I've recently started in a new unit and quite a few of the long term micros have 'toaster heads'. In my old unit this was not the case. Many of the nurses keep these babies prone, just turning their heads from side to side. The rationale for this is that they ventilate better and can have lower amounts of oxygen ( when you turn them supine or on their sides you have to increase the oxygen by 10-20%), they have less reflux and don't desat near as much, therefore far less setting off of alarms and easier shift for the nurse.
When I have these babies I change their position every three hours or as baby shows a need for a change by fussing, etc. I adjust their oxygen as they are gavaged over 1-2 hours, I aspirate air from OG's if they are on high flow to prevent reflux, I boundary them is good hand to mouth. tucked position and if they tolerate, I do a fair amount of supine to try to 'round out' their heads. It keeps me busier as a nurse, but I feel this is what is best for the baby. In report I've been told that the goal isn't to worry about how the baby's head looks, but rather to decrease their oxygen levels, have them tolerate fdgs, and have fewer desats.
I'm looking for info or links from nurses from units that practice great developmental care to help educate us (me included) on what is best for the preemie. Do toaster heads affect the developing brain or is it just a short-lived cosmetic issue? If prone keeps the oxygen level consistently lower does that decrease lung inflammation to warrant it or does it just make us feel that the baby is improving? If prone helps the baby tolerate feedings so he can be advanced and tolerate more calories earlier is that best for his brain?
If prone is best, then I will shift my focus to proper prone positioning using a prone positioner, and not just turning the baby over with head arched and covering him with a frog positioner. ( We have arched backs and turned out feet here, also.)
Jan 30, '13
I have always rotated my babies every 3 hours, yes prone is awesome for oxygenation and reflux. We have gel pillows for when they are supine. I haven't worried about toaster head, but that is a great topic to research? I was always more concerned with their abc's
Jan 30, '13
We do try to reposition our kids as they tolerate it, we use zflo mattresses and gel pillows. But if the kid is much better on their belly and you can wean them better then that how they go. You don't want to keep going up and down on oxygen because that can damage their eyes. They do ventilate better and many do digest better. It is better to decrease all the "bad" things than worry about the shape of their heads. Some kids heads seem to flatten out no matter what you do. It doesn't affect their development, it just isn't pretty or gerber baby like.
Jan 31, '13
If we have a kid that does lots better prone we leave them there for max of six hours, the other time is spent supine and we switch their head position. Although oxygenation is totally the priority, we don't like sending kids home with poorly shaped heads. We do focus more on head shape after about thirty weeks AGA.
Feb 2, '13
I observed my babies to be more comfortable in prone position especially after feeding and during phototherapy. I've heard though that prone position is a no-no in some NICU's (ie in Dubai). I don't know prone is good for oxygenation though and reflux at that. I think I might read more on that. Thanks for the info. And if you can send me a link, I'd appreciate it.
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