Influence of prone positioning on premature newborn infant stress assessed by means of salivary cortisol measurement: pilot study

The Effects of a Three-Stair Positioning Pillow Used for Preterm Infants on Physiologic Parameters and Sleep-Wakefulness Status: Randomized Controlled Trial

BACKGROUND

It is important to provide the necessary sleep for the growth of preterm infants in the neonatal intensive care unit. The purpose of this study was to determine the effect of 3-stair positioning pillows (TSPPs) developed for preterm infants with postnatal age 28 to 35 weeks on physiologic parameters and sleep-wakefulness status.

METHODS

This research was conducted as a randomized controlled experimental study. The CONSORT flowchart was used in the implementation of the randomized controlled trial. The preterm infants in the experimental group were placed in the prone position with TSPPs, whereas the preterm infants in the control group were followed in the routine prone position given in the neonatal intensive care unit. Preterm infants were followed for a total of 3 hours.

RESULTS

The sample of the study consisted of 60 preterm infants (experiment group = 30; control group = 30) who were hospitalized in the neonatal intensive care unit and met the selection criteria. Compared with the infants in the control group, the preterm infants in the experimental group were determined to have significantly lower heart rates, higher oxygen saturations, lower respiratory rates, longer sleep durations, and shorter wakefulness times (P < .001).

CONCLUSION

It was found that positioning preterm infants using TSPP had positive effects on physiological parameters (heart rate, oxygen saturation, and respiratory rate) and sleep-wakefulness status in favor of the experimental group.

IMPLICATIONS FOR PRACTICE

It is recommended to use a TSPP that supports the prone position to improve the physiologic parameters and sleep-wakefulness status of preterm infants in the neonatal intensive care unit. Larger studies need to be conducted utilizing longer follow-up protocols. Examining the effectiveness of TSPPs with different positioning materials in preterm infants is needed.

The Impact of Using Nesting Care on Heart Rate, Oxygen Saturation, and Pain Among Premature Neonates in Neonatal Intensive Care Units in Saudi Arabia: A Quasi-Experimental Study

BACKGROUND

Supportive positioning may mimic the intrauterine environment and enhance neonates' physiological and developmental outcomes. Limited research in Saudi Arabia examined the effect of supportive positioning aids (nesting) on infant outcomes in neonatal intensive care units (NICUs).

OBJECTIVE

This study compared nesting care to non-nesting care in the short-term outcomes of premature neonates (heart rate, oxygen saturation, and pain) in Saudi NICUs.

METHODS

A quasi-experimental design compared two groups of premature neonates from two NICUs regarding their heart rate, oxygen saturation, and pain level. Nesting was used in the first group, and not in the second group. Seventy premature neonates (35 per group) were recruited. An independent t-test was used to compare the two groups.

RESULTS

Heart rate was significantly lower in the nesting group than the non-nesting group at baseline and after procedures (136bpm and 139bpm vs 144bpm and 148bpm, P ≤ 0.05). The pain level was significantly lower in the nesting group than the non-nesting group at baseline and after procedures (3.7 and 3.8 vs 4.7 and 4.6, P ≤ 0.05). There was no significant difference between the two groups in oxygen saturation.

CONCLUSION

Nesting care supported premature neonates in the NICU. It helped stabilize the heart rate and pain. NICUs in Saudi Arabia would benefit from educating NICU nurses and informing NICU managers and policymakers of nesting care.

Systematic Review of the Effects of Positioning on Nonautonomic Outcomes in Preterm Infants

OBJECTIVE

To identify and synthesize the available evidence on the effect of different positions (prone, supine, and right and left lateral) on nonautonomic outcomes for preterm infants admitted to the NICU.

DATA SOURCES

We searched the CINAHL, MEDLINE, Scopus, and Cochrane databases for reports of primary research studies using a three-step strategy. We also searched for gray literature and reviewed the reference lists of retrieved articles.

STUDY SELECTION

We included reports of quantitative studies published in English from database inception through February 2022 that focused on positioning and nonautonomic outcomes (pain, comfort, skin integrity, behavioral state, and sleep quality and duration) for preterm infants in the NICU. Two authors independently screened titles and abstracts and assessed articles in full text against the inclusion criteria.

DATA EXTRACTION

Two authors independently extracted the data from the full-text articles using a standardized data extraction tool. We synthesized the data narratively because of the different designs and outcome measures among the included studies.

DATA SYNTHESIS

From a total of 550 records initially screened, we included 17 articles in our review. In the included articles, prone positioning improved sleep quality and duration, whereas supine positioning was associated with increased awakenings and activity. Infants demonstrated fewer self-regulatory behaviors in the prone position compared to supine or side-lying and were less stressed in the prone position. We found minimal evidence on the effect of positioning on skin integrity or pain.

CONCLUSION

There is limited good-quality evidence on the effect of positioning on nonautonomic outcomes in preterm infants. To inform clinical practice, high-quality randomized controlled trials focused on the positioning of premature infants are warranted.

Assessment of salivary cortisol concentrations for procedural pain monitoring in newborns

OBJECTIVES

The study aimed to evaluate the usefulness of salivary cortisol (SC) for the assessment of procedural pain intensity in preterm and term newborns.

METHODS

Three groups of neonates (term, 37⁰-41⁶ weeks; moderate to late preterm, 32⁰-36⁶; and very preterm, <32⁰) hospitalized in neonatal intensive care unit were assessed for the study. Response to nappy change, lung ultrasound (LUS), and blood sampling was analyzed. The intensity of pain was evaluated using continuous heart rate and blood oxygen saturation (SpO₂) monitoring, Neonatal Infant Pain Scale (NIPS), and SC concentrations. Saliva samples were collected before and 20 min after the procedure's end.

RESULTS

Seventy-one infants were examined: 30 term, 21 moderate to late preterm, and 20 very preterm. SC has increased significantly in response to nappy change only in very preterm newborns (2.13 ng/mL [1.55-3.68] vs. 2.84 ng/mL [1.93-9.06], p = 0.01). LUS did not affect concentrations of SC in any group. Significant increase in SC was observed after blood sampling in term and very preterm infants (2.2 ng/mL [1.45-2.92] vs. 4.29 ng/mL [3.88-5.73], p = 0.002, and 1.88 ng/mL [1.47-4.13] vs. 5.3 ng/mL [3.42-8.02], p = 0.002, respectively). A significant correlation between values of SC increase and NIPS scores was found (Spearman's rank correlation coefficient [r_s] = 0.31, p = 0.001).

CONCLUSIONS

We observed the increase in SC concentrations in response to painful stimulus. The presence of a correlation between NIPS scores and SC increase suggests that SC can be used as an objective parameter to assess pain in neonates.

Does the Head Position Affect Neonatal Lateral Ventricular Volume?

OBJECTIVE

This study aimed to determine whether there are differences in the lateral ventricular volumes, measured by three-dimensional ultrasound (3D US) depending on the posture of the neonate (right and left lateral decubitus).

STUDY DESIGN

This was a prospective analysis of the lateral ventricular volumes of preterm neonates recruited from Victoria Hospital, London, Ontario (June 2018-November 2019). A total of 24 premature neonates were recruited. The first cohort of 18 unstable premature neonates were imaged with 3D US in their current sides providing 15 right-sided and 16 left-sided 3D US images. The neonates in the second cohort of six relatively stable infants were imaged after positioning in each lateral decubitus position for 30 minutes, resulting in 40 3D US images obtained from 20 posture change sessions. The images were segmented and the ventricle volumes in each lateral posture were compared with determine whether the posture of the head influenced the volume of the upper and lower ventricle.

RESULTS

For the first cohort who did not have their posture changed, the mean of the right and left ventricle volumes were 23.81 ± 15.51 and 21.61 ± 16.19 cm³, respectively, for the 15 images obtained in a right lateral posture and 13.96 ± 8.69 and 14.92 ± 8.77 cm³, respectively, for the 16 images obtained in the left lateral posture. Similarly, for the second cohort who had their posture changed, the mean of right and left ventricle volumes were 20.92 ± 17.3 and 32.74 ± 32.33 cm³, respectively, after 30 minutes in the right lateral posture, and 21.25 ± 18.4 and 32.65 ± 31.58 cm³, respectively, after 30 minutes in the left lateral posture. Our results failed to show a statistically significant difference in ventricular volumes dependence on posture.

CONCLUSION

Head positioned to any lateral side for 30 minutes does not have any effect on the lateral ventricular volumes of neonates.

KEY POINTS

· Three-dimensional cranial ultrasound can measure neonatal ventricle volume.. · Ventricle volume in each lateral ventricle may be affected by posture of the neonate.. · The 30 minutes in any lateral posture is not sufficient to create volume difference in lateral ventricles..

What Did the Neonatal Integrative Developmental Care Model and Routine Developmental Care Affect on Stress of Premature Babies?

BACKGROUND: Neonatal integrative developmental care model (NIDCM) is a holistic model of premature baby care referring to seven basic neuroprotective developmental cares (DCs) by involving the family. AIM: This study aimed to assess the effect of the application of NIDCM on the stress response of premature babies. METHODS: The research design used was quasi-experimental with a non-equivalent control group pre- and post-test. The study was conducted in the neonatal care room of Dr. Wahidin Sudirohusodo Makassar Hospital from January 2020 to April 2021. The sample was 76 subjects consisting of 38 premature babies (19 controls and 19 interventions) and 38 mothers (19 controls and 19 interventions). The collected samples were taken to the Medical Research Laboratory of Universitas Hasanuddin (HUMRC) for testing. Furthermore, baby stress was assessed from salivary cortisol levels by enzyme linked immunosorbent assay. In addition, the effect of initial cortisol, final cortisol, and birth weight on changes in salivary cortisol in premature babies was determined using the Chi-square test. RESULTS: Neither NIDCM intervention nor routine DC has been shown to descriptive statistically decrease the stress response of premature babies in the neonatal care room, some of which are even increased. However, specifically in premature babies with a birth weight of <1800 g, NIDCM showed a better effect in lowering cortisol after treatment than regular DC. CONCLUSIONS: The application of NIDCM intervention reduces the stressor felt by the babies in the neonatal care room, besides the condition of babies with a birth weight of fewer than 1800 g needs special attention with the NIDCM intervention.

The Calming Effect of Maternal Breast Milk Odor on Term Infant: A Randomized Controlled Trial

Purpose: This study was carried out to assess the effect of the odor of breast milk and formula milk on reducing the acute pain of newborn infants during the heel-prick blood sampling. Methods: Eighty-four newborn were randomly assigned into two groups (formula milk group and breast milk group) with 42 infant searches. The pain that the newborn felt before, during, and after heel-prick blood sampling was assessed using Neonatal Infant Pain Scale; their heart rate and blood oxygen saturation were measured with a pulse oximeter. Saliva samples were taken from newborns before and after sampling, and their salivary cortisol level was measured. During sampling, the crying duration of newborn was recorded with a chronometer. Results: The pain threshold and heart rates of the newborn in the breast milk group were significantly lower than those in the formula milk group (p < 0.001). Salivary cortisol in the formula milk group increased and oxygen saturation levels in these infants decreased significantly more as compared to the breast milk group (p < 0.05). Conclusions: The odor of breast milk may be helpful in reducing the pain of newborn during heel-prick blood sampling.

Effect of Body Position on Cardiorespiratory Stabilization and Comfort in Preterm Infants on Continuous Positive Airway Pressure

PURPOSE

The purpose of the study is to investigate the effect of four body positions (supine, prone, left lateral, right lateral) on cardiorespiratory stabilization and comfort in preterm infants receiving Nasal Continuous Positive Airway Pressure (NCPAP).

DESIGN AND METHODS

In the study conducted as a randomized crossover design, the sample was composed of 20 preterm infants receiving NCPAP therapy. At each change of position, the baby was allowed to stabilize for 15 min, and heart rate and oxygen saturation values were recorded every 10 min for the next 60 min. The comfort levels of the infants in each position were evaluated at 30th and 60th minutes using the Premature Infant Comfort Scale.

RESULTS

At the end of the study, it was determined that there was no statistically significant difference between heart rate (p = .83), respiratory rate (p = .90) and oxygen saturation (p = .15) of the infants in terms of their positions. When the mean comfort scores of the preterm infants were compared in terms of position, it was found that there was a difference between the positions (p < .01). According to the scale evaluation, the highest comfort level of the infants was in the prone position, which was followed by right lateral, supine and left lateral positions.

PRACTICE IMPLICATIONS

Prone position was the most comfortable for preterm infants. However, comfort levels of preterm infants were also high enough in other positions so that no intervention is needed. In order to ensure comfort and cardiorespiratory stabilization, any of the four body positions can be chosen.

The Effect of Daily Exercise Program on Bone Mineral Density and Cortisol Level in Preterm Infants with Very Low Birth Weight: A Randomized Controlled Trial

PURPOSE

This randomized controlled double-blinded experimental study was carried out to determine the effects of the daily exercise program on bone mineral density and cortisol level in preterm infants with VLBW matched for birth weight, gestation week, and gender.

DESIGN AND METHODS

The study was carried out with preterm infants (n = 24) hospitalized in the NICU of a tertiary hospital. Ethical committee approval, institutional permission, parental written consent were obtained. A daily exercise program was implemented in preterm infants in the exercise group for 30 days, once a day, and continuing for 7-10 min. Before and after the study the following were evaluated in preterm infants in the exercise and control group: anthropometric measurements, tibia speed of sound (SOS) for bone mineral density, serum cortisol levels.

RESULTS

Serum cortisol levels (p = 0.05) were decreased, bone SOS values in the exercise group were increased (p = 0.009), after the study. The difference between pre-, post-study bone SOS and serum cortisol values of infants in the exercise group were high (p > 0.05). Percentage increases in anthropometric values in the exercise group were higher than the control group after the study (for all; p > 0.05).

CONCLUSIONS

The daily exercise program has positive effect on bone SOS and serum cortisol values in preterm infants. Neonatal nurses can implement the daily exercise program in clinical practice. Trial registration numberClinicaltrials.govNCT03773679.

Autonomic responses of premature newborns to body position and environmental noise in the neonatal intensive care unit

Objective

Evaluate the physiological and autonomic nervous system responses of premature newborns to body position and noise in the neonatal intensive care unit.

Methods

A quasi-experimental study. The autonomic nervous system of newborns was evaluated based on heart rate variability when the newborns were exposed to environmental noise and placed in different positions: supine without support, supine with manual restraint and prone.

Results

Fifty premature newborns were evaluated (gestational age: 32.6 ± 2.3 weeks; weight: 1816 ± 493g; and Brazelton sleep/awake level: 3 to 4). A positive correlation was found between environmental noise and sympathetic activity (R = 0.27, p = 0.04). The mean environmental noise was 53 ± 14dB. The heart rate was higher in the supine position than in the manual restraint and prone positions (148.7 ± 21.6, 141.9 ± 16 and 144 ± 13, respectively) (p = 0.001). Sympathetic activity, represented by a low frequency index, was higher in the supine position (p < 0.05) than in the other positions, and parasympathetic activity (high frequency, root mean square of the sum of differences between normal adjacent mean R-R interval and percentage of adjacent iRR that differed by more than 50ms) was higher in the prone position (p < 0.05) than in the other positions. The complexity of the autonomic adjustments (approximate entropy and sample entropy) was lower in the supine position than in the other positions.

Conclusion

The prone position and manual restraint position increased both parasympathetic activity and the complexity of autonomic adjustments in comparison to the supine position, even in the presence of higher environmental noise than the recommended level, which tends to increase sympathetic activity.

Comparison of Massage and Prone Position on Heart Rate and Blood Oxygen Saturation Level in Preterm Neonates Hospitalized in Neonatal Intensive Care Unit: A Randomized Controlled Trial

Background:

These days, most of the admitted infants in neonatal intensive care units (NICU) are premature infants. Infant massage and prone position has been recommended for several decades to have a positive effect on preterm and low birth weight infants. The objective of this study was to determine the effects of neonatal massage with prone positioning in preterm infants on Heart Rate (HR), and Oxygen Saturation (O₂Sa) status.

Materials and Methods:

This is a controlled randomized three-group clinical trial study conducted on hospitalized infants in selected hospitals of Alborz University of Medical Sciences in Karaj-Iran. There are about 75 preterm infants (33-37 weeks) who met inclusion criteria were randomly assigned to groups of position, massage as intervention groups, and a control group. Intervention (prone position and massage) was administrated for five straight days. The repeated measure ANOVA test was performed to evaluate and compare the effect of interventions. p value less than 0.05 was considered as statistical significance.

Results:

The Repeated Measure two-way Analysis of Variance (RM-ANOVA) result showed a significant difference in HR and SaO₂ in different time points among control, position and massage groups with RM-ANOVA (F_10,360 = 10.376, p < 0.001). HR values was reduced and SaO₂ values was increased in intervention groups with RM-ANOVA (F_5,360 = 2.323, p < 0.001).

Conclusions:

Results showed that massage and prone position equally led to the reduction of HR and increase of SaO₂, compared to control group.

The effect of nesting positions on pain, stress and comfort during heel lance in premature infants

BACKGROUND

Nesting positions are commonly used in procedural analgesic administration in premature neonates. The effectiveness of nesting positions is questioned. The aim of the this study was to assess the pain, stress, comfort and salivary cortisol and melatonin values in nesting positions during the heel lance procedure in premature infants at the NICU.

METHODS

Experimental research; repeated measurement design. The sample comprised 33 premature neonates with gestational age of 31-35 weeks who had been hospitalized in the NICU. Nesting positions were given using linen or towels. The procedure of heel lance was recorded on camera. The camera recordings were evaluated according to the NIPS and the COMFORTneo scale. Saliva samples were obtained five minutes prior to and 30 min after the heel lance procedure. Salivary Cortisol and Melatonin were measured using the Salimetrics Cortisol Elisa Kit and the Salimetrics Melatonin Elisa Kit.

RESULTS

The crying time, the mean NIPS score, the COMFORTneo score, the COMFORTneo NRS-pain scores and the COMFORTneo NRS-distress scores for premature neonates who were in the prone position during the procedure were significantly lower than the scores in the supine position (p < 0.000). Furthermore, the level of salivary cortisol five minutes prior to and 30 min after the heel lance procedure had significantly decreased in the prone position; however, there were insignificant differences in the mean levels of salivary melatonin between the positions.

CONCLUSIONS

Nesting in the prone position has a pain reducing effect, enhancing comfort and reducing stress in premature infants.

Clinical application of the Standard Operating Procedure of Positioning with Premature Infants

OBJECTIVE

To compare the physiological and behavioral responses of Premature Infant (PREEMIE) positioned by the Unit Routine Decubitus (URD) and the Standard Operating Procedure (SOP).

METHOD

A quasi-experimental comparative study performed at a Neonatal Intensive Care Unit in Southern Brazil. We evaluated 30 PREEMIEs with gestational age ≤32 weeks, randomly assigned to Unit Routine Decubitus (URD) and Intervention Group (IG), subdivided into Right Lateral Decubitus (RLD), Dorsal Decubitus (DD), Left Lateral Decubitus (LLD) and Ventral Decubitus (VD). It was evaluated before, during and after the procedure: Heart Rate (HR); Respiratory Frequency (RF); Peripheral Oxygen Saturation (SpO2); behavior by the Neonatal Behavioral Assessment Scale (NBAS); by NIPS.

RESULTS

During the intervention, RR (p = 0.023), indexes in NBAS (p = 0.01) and NIPS (p <0.0001) reduced significantly in SOP. HR and SpO2 did not present a significant difference.

CONCLUSION

Positioning according to the SOP shows benefit in relation to the behavioral and physiological status of PREEMIE.

Biobehavioral Responses of Preterm Infants to Conventional and Swaddled Tub Baths: A Randomized Crossover Trial

Bathing is a routine care procedure that exposes preterm infants to prolonged handling, which could cause stress and potentially disrupt infants' biobehavioral responses. The aim of this double-blind randomized crossover trial was to compare the preterm infant's body temperature, heart rate (HR), peripheral capillary oxygen saturation (SpO2), salivary cortisol levels, and sleep-wake states during and after swaddled and conventional tub baths. Forty-three infants born at 32 to 36 weeks postmenstrual age, weighing 2225 g or less, were enrolled in the study. Infants were videotaped before and after each type of baths. The time interval between baths ranged from 24 to 72 hours to allow a washout period. Physiological, hormonal, and behavioral responses were collected at baseline and during recovery from baths. No significant differences in the mean body temperature, HR, SpO2, salivary cortisol levels, and sleep-wake states between the bath types were observed in the baseline or recovery responses during the first 20 minutes after bath. Regardless of bath type, salivary cortisol levels showed a nonstatistical significant increase.

Sleep and salivary cortisol in preterm neonates: a clinical, randomized, controlled, crossover study

ABSTRACT Objective: Analyze the influence of ear protectors on the baseline levels of salivary cortisol and response and total sleep time of preterm neonates during two periods of environmental management of a neonatal intermediate care unit. Method: A clinical, randomized, controlled and crossover study conducted with 12 preterm neonates. The use of ear protectors was randomized in two periods. Sleep evaluation was performed using one Alice 5 Polysomnography System and unstructured observation. Results: No significant difference was observed between the baseline levels of salivary cortisol and response in preterm neonates from the control and experimental groups, and no statistical significance was observed between the total sleep time of both groups. No relationship was observed between the baseline levels of cortisol and response and total sleep time. Conclusion: Ear protectors in preterm neonates did not influence the salivary cortisol level and total sleep time in the studied periods.

Validation of newborn positioning protocol in Intensive Care Unit

RESEARCH OBJECTIVE

to verify the positioning indications of newborn sand build a standard operating procedure protocol for newborn positioning in Neonatal Intensive Care Unit (NICU).

METHOD

for protocol validation, the Delphi technique was used ,in which expert nurses in the field reviewed the proposed procedure.

RESULTS

we present the results of this validation in a protocol form, to contribute to the discussion about newborn positioning in NICU and standardization of nursing care related to positioning. We evaluated ten indicators, in which there was agreementof100.0% in seven, and of80% in three, above the 60% recommended by the validation technique.

CONCLUSION

given the importance of newborn positioning in NICU for its neuromuscular development, this study contributes to the adoption of an evidence-based practice for nursing.

A new type of swaddling clothing improved development of preterm infants in neonatal intensive care units

BACKGROUND

Preterm infants undergo stress owing to essential treatments and exposure to the extrauterine environment in neonatal intensive care units.

AIMS

The aim of this study was to enable preterm infants to maintain adequate positioning with a newly developed swaddling clothing, in order to improve low muscle tone and sleep quality, and to confirm the safety of the clothing.

STUDY DESIGN

This prospective clinical trial included an intervention group (preterm infants wearing bag-shaped clothing, allowing only exposure of the head, n=27), and a control group (preterm infants managed only with conventional swaddling, n=12).

OUTCOME MEASURES

We used the Dubowitz method to analyze behavior, recorded the frequency of vomiting and apnea in both groups, and assessed the sleep state in the intervention group.

RESULTS

Muscle tone and total score for the Dubowitz method significantly improved in the intervention group, compared with those in the control group. We evaluated the sleep state before and after the introduction of the device in the intervention group, and State 1 increased from 53.5% to 69.2% after introduction. No significant difference was seen in the frequency of vomiting and apnea between the groups.

CONCLUSIONS

The new swaddling clothing with enhanced stretch capacity improved the muscle tone and increased sleep time by decreasing the state level of preterm infants. This is an effective tool to assist in infant development in neonatal intensive care units.

Body positioning for spontaneously breathing preterm infants with apnoea

BACKGROUND

It has been proposed that body positioning in preterm infants, as compared with other, more invasive measures, may be an effective method of reducing clinically significant apnoea.

OBJECTIVES

To determine effects of body positioning on cardiorespiratory parameters in spontaneously breathing preterm infants with clinically significant apnoea.Subgroup analyses examined effects of body positioning of spontaneously breathing preterm infants with apnoea from the following subgroups.• Gestational age < 28 weeks or birth weight less than 1000 grams.• Apnoea managed with methylxanthines.• Frequent apnoea (> 10 events/d).• Type of apnoea measured (central vs mixed vs obstructive)

SEARCH METHODS

We used the standard search strategy of the Cochrane Neonatal Review Group (CNRG) to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 10), MEDLINE via PubMed (1966 to 14 November 2016), Embase (1980 to 14 November 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 2016 November 14). We also searched clinical trials databases and conference proceedings for randomised controlled trials and quasi-randomised trials.

SELECTION CRITERIA

Randomised and quasi-randomised controlled clinical trials with parallel, factorial or cross-over design comparing the impact of different body positions on apnoea in spontaneously breathing preterm infants were eligible for our review.

DATA COLLECTION AND ANALYSIS

We assessed trial quality, data extraction and synthesis of data using standard methods of the CNRG. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence.

MAIN RESULTS

The search conducted in November 2016 identified no new studies. Five studies (N = 114) were eligible for inclusion. None of the individual studies nor meta-analyses showed a reduction in apnoea, bradycardia, oxygen desaturation or oxygen saturation with body positioning (supine vs prone; prone vs right lateral; prone vs left lateral; right lateral vs left lateral; prone horizontal vs prone head elevated; right lateral horizontal vs right lateral head elevated, left lateral horizontal vs left lateral head elevated).

AUTHORS' CONCLUSIONS

We found insufficient evidence to determine effects of body positioning on apnoea, bradycardia and oxygen saturation in preterm infants. No new studies have been conducted since the original review was published. Large, multi-centre studies are warranted to provide conclusive evidence, but it may be plausible to conclude that positioning of spontaneously breathing preterm infants has no effect on their cardiorespiratory parameters.

Short-Term Effects of Hydrokinesiotherapy in Hospitalized Preterm Newborns

Background. In the neonatal intensive care unit (NICU) environment, preterm newborns are subject to environmental stress and numerous painful interventions. It is known that hydrokinesiotherapy promotes comfort and reduces stress because of the physiological properties of water. Objective. To evaluate the short-term effects of hydrokinesiotherapy on reducing stress in preterm newborns admitted to the NICU. Materials and Methods. Fifteen preterm newborns underwent salivary cortisol measurement, pain evaluation using the Neonatal Infant Pain Scale (NIPS), and heart rate, respiratory rate, and peripheral oxygen saturation measurements before and after the application of hydrokinesiotherapy. Results. The mean gestational age of the newborns was 34.2 ± 1.66 weeks, and the mean weight was 1823.3 ± 437.4 g. Immediately after application of hydrokinesiotherapy, a significant reduction was observed in salivary cortisol (p = 0.004), heart rate (p = 0.003), and respiratory rate (p = 0.004) and a significant increase was observed in peripheral oxygen saturation (p = 0.002). However, no significant difference was observed in the NIPS score (p > 0.05). Conclusion. In the present study, neonatal hydrotherapy promoted short-term relief from feelings of stress. Neonatal hydrokinesiotherapy may be a therapeutic alternative. However, this therapy needs to be studied in randomized, crossover, and blinded trials. This trial is registered with NCT02707731.

Salivary Cortisol Reactivity in Preterm Infants in Neonatal Intensive Care: An Integrative Review

Recently, more and more researchers have been using salivary cortisol reactivity to evaluate stress in preterm infants in the neonatal intensive care unit (NICU). The aim of this integrative literature review was to summarize the evidence of interventions leading to a change in salivary cortisol from the baseline in preterm infants in the NICU. The electronic databases of PubMed, CINAHL, Web of Science, and Scopus were searched for relevant studies. The inclusion criteria were studies with preterm infants exposed to an intervention evaluated by salivary cortisol reactivity before discharge from the NICU, which were published in English. In total, 16 studies were included. Eye-screening examination and heel lance provoked an increase in the salivary cortisol level. Music, prone position, and co-bedding among twins decreased the salivary cortisol level. Several studies reported a low rate of successful saliva sampling or did not use control groups. Future studies need to focus on non-painful interventions in order to learn more about salivary cortisol regulation in preterm infants. Moreover, these studies should use study designs comprising homogenous gestational and postnatal age groups, control groups, and reliable analysis methods that are able to detect cortisol in small amounts of saliva.