title: The effects of alternative positioning on preterm infants in the neonatal intensive care unit: a randomized clinical trial.
abstract: There is a paucity of studies that have investigated the developmental benefits of positioning in the neonatal intensive care unit. The purpose of this study was to investigate the effects of a new, alternative positioning device compared to traditional positioning methods used with preterm infants. In this randomized, blinded clinical trial, one hundred preterm infants (born ≤ 32 weeks gestation) from a level III neonatal intensive care unit in the United States were enrolled at birth. Participants were randomized to be positioned in the alternative positioning device or to traditional positioning methods for their length of stay in the neonatal intensive care unit. Infants were assessed using the NICU Network Neurobehavioral Scale between 35-40 weeks postmenstrual age. Clinical and feeding outcomes were also captured. Linear and logistic regressions were used to investigate differences in neurobehavioral outcome, feeding performance, and medical outcomes. Infants in the alternative positioning arm of the study demonstrated less asymmetry of reflex and motor responses on the NICU Network Neurobehavioral Scale (p=0.04; adjusted mean difference=0.90, 95% CI 0.05-1.75) than those positioned using traditional positioning methods. No other significant differences were observed. Reduction in asymmetry among preterm infants is an important benefit of alternative positioning, as symmetrical movement and responses are crucial for early development. However, it will be important to follow this sample of preterm infants to determine the effects of early positioning on neurodevelopmental outcome in childhood.
authors.affiliation: Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Avenue, Saint Louis, MO 63110, United States.
authors.forename: Laura
authors.initials: L
authors.lastname: Madlinger-Lewis
authors.affiliation: Washington University School of Medicine, Department of Psychiatry, 660 South Euclid, Saint Louis, MO 63110, United States.
authors.forename: Lauren
authors.initials: L
authors.lastname: Reynolds
authors.affiliation: Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Avenue, Saint Louis, MO 63110, United States.
authors.forename: Cori
authors.initials: C
authors.lastname: Zarem
authors.affiliation: Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Avenue, Saint Louis, MO 63110, United States.
authors.forename: Tara
authors.initials: T
authors.lastname: Crapnell
authors.affiliation: Washington University School of Medicine, Department of Pediatrics, 1 Children's Place, Saint Louis, MO 63110, United States; Washington University School of Medicine, Department of Neurology, 1 Children's Place, Saint Louis, MO 63110, United States; Washington University School of Medicine, Department of Radiology, 1 Children's Place, Saint Louis, MO 63110, United States.
authors.forename: Terrie
authors.initials: T
authors.lastname: Inder
authors.affiliation: Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Avenue, Saint Louis, MO 63110, United States; Washington University School of Medicine, Department of Pediatrics, 1 Children's Place, Saint Louis, MO 63110, United States. Electronic address: Pineda_R@kids.wustl.edu.
authors.forename: Roberta
authors.initials: R
authors.lastname: Pineda
mesh_terms: D002657:Child Development; D005247:Feeding Behavior; D005260:Female; D005865:Gestational Age; D006801:Humans; D018730:Infant Behavior; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal / Q000379:methods*; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D009043:Motor Activity; D056888:Patient Positioning / Q000379:methods*; D012121:Respiration, Artificial; D016896:Treatment Outcome
keywords: Development; NICU; Positioning; Preterm infants