VLBW infants and positioning

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Specializes in NICU.

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

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Specializes in NICU,PICU.

I've never heard of that? To me, midline means flat on your back, face up. We nest our kids and keep them calm and quiet. It is more stress, high vent settings and deep fluctuations in BP that can cause IVH. Keep them quiet and comfy.

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In my unit, we keep all infants less than 27 weeks midline for the first 7 days of life, vented or on CPAP, to prevent IVH.

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Specializes in NICU.

Intubated or NCPAP and under 34 wks-- midline (and usually supine) x 72 hrs.

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Specializes in NICU.

To the nurses whose units use these positioning guidelines - has it been shown to decrease IVH? I'd love to see some numbers on this, because I think it's a good idea myself and would like some back-up on the subject.

Midline doesn't necessarily mean flat on their backs - it could be on their side, so long as the head is also facing that side so that the neck and head are still midline with the rest of the body. Right?

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Specializes in NICU.

Right, Gompers, midline does not mean only flat on back. Can also be side-sying as long as head is facing in the same position. That is what we used to do, and I want to bring it up at my new NICU, but I want to back it up with research, etc. I can't find anything, though. I live in a different state now, and don't keep in touch with anyone from my old NICU that I can ask.

Thanks for input so far.

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Specializes in Neonatal ICU (Cardiothoracic).

I've spent this year researching IVH and developing protocols for our unit, and I'll have to go dig it out, but there is definitely research out there that shows that positioning the HEAD midline for 72 hours (or longer, depending on the study) prevents the cerebral blood from pooling, due to the decreased "outflow" of blood from the baby's head caused by the head being twisted to one side or the other which partially occludes the outflow vessels. I believe the Vermont-Oxford Network did a study called "Potentially Better Practices" or something like that, but I'll have to go find it and let you know...... If anyone is interested, I have a protocol/tool I developed for our unit if anyone is interested in looking at it. We've decreased our IVH rate from 22% annually in infants

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I've never heard of the corrilation between postioning and IVH. I'm curious to see how babies's heads are postioned midline while on an oscillator.

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Specializes in NICU.
I've never heard of the corrilation between postioning and IVH. I'm curious to see how babies's heads are postioned midline while on an oscillator.

I would imagine that they lay on their sides facing the oscillator tubing? Sometimes you can lay them on their backs with their heads midline and still have a good wiggle though, but we usually only do that on big PPHN kids with huge ETTs.

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I've heard of the correlation of head positioning and prevention of IVH. Don't have any research to back it up though, but I'm sure the doc's do. As Steve said putting the head in the midline affects the blood flow to the brain and also affects the ICP, thus preventing the incidence of IVH.

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Specializes in NICU,PICU.

Gotcha...we don't turn their heads...in my unit midline means belly up, head up. Most kids on the osc. are on their backs anyways....we don't turn them side to side, our little ones are like this until they get all their survanta doses, and aren't getting frequent chest xrays. We make a nest for them, like a huge O and lay them in the middle so they stay how we have them. I hate that big fat oscillator tubing.

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Specializes in NICU.

What Steve posted makes sense, as to why it would be better positioning to keep them midline.

I think this is our policy although it's not really enforced. I'm still pretty new and my preceptor never really enforced this with me ..... I should ask her though. The other day when I was admitting a little 24 weeker (my first major admit like that, scary!), my pod partner (a traveler) was yelling at me because the baby's head was to the side. Sheeesh. "At our old hospital we kept all the babies midline". "At our old hospital we did this .... and we did that". Everything was so good there, huh? And we do everything so wrong? Well then go back there for goodness sakes! But anyway, that's a bit off topic lol.

I'd like to see more research too .......

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