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C. Matte1,2, M. Hammoud1, S. Clark1, M. Campeau1, L. Brassard1, A.-C. Nadeau-Robert1, C. Groulx-Comeau1, C. Petro Ospina1, S. Boutin1, E. Robino1, R. Brosseau1, T.M. Luu2,3, J.-O. Dyer1,4
1Université de Montréal, School of Rehabilitation, Faculty of Medicine, Montréal, Canada, 2Centre Hospitalier Universitaire Sainte-Justine Research Center, Montréal, Canada, 3Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, Montréal, Canada, 4Université de Montréal, Groupe Interdisciplinaire de Recherche sur la Cognition et le Raisonnement Professionnel, Centre de Pédagogie Appliquée aux Sciences de la Santé, Faculty of Medicine, Montréal, Canada
Background: Different decubitus positions (i.e., prone, supine, or lateral) have been shown to impact measures of health in preterm neonates (PNN). However, there are no consensus clinical recommendations on which decubitus position to choose for these patients based on their health status in the neonatal intensive care unit (NICU).
Purpose: This project aimed to develop clinical recommendations for decubitus positioning of PNN in the NICU that are endorsed by caregivers.
Methods: The project used a mixed (qualitative, quantitative) sequential design in three phases. Phase I (Sept 2018-Aug 2019) consisted of a systematic scoping review of evidence published until 2019 in PubMed, Medline, All EBM Reviews, Embase, and CINAHL databases on the effects of different decubitus positions on the health measures of PNN in the NICU. Data from this review were used to draft evidence-based recommendations. In phase II (Sept 2019- Aug 2020), three focus groups were conducted with caregivers (n = 23; 5 clinical nurses; 4 nurse practitioners; 4 parents; 3 physiotherapists; 3 occupational therapists; 2 respiratory therapists; 1 health services manager; and 1 neonatologist) from a university hospital NICU (Centre hospitalier universitaire Sainte-Justine in Montreal, Quebec, Canada). This phase allowed to obtain feedback from these caregivers on the relevance and feasibility of the preliminary recommendations. Phase III (Sept 2020-Aug 2021) used a three-round Delphi consultation to reach consensus from caregivers (n =20; 7 clinical nurses; 1 nurse practitioner; 1 parent; 2 physiotherapists; 1 occupational therapist; 4 respiratory therapists; and 4 neonatologists) working in NICUs in the province of Quebec, Canada, to produce final consensus clinical recommendations.
Results: Phase I: The systematic scoping review selected 61 articles showing evidence of the effects of different decubitus positions on the health of PNN in the NICU. From the data extracted, the research team drafted 11 evidence-based recommendations on decubitus positioning to improve cardiorespiratory measures, sleep quality, nutrition, digestion, and to reduce cranial deformities.
Phase II: The main themes that emerged from the focus groups regarding the relevance and feasibility included: Evidence-based recommendations offer increased clinical credibility for positioning; Recommendations are more relevant if they are tailored to the client; Other care procedures influence the feasibility of the recommendations.
Phase III: At the conclusion of the Delphi consultation, 7 recommendations were approved by the panel of NICU caregivers in the province of Quebec. The first recommendation (R1) states that an interdisciplinary team should decide on the safety of the prone position. Other recommendations state that the prone position should be preferred to improve cardiorespiratory measures (R2), sleep (R3), and nutrition (R4). Finally, there are consensus recommendations on positioning routines (R5), positioning accessories and tools (R6), and positioning in relation to other developmental care (R7).
Phase II: The main themes that emerged from the focus groups regarding the relevance and feasibility included: Evidence-based recommendations offer increased clinical credibility for positioning; Recommendations are more relevant if they are tailored to the client; Other care procedures influence the feasibility of the recommendations.
Phase III: At the conclusion of the Delphi consultation, 7 recommendations were approved by the panel of NICU caregivers in the province of Quebec. The first recommendation (R1) states that an interdisciplinary team should decide on the safety of the prone position. Other recommendations state that the prone position should be preferred to improve cardiorespiratory measures (R2), sleep (R3), and nutrition (R4). Finally, there are consensus recommendations on positioning routines (R5), positioning accessories and tools (R6), and positioning in relation to other developmental care (R7).
Conclusions: This project allowed to develop consensus clinical recommendations for decubitus positioning of PNN in the NICU. Further studies are needed to verify how these recommendations can be implemented.
Implications: Implementation of these recommendations would promote the tailoring of decubitus positioning to the needs of PNN, which may help improve their health.
Funding acknowledgements: Catherine Matte was funded by the Ordre professionnel de la physiothérapie du Québec for this project.
Keywords:
Preterm newborns
Decubitus position
Clinical recommendations
Preterm newborns
Decubitus position
Clinical recommendations
Topics:
Paediatrics
Critical care
Professional practice: other
Paediatrics
Critical care
Professional practice: other
Did this work require ethics approval? Yes
Institution: Centre hospitalier universitaire Sainte-Justine (CHUSJ) / Université de Montréal (UdeM)
Committee: Centre de Recherche (CHUSJ) / Research in Health Sciences (UdeM)
Ethics number: 2019-2188 (CHUSJ) / CERSES-20-160-D (UdeM)
All authors, affiliations and abstracts have been published as submitted.
