The Effect of Positions on Physiological Parameters of Preterm Neonates Receiving Mechanical Ventilation
Condition: Preterm; Nursing Caries
MeSH terms: Premature Birth
Study type: Interventional

Summary: 
      This study was planned as an experimental study with a randomized crossover design to
      determine the effect of supine, prone, right lateral, left lateral, and quarter prone
      positions used during daily routine care in the neonatal intensive care unit on physiological
      parameters (oxygen saturation, heart rate, respiratory rate) of preterm neonates receiving
      mechanical ventilation.
    

Detailed description: 
      Preterm neonates face various adaptation problems starting from their birth due to their
      underdeveloped organ systems. A significant portion of preterm neonates need advanced care
      due to respiratory system problems, especially due to insufficient adaptation of the
      respiratory systems to the extrauterine environment, and the majority of them require
      mechanical ventilation. For these reasons, it is a priority to restore the respiratory
      functions of preterm neonates. To ensure the functionality of body systems in the
      developmental care of neonates in this process, the method of neonatal positioning, which is
      one of the individualized supportive developmental care methods, is necessary. The primary
      goal of positioning in neonatal intensive care units is to reduce the effects of pain and
      environmental stimuli caused by interventions for treatment and care for neonates and to help
      them cope with stress by maintaining their posture. Developmental positioning practices aim
      to support neuromotor development and minimize pain by maintaining the comfortable position
      of the neonate surrounded by the midline. The positioning has been shown to significantly
      affect the respiratory systems of neonates and affect oxygenation and lung ventilation.
      Change of position is also crucial in physiological and neurodevelopmental aspects for
      neonates receiving mechanical ventilation. It is important to reposition neonates since they
      remain in the same position all the time, which may lead to the accumulation of secretions
      and the formation of pressure sores. Positioning is an important factor in the development of
      neonates; therefore, correct positioning is critical for the comfort of neonates in the short
      and long term. Giving and maintaining a suitable position for neonates is an important
      nursing intervention. With developmentally supportive positioning applications, infants are
      positioned in supine, prone, lateral (right/left) and quarter prone positions. Considering
      these positions one by one, the supine position, where nursing care can be provided more
      easily, increases the sensory-motor activities of the neonate and reduces the energy
      consumption resulting from the infant's activities. Neonatal intensive care units mostly
      place neonates in the prone position since it has a positive effect on breathing, sleep
      quality, and behavioral conditions. The prone position makes the newborn feel safer with the
      adjustments made in the extrauterine environment. The lateral (right/left) position is one of
      the positions reducing the extensor effects of gravity and supporting the midline orientation
      of the hands and feet along with the head, which can be preferred in cases where the prone
      position cannot be used. In the quarter-prone position, neonates are placed in a functional
      position similar to the prone position but with one side of the body slightly elevated to
      encourage the synchronous movement of the thoracic and abdominal respiratory muscles. It has
      been observed that the quarter prone position provides similar advantages as the prone
      position by increasing lung compliance, tidal volume, respiratory rhythm, and oxygenation
      during sleep. Preterm neonates are placed in these positions in daily routine care of
      neonatal intensive care units.

      The review of the relevant literature reveals studies comparing different groups regarding
      the positioning of preterm neonates receiving mechanical ventilators in the neonatal
      intensive care unit. These studies have mainly focused on the effect of supine, prone, right
      lateral and left lateral positions in preterm neonates receiving mechanical ventilation.

      There is no study collectively comparing supine, prone, right lateral, left lateral and
      quarter prone positions used during daily routine care of preterm neonates receiving
      mechanical ventilation, which was aimed in this study. In this context, it was considered
      that evaluating the effect of supine, prone, right lateral, left lateral and quarter prone
      positions routinely used in the neonatal intensive care unit on the physiological parameters
      of preterm neonates receiving mechanical ventilation (oxygen saturation, heart rate,
      respiratory rate) and determining which position is more effective for preterm infants will
      contribute to the literature and guide the care provided by neonatal nurses.

      Place And Tıme Of The Study:

      This study was planned to be conducted in the Neonatal Intensive Care Unit of the University
      of Health Sciences Etlik Zubeyde Hanim Gynecology Training and Research Hospital between June
      2022 and June 2023 after obtaining the necessary institutional and ethical committee
      approvals.

      Hypotheses Of The Study:

      Hypothesis 0(H0): There is no difference between prone, supine, right lateral, left lateral
      and quarter prone positioning of preterm infants in terms of physiological parameters of the
      infant.

      Hypothesis 1.1(H1.1): Supine positioning of preterm infants is more effective in
      physiological parameters than other positions.

      Hypothesis 1.2(H1.2): Prone positioning of preterm infants is more effective in physiological
      parameters than other positions.

      Hypothesis 1.3(H1.3): Left lateral positioning of preterm infants is more effective in
      physiological parameters than other positions.

      Hypothesis 1.4(H1.4): Right lateral positioning of preterm infants is more effective in
      physiological parameters than other positions.

      Hypothesis 1.5(H1.5): Quarter prone positioning of preterm infants is more effective in
      physiological parameters than other positions.

      Unıverse And Sample Of The Study:

      The universe of the study comprised preterm neonates receiving mechanical ventilation in the
      Neonatal Intensive Care Unit of the University of Health Sciences Etlik Zubeyde Hanim
      Gynecology Training and Research Hospital. Multi-group comparisons were planned in the
      analysis of the hypotheses of the study and the sample size calculated according to the
      statistical method to be used was taken as a basis.

      Using "G."Power version 3.1.9.2" software, the sample size was calculated at a confidence
      level of 95%. As a result of the analysis, α=0.05, the standardized effect size was
      calculated from a similar study conducted in this field. The minimum sample size was
      estimated as 8 subjects for each group when the effect size was taken as 0.72 (high), with
      theoretical power of 0.80. As evaluations will be carried out in 5 groups in this study, the
      minimum sample size was found to be 40.
    

Intervention name(s): The Effect of Supine Position on Physiological Parameters in Mechanically Ventilated Preterm Newborns; The Effect of Prone Position on Physiological Parameters in Mechanically Ventilated Preterm Newborns; The Effect of left lateral Position on Physiological Parameters in Mechanically Ventilated Preterm Newborns; The Effect of right lateral Position on Physiological Parameters in Mechanically Ventilated Preterm Newborns; The Effect of Quarter prone Position on Physiological Parameters in Mechanically Ventilated Preterm Newborns
Intervention type(s): Other; Other; Other; Other; Other
Intervention description(s): Preterm neonates who receive mechanical ventilation support and meet the study criteria will be provided with daily routine nursing care. Afterward, when it is time for positioning, the infant will be randomly placed in positions assigned according to the randomization. After positioning, data will not be collected for the first 30 minutes of each positioning in order to ensure the stability of the neonate. Starting from the 30th minute, the heart rate and oxygen saturation of the preterm neonate will be checked on the monitor at 15-minute intervals over the course of 90 minutes, and the respiratory rate will be counted and recorded for 1 minute by the researcher. For each position, the procedures will be repeated in the same way and the values will be recorded.; Preterm neonates who receive mechanical ventilation support and meet the study criteria will be provided with daily routine nursing care. Afterward, when it is time for positioning, the infant will be randomly placed in positions assigned according to the randomization. After positioning, data will not be collected for the first 30 minutes of each positioning in order to ensure the stability of the neonate. Starting from the 30th minute, the heart rate and oxygen saturation of the preterm neonate will be checked on the monitor at 15-minute intervals over the course of 90 minutes, and the respiratory rate will be counted and recorded for 1 minute by the researcher. For each position, the procedures will be repeated in the same way and the values will be recorded.; Preterm neonates who receive mechanical ventilation support and meet the study criteria will be provided with daily routine nursing care. Afterward, when it is time for positioning, the infant will be randomly placed in positions assigned according to the randomization. After positioning, data will not be collected for the first 30 minutes of each positioning in order to ensure the stability of the neonate. Starting from the 30th minute, the heart rate and oxygen saturation of the preterm neonate will be checked on the monitor at 15-minute intervals over the course of 90 minutes, and the respiratory rate will be counted and recorded for 1 minute by the researcher. For each position, the procedures will be repeated in the same way and the values will be recorded.; Preterm neonates who receive mechanical ventilation support and meet the study criteria will be provided with daily routine nursing care. Afterward, when it is time for positioning, the infant will be randomly placed in positions assigned according to the randomization. After positioning, data will not be collected for the first 30 minutes of each positioning in order to ensure the stability of the neonate. Starting from the 30th minute, the heart rate and oxygen saturation of the preterm neonate will be checked on the monitor at 15-minute intervals over the course of 90 minutes, and the respiratory rate will be counted and recorded for 1 minute by the researcher. For each position, the procedures will be repeated in the same way and the values will be recorded.; Preterm neonates who receive mechanical ventilation support and meet the study criteria will be provided with daily routine nursing care. Afterward, when it is time for positioning, the infant will be randomly placed in positions assigned according to the randomization. After positioning, data will not be collected for the first 30 minutes of each positioning in order to ensure the stability of the neonate. Starting from the 30th minute, the heart rate and oxygen saturation of the preterm neonate will be checked on the monitor at 15-minute intervals over the course of 90 minutes, and the respiratory rate will be counted and recorded for 1 minute by the researcher. For each position, the procedures will be repeated in the same way and the values will be recorded.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: Preterm neonates to be included in the study will be placed in 5 different positions using a crossover design.In order not to repeat the order of positions,5 groups will be created as follows:ABCDE;BCDEA;CDEAB;DEABC;EABCD.The number of the groups created for not repeating the order of positions will be determined using the lottery method;Group1=CDEAB;Group2=BCDEA;Group3=EABCD;Group4=DEABC;Group5=ABCDE.Then,which position corresponds to which letter will be determined using the lottery method;A=quarter prone position,B=prone position,C=supine position,D=left lateral position,E=right lateral position.Afterward,40 preterm neonates will be randomly assigned to 5 groups using the block randomization method in line with the sample calculation. The order of the positions for the preterm neonate will be determined according to the position order of the group including the preterm infant.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: preterm neonate; position; mechanical ventilation; physiological parameters; nursing caries