ELBW Supine+Midline for ____ days

[Justin-RN]

What is everyone doing in their practice?

When we admit the little 22-25 weekers, we have a "rule" (Don't think it's written protocol) to leave them supine with their head midline for 96 hours to prevent IVH.

Unfortunately, not everyone does that, (I don't know why) and some of our newer nurses have even heard of that (a problem with education/orientation).

The reason I ask is because I'm writing an EBP paper on this to complete my BSN.

I'm also having trouble finding solid research on this, does anybody know of any good studies and articles on this topic?

I appreciate the insight. I'm new to the forum, very interested to see what everyone is doing in their neo worlds!

[Bortaz, MSN, RN]

We do 72 hours with the head midline. One thing I have found, though, is that a lot of nurses think the head can only be midline while supine, and not prone or side-lying. I don't know why they believe this, but they do.

[TiffyRN, BSN, PhD]

a lot of nurses think the head can only be midline while supine, and not prone or side-lying. I don't know why they believe this, but they do.

I myself have not figured out an acceptable way to do prone with head midline. Really jacks with my ETT positioning! ?

[Bortaz, MSN, RN]

I don't usually do prone, either, but I do do side-lying a lot.

[Justin-RN]

Tried prone the other night, didn't work. Haha, just giving ya grief!

I will rotate them some on the Z-flow if needed, but usually I just change pressure points.

[Kristen, NICU RN]

There is no written rule where I work and unfortunately I don't think a lot of nurses practice this. In my own practice I like to keep the ELBWs midline for the first week of life. Supine w/ head midline or side to side w/ head midline. We also keep the HOB very slightly elevated.

[ScammRNC]

Our policy is 72 hours with head midline. That can be supine or on the sides, but we don't do prone.

[essT]

I'm starting some work on IVH prevention protocols in my unit. Something I haven't seen addressed yet is how (or if) to do skin-to-skin with these babies and maintain midline positioning. Does anyone have insights to share? I'm thinking about babies at the upper limit of these guidelines, say 28-32ish weekers, stable on bubble CPAP, peripheral IVs only, -- not 23 weekers on the vent with lines.

[NICU Guy, BSN, RN]

72 hrs with head in midline.

[NICUmiiki, DNP, NP]

7 days with head midline. Not necessarily supine.

[essT]

So do parents not hold their babies until they are past the cutoff for midline positioning?

[NICUmiiki, DNP, NP]

Parents do hold. Just requires care to keep them midline the entire time.