Effects on oxygen saturation levels of handling premature infants within the concepts of kinaesthetic infant handling: pilot study

Premature newborn positionings and physiologic parameters – a randomized clinical study

Abstract Introduction Multiple studies have shown the effects of prone (PP), supine (SP) and kangaroo (KP) positions on clinical and physiological outcomes in preterm newborns, but none compared these three types of positioning between them. Objective To investigate the influence of these positionings on heart rate, respiratory rate, peripheral oxygen saturation (SpO2) and alertness status in clinically stable preterm newborns (NBs) admitted to a neonatal intensive care unit. Methods In a randomized clinical trial, clinically stable NBs with gestational ages from 30 to 37 weeks who were breathing spontaneously were allocated in three positioning groups: PP, SP and KP. Heart rate, breathing frequency, SpO2 and alertness status were evaluated immediately before and after 30 minutes of positioning. Results In all, 66 NBs were assessed (corrected age: 35.48 ± 1.94 weeks; weight: 1840.14 ± 361.09 g), (PP: n = 22; SP: n = 23; KP: n = 21). NBs in the PP group showed a significant improvement in peripheral SpO2 (97.18 ± 2.16 vs 95.47 ± 2.93 vs 95.57 ± 2.95, p = 0.03) compared with the SP and KP groups. Conclusion In clinically stable preterm NBs, the PP was associated with better peripheral oxygen saturation than the SP or KP. In addition, there was a reduction in heart rate within prone position group and in the KP group there was an increase in the number of NBs in the deep sleep classification.

Longitudinal Responses to Weighing and Bathing Procedures in Preterm Infants

Knowledge of the effects of nursing-induced stress on short-term outcomes in preterm infants is limited. Effects of 2 standard nursing procedures-weighing and bathing-on autonomic and motor stability of preterm infants were studied during their hospitalization. Outcomes were evaluated during and after the procedures. Eleven preterm infants were observed between 32 and 35 weeks' postmenstrual age (PMA) (postnatal days range: 4-63). Neonatal responses were assessed according to the Synactive Theory of Development and nursing was performed taking into account Newborn Individualized Developmental Care and Assessment Program (NIDCAP) principles. Effects of the studied nursing procedures on infants' stability during and after their execution were evaluated by nonparametric statistics. During monitored procedures, stress responses in autonomic and motor systems were observed at all PMAs. However, after 32 weeks' PMA, preterm infants also showed an autonomic and motor stability recovery 5 minutes after procedure completion. Contrary to our hypothesis, preterm infants showed to be stressed by weighing and bathing procedures up to 35 weeks' PMA. However, if facilitated and supported after nursing conclusion by interventions such as swaddling and nesting, according to NIDCAP principles, they recovered autonomic and motor stability by 5 minutes after ending procedures.

Effect of time and body position on ventilation in premature infants

BACKGROUND

Infants with respiratory dysfunction undergo regular position changes to improve lung function however it is not known how often a position change should occur. This study measured changes in lung function occurring over time after repositioning in preterm infants.

METHODS

Changes in end-expiratory level (EEL) and ventilation distribution were measured 30 mins, 2 h, and 4 h after repositioning into either prone, quarter turn from prone, or supine using Electrical Impedance Tomography (EIT). Physiological measurements were also taken.

RESULTS

Sixty preterm infants were included in the study. Infants receiving respiratory support (mechanical ventilation or continuous positive airway pressure (CPAP)) had improved ventilation homogeneity after 2 h (P < 0.01), maintained at 4 h. Spontaneously breathing infants had improved homogeneity at 2 h (P < 0.01) and improved global EEL after 4 h (P < 0.01) whereas infants receiving CPAP demonstrated an improved global EEL at 2 h (P < 0.01).

CONCLUSION

Regional ventilation distribution is influenced by time independent of changes due to body position. Differences exist between infants on ventilatory support compared with those who are spontaneously breathing. Infants receiving ventilatory support have a physiological peak in lung function after 2 h which remains above baseline at 4 h. A change in body position facilitates an improvement in lung function in infants on ventilatory support.

Influence of the Kinaesthetics care conception during patient handling on the development of musculoskeletal complaints and diseases - A scoping review

Abstract

The Kinaesthetics care conception is a nursing approach for patient handling which aims to prevent work-related complaints and diseases. The evidence about the influence of Kinaesthetics on musculoskeletal disorders among persons who handle patients is unclear to date. The purposes of the scoping review are to gain insight into the current state of research regarding the clinical effectiveness of Kinaesthetics (in terms of perceived exertion and musculoskeletal complaints) among persons who handle patients and to identify potential research gaps. A scoping review was conducted. The search strategy comprised a systematic search in electronic databases (MEDLINE, EMBASE, AMED, CINAHL), a hand search, a fast forward search (Web of Science) and a Google scholar-search. The review process was carried out independently by two reviewers. Methodological quality was assessed for all studies using three methodological main categories (reporting quality, internal validity, external validity). Thirteen studies with different study designs were included. Seven studies investigated musculoskeletal complaints and nine studies the perceived exertion of nursing staff. Most studies were of very low methodology. Most studies reported a decrease of musculoskeletal complaints and perceived exertion due to Kinaesthetics. In conclusion, there is only little evidence of very low quality about the effectiveness of Kinaesthetics. Out of the studies it could be assumed that Kinaesthetics may decrease the patient handling related perceived exertion and musculoskeletal pain of persons who handle patients. But an overestimation of these results is likely, due to inadequate methodology of included studies. As a result, no clear recommendations about the effectiveness of the Kinaesthetics care conception can be made yet. Since a research gap was shown, further high quality intervention studies are necessary for clarifying the effectiveness of Kinaesthetics.

PROSPERO registry number

CRD42015015811

[Handling of preterm infants in a neonatal intensive care unit]

While hospitalized in neonatal units, preterm infants undergo various manipulations and procedures that have negative health consequences. The aim of this study was to describe the manipulations that preterm infants are subjected to over a 24-hour period in a neonatal intensive care unit (NICU). An observational, descriptive, exploratory study was conducted with 20 preterm infants who were filmed continuously in a NICU over a 24-hour period from September 2008 to March 2009. Preterm infants were subjected to an average of 768 manipulations and 1341 procedures. The average duration of the manipulations over the 24-hour period was 2 hours and 26 minutes. Each manipulation included an average of 2.2 procedures, most occurring during the morning shift. Individual manipulations accounted for 65.6% of all manipulations, and most manipulations lasted less than a minute. The results of this study show that preterm infants in the NICU underwent an excessive number of manipulations over the 24-hour period evaluated.

Origins of tactile vulnerability in high-risk infants

PURPOSE

This study examined the degree to which birthweight, gestational age, fetal drug exposure, hazardous postnatal medical events, and a mother's predisposition toward touch predicted the likelihood of an infant's tactile vulnerability during nursing care.

SUBJECTS

The convenience sample included 99 hospitalized infants in their second week of life and their mothers.

DESIGN

The design was correlational.

METHODS

A standardized observational assessment was used to code the infant's physiological and behavioral responses to touch during 4 different episodes of nursing care. Chart review was performed to collect information regarding fetal drug exposure, birthweight, gestational age, and postnatal medical events. Mothers completed a questionnaire regarding their own comfort with using touch and being touched.

MEASURES

The Tactile Vulnerability Assessment measured infant reactivity to and tolerance for touch during nursing care. The Postnatal Complications Scale identified hazardous medical conditions and treatments experienced by the infant during the first 2 weeks of life, and the Physical Contact Assessment evaluated a mother's predisposition toward touch.

RESULTS

The number of hazardous postnatal medical events experienced by an infant was the primary predictor of tactile vulnerability, accounting for 28% of the variance in the infant's likelihood of developing hyperarousal and distress from touch during care. Illicit fetal drug exposure and maternal predisposition toward touch were also significant predictors.

CONCLUSIONS

The significant relationship of postnatal medical events to tactile vulnerability suggests that it may be associated with the presence of infant pain or injury to the infant's central nervous system. Symptoms of drug withdrawal and the impact of teratogens on arousal regulation may also be implicated in greater distress from touch by infants. In addition, findings suggest the potential for inherited transmission of a vulnerability to touch. Assessment of infant vulnerability, including discussion with parents about their views of the infant's needs regarding touch, may enhance problem identification and early intervention to reduce infant distress and further medical problems.

Kinesthetic stimulation for preventing apnea in preterm infants

BACKGROUND

Recurrent apnea is common in preterm infants, particularly at very early gestational ages. These episodes of loss of effective breathing can lead to hypoxemia and bradycardia, which may be severe enough to require resuscitation including use of positive pressure ventilation or other treatments. Physical stimulation is often used to restart breathing and it is possible that repeated stimulation, such as with an oscillating mattress (kinesthetic stimulation), might prevent apnea and its consequences.

OBJECTIVES

In preterm infants at risk for apnea, does prophylactic use of kinesthetic stimulation lead to a clinically important reduction in apnea and bradycardia, and use of intemittent positive preswsure ventilation (IPPV).

SEARCH STRATEGY

The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal trials, Cochrane Controlled Trials Register, MEDLINE, previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language.

SELECTION CRITERIA

All trials in preterm infants at risk of developing clinical apnea which utilised random or quasi-random allocation to treatment with an oscillating mattress or control, were eligible.

DATA COLLECTION AND ANALYSIS

Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used with separate evaluation of trial quality and data extraction by each author and synthesis of the data using relative risk.

MAIN RESULTS

There were no differences in short term effects (apnea /bradycardia, IVH, use of IPPV, sleep/wake cycles and neurological status at discharge) or longterm effects (in one trial - growth and development to one year).

REVIEWER'S CONCLUSIONS

Implications for practice. Prophylactic use of kinesthetic stimulation cannot be recommended to reduce apnea/bradycardia in preterm infants. Implications for research. There are currently no clear research questions regarding prophylactic use of kinesthetic stimulation to prevent apnea in preterm infants.