What is a 'circular gel pillow? Is it like a donut??

We make nests out of rolled blankets, which puts 2 layers of blanket between mattress and baby. When prone, we use a 'prone roll' usually made from sheepskin, with the baby elevated on it with shoulders down. The only part of baby to touch mattress would be forearms and shins.

I would be interested in more information...can you share???????

It is an adult pillowcase...folded in 1/3's.

The diaper is kept in the same fold that it comes in the package.

I'm not sure of the exact name of the gel pillow, it is not a donut shape...it is about the diameter of a grapefruit. It must be flipped and moved around when you reposition the baby q3 or q4 (whichever you do) because it does become flat.

We do constantly emphasize to the parents throughout the stay to not try to mimic any of the "nesting" when they take the baby home....b/c they won't have the monitors that we have and another reminder is given during discharge teaching.

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Specializes in NICU, Post-partum.
:yeah:Thanks, Baby Lady, for your detailed reply! I fully appreciate and understand your responses, but have a couple questions. When you mention 'snugglies', do you have a homemade version or do you use Children's Medical Ventures purchased ones? If either one is used, and I also highly support the use for all the reasons you mentioned, then that is at least an additional layer between the baby and the bed. I, too like using a silky pillow case under the infant's head, as the head is heaviest part of the infant and therefore the most likely to develop pressure sores. But when it is folded and utilized then that is more layers between the infant and mattress. And when the infant is prone, there would be the blanket covering the mattress, the Snuggli material, the pillowcase at the head, and the layer of diaper his chest is resting on . . . so 4 layers. Our unit trialed Children's Medical Ventures new sponge-like prone positioners last year, they come in 4 sizes, and we loved them and now use them when we place an infant prone.

I have written Giraffe for more research on their mattresses to determine if they have enough data to even be concerned about how many layers we have between the baby and the mattress. My nursing goals for these wee ones are very simple: deep boundaries with feet inside the boundary to brace against, some manner of containment, whether lightweight blanket or Snuggli, head cover, isolette cover, a scented wash cloth near face to sniff mom's familar scent, a CD of her voice, a clean and properly sized pacifier, and Kangaroo care as often as possible. I'm hoping for the day when we do most of our cares while baby is nestled on mom's or dad's chest, since private room NICU's with beds and recliners are becoming more common. Kangaroo Mother Care is what babies want and now it is possible. Think of the money we could save on $40,000 incubators and then we wouldn't have to worry about mattresses or bedding. We could feed and care for the parents and THEY could provide the environment for the baby for as much of the time as they could be present in the unit. Maybe I'll get to see this happen before I retire in the next 10 years! :saint:

Thank you!

I'm actually a new grad in the NICU and they sent us to this AMAZING seminar just two weeks ago on this very topic. I had no idea of how important positioning was....I thought it was only for comfort...boy, did I have a lot to learn!!!

I don't work again until Thursday, so I will find out the exact name of the snugglies for you!

One of the reasons we don't use a lot of layers is because of the frequency of X-rays.

Anytime you have more than 2 layers, you will lose clarity in the X-rays or the additional padding must be removed prior to it...and this is not good for the fragile touch-me-nots.

Another reason they limit the padding is because they don't want the parents to mimic the padding at home...no matter how many times you tell them not to..there is that small sector that will.

I'll see if I can even get you a picture of proper vs an improper positioning example using the snugglies...the pictures that I send to you will be stock photos and not HIPAA violations or pics I have taken myself....that last part for the moderators. :)

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Specializes in NICU, NSY, LD/OB.

We use sheepskin even on the giraffee mattresses . . . frankly, although the company has high claims for their mattresses, plain ol' sheepskin sure does feel 'cushy'er to us and it is probably just a case of whomever makes sheepskins not having the advertising budget that the giraffe people have. We use snuglies. We also have zflo packs and gel pillows . . we had prone positioner "sponges" too but they got lost fairly quickly - we think people mistook them for disposable items.

Fancier is not always better, IMHO.

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Specializes in L&D, Newborn Nursery, NICU.

We have been using z-flow positioners in our unit for a year with good result. We don't see skin breakdown at all now and we are seeing much better head shapes as well. No more toaster heads!! :chuckle

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Specializes in NICU.

We try to keep the layers down, and are aware of the recommendations from Giraffe. The developmental positioning/containment trumps the mattress benefits for us, though. So.....

After a layer that covers the mattress, there's a gel pillow for all babies in any incubator-type bed. For the E/VLBW babies, they're large enough that they go from head to sternum.

Then it's the Snugli, with some kind of cloth liner for the inevitable soiling. Snuglis can be a hot commodity, so we protect them.

If they're old enough and stable enough to be prone, we support them with folded, smooth cotton infant t-shirts under their belly. The only part left touching the mattress is their lower leg.

We very rarely see skin breakdown from pressure. Also, we don't usually start to consider transitioning the babies to clothes until they're 1700g or so. I dislike blanket swaddling anyone smaller, and won't do so if they have any kind of lines. If I swaddle someone in an incubator, it's for that champion leg bracer who is determined to jump ship. :)

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