The Effect of Position on Gastric Residual Volume and Comfort Level in Newborns
Condition: Comfort; Newborn, Infant, Disease; Position; Residual
Study type: Interventional

Summary: 
      The purpose of this randomized controlled trial is to determine the effect of different
      positions (supine, prone, right lateral and left lateral) in post-op term newborns staying in
      Pediatric Cardio Vascular Surgery (PCVS) Intensive Care Unit on gastric residual volume and
      comfort level.
    

Detailed description: 
      In the study, crossover design from experimental designs was preferred. Crossover design is
      an experimental design type in which two or more interventions are applied in a sequence to
      each case in the study group. In these studies, each group is its own control group. In this
      design type, all different interventions in the study are applied to the same case; thus,
      differences that may arise due to individual differences are prevented. Additionally, less
      number of cases is sufficient in order to obtain the same number of observation data compared
      to the other design examples. Due to these properties, randomized crossover design model was
      used in this study. The study will be conducted in PCVS Intensive Care Unit of a University
      Hospital in Turkey between October 2020 and August 2021.

      In this study, sample size was calculated at the confidence interval of 95% using "G.
      Power-3.1.9.4" program. In a study the effect size used for determining the sample size in
      the study was found to be 0.54 based on the mean and standard deviation values of the study.
      By using this effect size, minimum sample size was found as 38 children in order for the
      gastric residue amount difference between positions to express statistically significance
      (p<0.05) with theoretical power of 0.95. By considering that there might be losses in the
      study, it is planned to include a total of 44 children in the study.

      The order of the 4 positions to be given to the infants in the study group (A:Prone Position,
      B:Right lateral Position, C:Left lateral Position, D:Supine Position) was determined by lot
      method. 4 different orders were chosen randomly from all possible orders of 4 positions to be
      given to the infants in the study group (24 different orders). Each different order of the
      positions was expressed as a group. 4 orders randomly selected from 24 different orders were
      as follows:

      The order in the first group is A, C, D, and B; The order in the second group is D, A, B, and
      C; The order in the third group is C, B, A, and D; The order in the fourth group is B, D, C,
      and A.

      Groups and position orders according to the result of the draw:

        1. st GROUP ORDER; Prone (A), Left lateral (C), Supine (D), and Right lateral (B)

        2. nd GROUP ORDER; Supine (D), Prone (A), Right lateral (B), and Left lateral (C)

        3. rd GROUP ORDER; Left lateral (C), Right lateral (B), Prone (A), and Supine (D)

        4. th GROUP ORDER; Right lateral (B), Supine (D), Left lateral (C), and Prone (A)

      Assigning the infants to 4 groups was made in Microsoft Excel program using "RANDBETWEEN"
      command. All positions will be applied once to each infant. The newborns to be assigned to
      the groups according to this result are stated in the below table.

      Groups Newborns

        1. st group A, C, D, B 1, 5, 10, 11, 12, 20, 21, 30, 36, 38, 44

        2. nd group D, A, B, C 19, 22, 23, 24, 25, 27, 28, 31, 32, 33, 42

        3. rd group C, B, A, D 3, 4, 6, 7, 9, 13, 15, 29, 34, 37, 43

        4. th group B, D, C, A 2, 8, 14, 16, 17, 18, 26, 35, 39, 40, 41

      Data Collection tools:

      In the data collection, "Information Form" prepared by the researcher to record the
      descriptive information of the newborn, "Newborn Comfort Behavior Scale" to evaluate the
      comfort level and "Residue Follow-up Form" to record the residual amount and the "Vital Signs
      Follow-up Form" to record the vital signs will be used.

      Information Form: It is a form prepared by the researcher in line with the literature to
      record the natal and postnatal information of the newborn. The information in this form will
      be filled out by the researcher.

      Newborn Comfort Behavior Scale: It is a Likert-type scale developed to be used to assess
      sedation and comfort needs, pain, and distress of newborns followed-up in the intensive care.
      The Newborn Comfort Behavior Scale will be evaluated at the 30th, 60th and 120th minutes
      after the position. The comfort level scale scoring will be evaluated and filled by the
      researcher and a second observer working in the Intensive Care Unit for 5 years.

      Residue Follow-up Form: The form prepared to follow up the residue includes the position
      given, amount of nutrition, the way of feeding, feeding type, and residue amount control. The
      researcher will evaluate and fill out the form at the 30th, 60th and 120th minutes after
      feeding.

      Vital Signs Follow-up Form: This form prepared by the researcher in line with the literature
      was composed of the parameters of heart rate (min), respiratory rate (min) and oxygen
      saturation value (%SpO2) of the newborn. The researcher will evaluate and fill out the form
      at the 30th, 60th and 120th minutes after positioning.
    

Intervention name(s): Supine position; Prone position; Lateral position
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): After the infants are treated and fed, they will be given the supine position. After positioning, the residue control will be performed in accordance with the procedure steps guideline at the 30th, 60th and 120th minutes and it will be recorded on residue follow-up form. In addition, the comfort level, heart rate, respiratory rate, and oxygen saturation levels of the infant will be evaluated and recorded at the specified times. At the end of two hours, until the next feeding hour (between 121st-180th minutes), the routine position (supine position) applied in the clinic will be given to the infant and waited in order for physiological parameters and comfort levels to return the period without intervention. The aim here is to ensure for the case to get over the effect of the previous position. No data will be collected within this period.; After the infants are treated and fed, they will be given the prone position. After positioning, the residue control will be performed in accordance with the procedure steps guideline at the 30th, 60th and 120th minutes and it will be recorded on residue follow-up form. In addition, the comfort level, heart rate, respiratory rate, and oxygen saturation levels of the infant will be evaluated and recorded at the specified times. At the end of two hours, until the next feeding hour (between 121st-180th minutes), the routine position (supine position) applied in the clinic will be given to the infant and waited in order for physiological parameters and comfort levels to return the period without intervention. The aim here is to ensure for the case to get over the effect of the previous position. No data will be collected within this period.; After the infants are treated and fed, they will be given the left or right position. After positioning, the residue control will be performed in accordance with the procedure steps guideline at the 30th, 60th and 120th minutes and it will be recorded on residue follow-up form. In addition, the comfort level, heart rate, respiratory rate, and oxygen saturation levels of the infant will be evaluated and recorded at the specified times. At the end of two hours, until the next feeding hour (between 121st-180th minutes), the routine position (supine position) applied in the clinic will be given to the infant and waited in order for physiological parameters and comfort levels to return the period without intervention. The aim here is to ensure for the case to get over the effect of the previous position. No data will be collected within this period. These processes will continue until the 4 positions are completed. Infants will stay in each position for 2 hours.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: Randomized Controlled Crossover Design Model
Masking: Single (Investigator)
Primary purpose: Supportive Care
Keywords: Newborn; Comfort Score; Residual Volume; infant positioning