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Optimizing positioning of your preterm baby in the NICU

Parenting in the NICU - a quick look

quick look preemiehelp

Learning about the NICU and ways of helping and bonding with your preemie can help you manage some of the stress and uncertainty associated with a preterm birth.


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Finding special ways to connect & understand preterm birth

The joy of childbirth is often short-lived for parents of preterm babies. Isolation from your newborn, extended hospital stays, and the uncertainty associated with medical procedures, takes a massive emotional and physical toll. This section has been created to help you navigate your way through some tough times. It covers everything from family-centred care, tips on how to bond with your preemie, helping out in the NICU, what to bring, to learning to read your prem's body language

 


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Optimizing positioning of your preterm baby in the NICU

Preterm babies are born before their little muscles are able to support them properly. Preemie babies need some extra help from parents and medical staff to adopt good positioning that will help their development.

Overview: optimizing preterm baby's position

Preterm babies have weak muscle tone when they are born, so if they aren’t supported they tend to sprawl out, whereas babies born at term tend to curl-up. Although there is no scientific evidence to suggest that the position a preemie takes is uncomfortable or problematic, many parents are concerned about their baby’s level of comfort.

More importantly, there is some evidence that there are beneficial effects for the development of normal posture and muscle tone when preterm babies are assisted and supported to lie in better positions. This supporting positioning encourages preterm babies to practice flexing their muscles, which helps with normal development of muscle tone. Developmental benefits may include achieving developmental milestones such as sitting, crawling, walking, and moving their arms and legs normally.

(Bradford, 2003; Liu et al., 2007)
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Practicing Flexion for Preterm Babies

Practicing Flexion is Important for Preemies

Usually babies develop muscle tone by pushing their arms, legs, hands, feet, and shoulders against the walls of the uterus; which is called flexion. As a baby grows there is less room in the uterus, which means baby flexes more often and therefore develops better muscle tone. Swaddling and containment of your preemie baby with general flexion of the extremities and trunk is a way of generally mimicking this effect outside of the womb.

Motor coordination, balance, and posture difficulties are common in preterm babies, for example, around 40% to as high as 80% of preterm babies who weigh less than 1500 g (3 ⅓ pounds) show early signs of movement difficulties, such as supporting their own heads and sitting up unaided. Promoting good positioning and encouraging opportunities for flexion can help prevent these problems from developing.

(Bradford, 2003; Liu et al., 2007)

Learn more about Optimizing motor development


Swaddling your preemie baby

It is called swaddling when you wrap your baby up snugly in a cloth or blanket so that movement of limbs is restricted.

How do I swaddle my preemie baby?

  • If you’re unfamiliar with swaddling it’s a good idea to practice first using a doll so that you have confidence when interacting with your preemie.
  • Talk to your baby, explaining to them what you’re doing
  • Place a cotton sheet or blanket on a flat surface (some companies sell blankets especially for swaddling)
  • Fold down the top corner about 15cm (6 inches)
  • Gently place your preterm baby on her back in the middle of the blanket and so her head is on the fold
  • Hold her left arm close to her body and pull the right side of the blanket over her and tuck the leading edge under her right arm and around under her back. The right arm of your preterm baby should remain as before
  • Fold the bottom point of the blanket over your baby’s feet up under her chin, after making sure that nothing is creating any discomfort for her
  • Pull the left side of the blanket over and tuck it under her back on the left side, ensure your preterm baby’s right arm is close to her body
  • Some babies prefer to have their arms free so you may choose to swaddle your prem under the arms
  • The swaddle should be firm, which makes your baby feel secure but make sure you don’t do it too tight such that it affects circulation
  • Make sure you don’t cover your baby’s face and beware you don’t overheat your preemie

What are the benefits of Swaddling?

  • Promotes sleep with decreased awakenings during quiet sleep and longer periods of REM sleep
  • Improves self-regulation
  • Diminished stress response and a decrease in arousal level, including decreased crying
  • May promote neuromuscular development in preterm infants
  • Reduced pain response
(Brackbill, 1973; Caglayan, Yaprak, Sackin, Kansoy, & Aydinlioglu, 1991; Fearon, Kisilevsky, Hains, Muir, & Tranmer, 1997; Franco et al., 2005; Gerard, Harris, & Thach, 2002; Giacoman, 1971; Liu, et al., 2007; Neu & Browne, 1997; Ohgi, Akiyama, Arisawa, & Shigemori, 2004; Prasopkittikun & Tilokskulchai, 2003; Short, Brooks-Brunn, Reeves, Yeager, & Thorpe, 1996; van Sleuwen et al., 2006)

Containment, Nesting & supporting preterm babies

Containment is often used in the NICU to help preemies establish a good position to optimize development and support. There are specially made baby support items you can buy from various manufacturers, however these can be expensive but don’t worry there are many soft items you can use as a good substitute, such as soft rolls of flannelette baby sheets, small foam shapes, small pillows or even mini bean bags.

The supports can be placed at all or any of the following places: hips, back, shoulders, knees, or neck. Preterm babies usually don’t like having a lot of space around them. Some preemie babies will make their way to the corner of their incubator. If this occurs it is better to leave them there so they don’t waste energy trying to make their way back to the corner each time they are repositioned.

Nesting is also common practice in the NICU. Staff may “nest” a premmie by tucking a roll of material all the way around the body. This creates a support position with which to optimize good posture and muscle development, as well as creating a comfortable and secure feeling for your baby.


How good positioning can help your preterm baby?

The potential benefits of good positioning

  • Helps develop normal movement and posture
  • May enable your baby to breathe more easily and encourage a regular heartbeat
  • Promotes regular sleeping patterns due to increased comfort and improved breathing
  • Aids in good digestion, placing a preterm baby in a supported and comfortable position can help reduce gastric reflux, a common problem for preterm babies
  • Helps prevent your preemie from the agitated and sometimes frantic, fidgeting that premature babies often display, due to discomfort or distress

How do I provide good positioning support for my preemie baby?

  • Place soft supports at your baby’s hips, knees, shoulders, neck, and back
  • Regularly change your baby’s head position
  • Raise the head end of his incubator to a 30 degree angle
  • Change the position he lies in from time to time
  • Position soft boundaries around your bub to encourage flexion against them
  • Bring your baby’s hands up close to their mouth
  • Put him in the balanced “midline” position, again bringing his hands up near his mouth
  • Take notice of your preemie’s body language to ensure they are comfortable
  • Position your prem so they are lying on their front; lying on the front can also help if your baby is finding it difficult to breathe

 


Technical References

Brackbill, Y. (1973). Continuous stimulation reduces arousal level: stability of the effect over time. Child Dev, 44(1), 43-46.
Ancel, P.-Y., Livinec, F., Larroque, B., Marret, S., Arnaud, C., Pierrat, V., et al. (2006). Cerebral palsy among very preterm children in relation to gestational age and neonatal ultrasound abnormalities: the EPIPAGE cohort study. Pediatrics, 117(3), 828-835.
Caglayan, S., Yaprak, I., Sackin, E., Kansoy, S., & Aydinlioglu, H. (1991). A differenct approach to sleep problems of infancy: swaddling above the waist. Turkish Journal of Pediatrics, 33, 117-120.
Fearon, I., Kisilevsky, B. S., Hains, S. M., Muir, D. W., & Tranmer, J. (1997). Swaddling after heel lance: age-specific effects on behavioral recovery in preterm infants. J Dev Behav Pediatr, 18(4), 222-232.
Franco, P., Seret, N., Van Hees, J.-N., Scaillet, S., Groswasser, J., & Kahn, A. (2005). Influence of swaddling on sleep and arousal characteristics of healthy infants. Pediatrics, 115(5), 1307-1311.

Giacoman, S. L. (1971). Hunger and motor restraint on arousal and visual attention in the infant. Child Dev, 42(2), 605-614.

Neu, M., & Browne, J. V. (1997). Infant physiologic and behavioral organization during swaddled versus unswaddled weighing. J Perinatol, 17(3), 193-198.
Ohgi, S., Akiyama, T., Arisawa, K., & Shigemori, K. (2004). Randomised controlled trial of swaddling versus massage in the management of excessive crying in infants with cerebral injuries. Arch Dis Child, 89(3), 212-216.
Prasopkittikun, T., & Tilokskulchai, F. (2003). Management of pain from heel stick in neonates: an analysis of research conducted in Thailand. J Perinat Neonatal Nurs, 17(4), 304-312.
Short, M. A., Brooks-Brunn, J. A., Reeves, D. S., Yeager, J., & Thorpe, J. A. (1996). The effects of swaddling versus standard positioning on neuromuscular development in very low birth weight infants. Neonatal Netw, 15(4), 25-31.
van Sleuwen, B. E., L'Hoir, M. P., Engelberts, A. C., Busschers, W. B., Westers, P., Blom, M. A., et al. (2006). Comparison of behavior modification with and without swaddling as interventions for excessive crying. J Pediatr, 149(4), 512-517.

 

 



AlbertEinstein_iconOne of the greatest minds in history, Albert Einstein was born preterm.

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Preemie, Premmie, or Prem?

Most babies spend between 38 and 42 weeks in their mother’s uterus. So, technically a preterm birth, preemie, premmie, or prem, is an infant who is born less than 37 completed gestational weeks. 


Read More: Defining Preterm birth


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New Release - Preemie Development

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