Postural and motor care of the premature baby

Adaptive Positioning Intervention for Premature Infants: Issues for Paediatric Occupational Therapy Practice

Adaptive positioning is one aspect of occupational therapy intervention with premature infants. This article reviews briefly the literature on the benefits of positioning strategies with premature infants, as well as the literature pertaining to infant alert states and the development of early parent-child interactions, in an attempt to present important roles for the occupational therapist working with this population: It is suggested that for successful implementation of positioning intervention, occupational therapists need to be able to recognise infant states and educate caregivers of their implications. In addition, occupational therapists should encourage caregivers to assume a greater responsibility for the positioning aspect of their infants care.

Effect of a postural support nappy on 'flattened posture' of the lower extremeties in very preterm infants

OBJECTIVE

To determine whether the use of a postural support nappy (PSN) would reduce the features of 'flattened posture' in the lower extremities of infants < 31 weeks gestation who are nursed prone.

METHODOLOGY

Randomized, observer blind, controlled trial conducted at King Edward Memorial Hospital for Women, Perth, Western Australia. Infants were randomly assigned and stratified by gestational age to be nursed in a conventional nappy (n = 29) or a PSN (n = 31) when in the prone position. The features of 'flattened posture' were measured as angles and assessed by blinded observers prior to commencement of the intervention, 4 weeks post intervention, then bi-weekly until discharge.

RESULTS

A significant reduction in the features of 'flattened posture' occurred in the PSN group after 4-6 weeks of intervention and stabilized by 8 weeks until discharge. No changes were detected in the control group. No significant difference was observed between infants < 29 weeks gestation compared to infants of 29-30 weeks gestation in either treatment group.

CONCLUSIONS

Use of the PSN in infants < 31 weeks gestation who are nursed in the prone position significantly reduces the features of 'flattened posture' in the lower extremities. This is of benefit in the short term, and follow up of these infants into childhood will demonstrate whether the long-term effects of 'flattened posture' can be prevented.

The use of waterbeds for very low-birthweight infants: effects on neuromotor development

One hundred and seven infants aged < 32 weeks of gestation were stratified according to birthweight and randomly assigned to either a waterbed group (N = 53) or a mattress group (N = 54). All the infants were assessed on removal from the surface: 68 infants at 40 weeks gestation and 52 infants at four, eight, 12 and 18 months adjusted age. At the 18-month assessment, outcome was classified as normal, suspicious or abnormal. There were no significant differences between the groups at any age. The results suggest that the use of the waterbed as a positional surface in the neonatal intensive-care unit has no influence on the motor development of very low-birthweight infants.

Assessment of Sitting in Children with Cerebral Palsy from Videofilm

The purpose of this study was to investigate the reliability of two dependent measures, (1) counting of pathologic movements (CPM) and (2) the Sitting Assessments Scale (SAS). The measures were intended for use in clinical physiotherapy practice, to provide both quantifiable and qualitative information from videofilm concerning functional sitting in children with cerebral palsy (CP). Two separate groups of final term physiotherapy students (three students in each group) tested one technique each for interrater reliability. The SAS-measure also was tested for interrater reliability. Videofilm of twelve children with CP ranging in age from 2 to 16 years were assessed. The students' results were compared to earlier results by experiences physiotherapist. The results demonstrated excellent interrater reliability for SAS (p<0.001) and good interrater reliability for the CPM technique. The degree of user experience seems to play a role in the use of the CPM measure. Considering evaluation of postural control and functional performance over all, SAS appears to be superior to CPM.

Outcome of 100 randomly positioned children of very low birthweight at 2 years

Prematurely born children often show a tendency to adopt extensor motor patterns during the first years of life. These children and especially those children of very low birthweight are considered to be at high risk for abnormal development. Positioning in an ordinary manner or in a more flexed position imposed at random during the neonatal period until discharge from hospital did not have a statistically significant influence on the development of these children at 24 months after term. Analysis of the optimality score of the 100 randomly selected children, born consecutively at the University Women's Hospital, Bern, showed a significant influence of prenatal optimality and congenital malformations on their later outcome.

The effect of a 'containing' position in a hammock versus the supine position on the cutaneous oxygen level in premature and term babies

We evaluated the influence of positioning, and particularly a containing position in a hammock compared with the supine position, on the respiration of the newborn. Recordings of the transcutaneous oxygen level of 40 preterm babies and 10 full-term babies placed in their incubators alternately in the two positions have been analyzed. We found no significant differences between the means of the oxymetric indexes in the hammock and in the supine position, even when the babies had different gestational ages and birth weights. The advantages of the containing position for the neuromotor and relational development of the newborn in the first year of life in comparison with the effects of supine placement, which should be avoided as much as possible in the premature, are pointed out.