VLBW infants and positioning

[NICU Mama]

I worked in a unit in the past where we kept all infants less than, I think it was 1500 gms, who were on a ventilator, in the midline position for the first 7 days of life. This meant they had to stay supine or side-lying as long as they were kept midline. The reason for this was to help prevent IVH. After they were more than 7 days old, were were then able to turn their heads from side to side and could have them lie prone. Does anyone else do this practice. I'm working in a new level 3 nicu, and we don't do this. I looked on the internet to find information supporting this midline positioning to prevent IVH, but couldn't find anything. Thanks for your input.

NICU Mama

[MegNeoNurse]

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........

[MegNeoNurse]

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

[ScammRNC]

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.