Quality of rest state in the premature infant in flexed side-lying and supine positioning

The infant born prematurely is thrust into a confrontation with an extremely threatening environment; this is a battle for which the infant is not physiologically or anatomically prepared. At great risk for damage are the respiratory and nervous systems. Neonatal specialists are increasingly directing efforts towards the identification of interventions to enhance the opportunity for normal growth and development. Positioning of the premature infant is one area receiving much attention.

The purpose of this study was to examine the relationship between positioning (supine and flexed lateral) and certain characteristics of rest periods in the premature infant in a neonatal intensive care unit. This was a descriptive study of 8 infants born at less than 34 weeks gestation. Infants were placed undisturbed in each position for a 30 minute time period. During this period, observations were made of activity state, oxygen requirements, blood pressure and heart rate. Descriptive analysis of the data was performed to evaluate the presence and extent of relationships.

The descriptive analysis revealed a strong relationship between positioning of the premature infant and oxygen requirements. A decrease in oxygen requirements was observed in the lateral position as compared with the supine position in 7 of the 8 subjects. The only subject not exhibiting this pattern of oxygen requirements was the infant of the greatest gestational age (33 weeks). The descriptive analyses of the data collected for the other parameters failed to reveal any strong associations.

The observed association between lateral positioning and decreased oxygen requirements in this study should be studied in greater depth with a larger sample size and statistical analysis. A replication of the entire study with a larger sample may also reveal relationships among the other variables which did not become evident in this pilot study.