Placing newborns prone position

[newlvngrad]

Hello All,

I am trying to find some information on placing babies prone. Why do NICU nurses do this? Is it good for them developmentally wise? I had read somewhere that it helps with the diaphram development, is this true? Do they like being in this position. I am an LVN and postpartum doula and am looking for some research on this. I find that laying my babies on their side helps them sleep alot better than they would on their backs. I know that placing them on their side turns off the MORO reflex so they are more comfortable sleeping on their sides. I look forward to you replys and thank you in advance!

[Elvish, BSN, DNP, RN, NP]

Moved to NICU forum :)

[NicuGal, MSN, RN]

First I would like to say that babies should be sleeping on their backs, not on their sides or stomach due to the increased risk of sids. As an LVN and a doula, you should be following the Academy of Pediatric guidelines.

NICU is different... our kids are on monitors 24/7. We will place small ones on their bellies as it opens up the chest area and does allow for better expansion of the chest and diaphragm, it has nothing to do with development. Also there is some research that says it is better for reflux infants, but there is also research against that. We start to transition them to back sleeping once they are nippling feeds and getting close to discharge.

Our discharge teaching does include how to get baby some belly play time due to the fact that there are many parents that take being on their backs as they can never be any other way. We tell them to get down on the floor with them, put them on their bellies to play so that they can develop the muscles they need to lift their heads, roll over, etc.

[mvg rn]

below is in artical summary that gives reasons perterm infant are put to sleep in a prone postion by nicu nurses. mind you at the end they do advacate for supine sleeping to reduce the risk os sids, but as the previous poster noted our babies in the nicu are on monitors.

preterm infants and sleeping position

william t. basco, jr, md, faap

posted: 10/03/2006

effect of prone and supine position on sleep, apneas, and arousal in preterm infants

bhat ry, hannam s, pressler r, rafferty gf, peacock jl, greenough a pediatrics. 2006;118(1):101-107

summary

according to bhat and colleagues, previous research has demonstrated that, in preterm infants, prone sleeping position is associated with a marked increase in rates of sudden infant death syndrome (sids).[color=#004276][1] this study sought to examine a larger number of preterm infants than that included in other studies in order to determine how sleep position might be associated with apneas or sleep quality.

the subjects for this study were infants born at

the authors defined apnea as a lack of nasal airflow of ≥ 5 seconds. an arousal was defined as ≥ 10 seconds of movement, with ≥ 60 seconds of movement or crying constituting an "awakening." the authors studied 24 infants, 14 of whom developed bronchopulmonary dysplasia (bpd). these 14 infants were on supplemental oxygen during their respective studies. the policy of the unit was to have infants sleep supine for at least 2 weeks prior to discharge so that the infants studied would be used to the supine position.

overall, prone sleeping position was associated with more sleep and more efficient sleep. for example, the mean number of minuses of sleep time recorded was 116 in the supine position and 146 minutes in the prone position. infants in prone sleep also spent more time in quiet sleep (25.8 minutes on average vs 15.5 minutes for infants in the supine position). prone sleep times were associated with fewer awakenings (3.5 vs 9.7) and arousals. however, central apneas were much more common among infants sleeping in the prone position (5.6 on average) than among infants sleeping in the supine position (2.2). obstructive apneas were more common in among infants in the supine position at 0.9 vs 0.5 among infants in the prone position. the results were similar when the infants were analyzed as subgroups - with and without bpd.

the authors concluded that prone sleeping position is associated with fewer spontaneous arousals and more episodes of central apnea.

viewpoint

this study supports the clinical observation that infants may sleep better in the prone position (as evidenced by longer sleep times and fewer arousals in this study). however, the increased risk of central apneas is notable. back-to-sleep campaigns have led to decreases in the rates of sids; these data lend evidence to the recommendation that infants avoid sleeping in the prone position.[color=#004276][2]

[aerorunner80, ADN, BSN, MSN, APRN]

We do this, as another poster put so well, because our babies are premature. Our unit also starts to put babies supine when they start to nipple. Two weeks before discharge we put a sign on the bed stating that the baby must be supine, bed flat (unless ordered by a practitioner for reflux), no barriers, extra blankets, or toys.

Premature babies are just that. Premature. All of their systems are still growing, including muscles. We prone our premature babies because it helps open up the chest and compensate for weak/premature chest muscles, including the diaphragm. It allows for more complete lung expansion due to the pull of gravity on the diaphragm.

It also allows us to flex the babies like they would be in utero. When we prone our babies, they are almost always put on a waterbed. We try as much as we can to put them in a position that they would be inside mom and to mimic that environment which is also why we humidify the air in the incubator for the first week of life.

Is it perfect? Absolutely not! But we try.

If you are helping out with the delivery of healthy, term infants, always remember to dry them, bundle them up, and put them BACK to sleep. Parents will mimic what they see us do in the hospital and we need to set a good SAFE example for them. I can't stress the importance of this enough.

[prmenrs, RN]

I point out to parents that "we cheat", i.e., our babies are monitored. Once the baby is out of the isolette, it's time to start putting them on their back, unless there are mitigating factors.

In the OP's situation, it should be "Back to Sleep" always. In the NICU, it's not so cut and dried. I don't know if that helps or not. The article is interesting--since they sleep better on their tummies (and they need quality sleep to grow) AND they're monitored, (so an apneic event would be attended), I would opt for prone. But NOT @ home, and never w/o a monitor.

[BabyLady, BSN, RN]

As soon as we put babies on their bellies, we tell parents that they should not duplicate the positioning they see in the NICU at home.

We tell them point blank, "Our babies are on a 20 second apnea monitor...if they stop breathing for 20 seconds, we know it...you will not have that luxury at home...so when you get the baby home, they need to sleep on their backs due to increased risk of SIDS."

That pretty much spells it out for them...we repeat it several times for them from admission to discharge and reinforce that babies do need tummy time but it should be when the baby is awake and actively supervised.