The Effect of Feeding Positions During Tube Feeding on Stress, Pain Level and Feeding Tolerance of Preterm Infants
Condition: Pain; Stress; Enteral Feeding Intolerance
Study type: Interventional

Summary: 
      Premature infants have a need for an orogastric or nasogastric feeding tube because of the
      immaturity of coordination between suck-swallow and breathing. Tube feeding could cause
      feeding intolerance and stress. One of the recommendations to prevent feeding intolerance is
      giving suitable position during tube feeding. Also, feeding intolerance is related to stress.
      The aim of this study was to investigate the effect of semi-elevated supine (ESU) and
      semi-elevated right lateral (ESRL) positions on the stress, pain levels and feeding tolerance
      of premature infants during the tube feeding (TF). This was a clinical trial with a crossover
      design in which subjects randomly received a sequence of either ESU position or ESRL
      position, during the TF.
    

Detailed description: 
      Purpose: The aim of this study was to investigate the effect of semi-elevated supine (ESU)
      and semi-elevated right lateral (ESRL) positions on the stress, pain levels and feeding
      tolerance of premature infants during the tube feeding (TF).

      Method: This was a clinical trial with a crossover design in which subjects randomly received
      a sequence of either ESU position or ESRL position, during the TF. The sample size
      calculation was based on the crossover design. It assumed criteria that included the
      expectation of minimal differences in the average pain and stress score, 1.0; a difference of
      2.0 in the standard deviation between ESU and ESRL positions; power, 0.80 and p < .05. The
      sample size was calculated to be 34 participants. The inclusion criteria for participants
      were 30-34 weeks gestational age, stable vital signs, no oral feeding skills, feeding by
      orogastric tube, and had parental consent. Exclusion criteria were respiratory distress,
      congenital anomalies, necrotizing enterocolitis history, neurological and cardiological
      problems, receiving analgesic, sedative, or muscle relaxant medication that may affect pain
      and stress. The position to be given to the participants during TF first was determined by
      randomization. The sequence of feeding position was randomized by computer. Sixteen of the
      infants started TF with ESU position, whereas the other 18 started with ESRL position.

      The study data were collected with "Descriptive Properties Form of Premature Newborn",
      Premature Newborn Follow-up Form", "Newborn Stress Scale", "ALPS-Neo Newborn Pain and Stress
      Assessment Scale".

      For each participant, two feeding positions were applied at consecutive feeding time. Feeding
      tolerance was assessed by abdominal circumference measurements and checking gastric
      residuals. The abdominal circumference of the participants was measured with a tape measure
      before and after TF. Vital signs and oxygen saturation levels were measured before, during
      and after TF. The stress and pain levels of the participants were evaluated independently by
      the researchers before, during and after TF. Significance level p <0.05 was used for all
      statistical analyses. Ethics committee approval, written permission from institutions and
      families were obtained for conducting the study.
    

Intervention name(s): ESU position; ESRL position
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Semi-elevated supine (ESU) position was given during tube feeding; Semi-elevated right lateral (ESRL) position was given during tube feeding
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: body position; enteral feeding intolerance; nursing care; pain; stress