Effects of Infant Positioning in the NICU

Saturday, 7 November 2015

Kristin Sierra Wade, BSN, RN
Newborn Intensive Care Unit, University of New Mexico Hospital, Albuquerque, NM, USA

When babies are born, they are thrown into a world very different from the one they knew in the womb. This is especially true for premature or critically ill newborns, whose immediate physiological needs are put above long-term and developmental needs. One of the earliest neurodevelopmental interventions in the neonatal intensive care unit (NICU) is therapeutic positioning, and it is often nursing judgment as to how an infant is positioned during rest. This simple, yet powerful, intervention can greatly affect the patient’s outcome in either a positive or negative way. If done thoughtfully, positioning can maintain an open airway, allow lung expansion and gas exchange, regulate temperature and intracranial pressure, and promote digestion. In the first three days of life, preterm infants are most vulnerable to brain injury from intraventricular hemorrhage. Their fragile blood vessels simply cannot compensate for the quick changes in arterial blood pressure that often occur in intensive care settings. Lying supine with the head of bed elevated and neck placed midline can prevent these devastating injuries. After those three days, the neonate’s needs change. The focus may shift to improving gas exchange or promoting gastric motility. Bedside nurses should adapt their positioning approach based on the infant’s changing condition, all while keeping development in mind. Whether the infant is supine, prone, or side-lying, their joints can stay flexed with the help of commercial and handmade positioning aids. These devices help to mimic the constricting effect of the uterus, and allow for proper joint and tissue development. This poster offers a visually-attractive summary of recent research on the outcomes of various newborn positions. It is designed to be a quick read for neonatal nurses so that they can immediately put the information into practice with the articles to refer back to and share with other staff members.