INTRODUCTION:

A newborn is precious not only to his parents, family, community and nation but to the world at large. Each year, in India over one million newborns die before they complete their first month of life.¹Appropriate and timely management of newborn babies can save them and provide better quality of life. A newborn baby’s survival depends on its ability to adapt to an extra uterine environment.²

Neonates who lack appropriate care, are at high risk of poor health and reduced productivity in childhood and later. Correct body positioning is a major nursing concern to prevent problems and reduce complications. Since body alignment is known to affect many physiological parameters, the positioning of neonates is vital.³

The American Academy of Pediatrics recommends the supine sleeping position for healthy infants in the first year of life as a preventive measure for sudden infant death syndrome.¹ The goal of therapeutic positioning of infants is to provide adequate support and minimize positional deformities.⁴ The supine position supports the infants and attention must be paid to maintain the supine position comfortably.⁵Nurses rses form the are the one who constantly monitor and care the sick neonate and the most responsible to report the progress of the baby to the physicians. Monitoring vital signs like temperature, heart rate and respiratory rate is one of the most important works in the neonatal nursing.⁶ Nurses can initiate prompt management by providing proper positioning to term neonates and assists them in better survival.⁷Positioning affects ventilation perfusion matching and arterial oxygen levels. Besides this, neonates require assistance to attain a favorable position. Thus selecting an appropriate body position and assisting neonates into it are important considerations for nurses in Neonatal Intensive Care Unit.^5,8Nurses are in key positions to teach the healthcare team and parents regarding the best way to position these infants to achieve their development in a proper way. Regular educational and practical sessions led by neonatal nurses with their daily input and support in the clinical area would be valuable in enhancing correct positioning practices, so that the developmental outcome for each baby is optimal.⁹

MATERIALS AND METHODS:

Quantitative approach with one group pre-test post-test design was adopted for this study. Forty term neonates based on inclusion criteria were selected using Purposive sampling technique. Tool was constructed with baseline proforma and observation chart to record the selected physiological parameters. A table was used to record physiological parameter readings of term neonates at supine, lateral and prone positions at 5^th, 15^th and 30^th minutes. It includes the selected physiological parameters such as heart rate, respiratory rate and oxygen saturation of term neonates. Heart rate was checked through auscultation by stethoscope for one-minute, respiratory rate was monitored by abdominal movements for one minute and oxygen saturation was checked by pulse oximeter. The Content validity of the present tool was assessed by one pediatrician and seven experts in pediatric nursing. Reliability was assessed by Karl Pearson’s Correlation Coefficient with highly reliable readings of 0.86.

The investigator obtained ethical clearance and the formal consent from the authorities concerned was obtained. The purpose of the study was explained and an informed consent was taken from the parents of the subjects. The selected term neonates were kept initially in supine position and their heart rate, respiratory rate and oxygenation was assessed at the 5^th, 15^th and 30^th minute intervals. After two hours the position was changed to lateral and the physiological parameters were assessed at the same interval as supine position. Again after two hours prone position was given and the selected physiological parameters were assessed at 5^th, 15^th and30^th minutes. It took six hours for data collection for each subject.

RESULTS:

Section 1: Frequency and percentage distribution of term neonates according to demographic variables:

Out of the forty term neonates, 55% were females and the rest were males. 45% of them had the birth weight of 2500-3000 grams. 60% of term neonates belonged to thirty - seven to thirty-eight weeks of gestational age and 68% of term neonates were in the neonatal age group of one to three days. Considering the birth order of neonates, 58% of them were first baby in their family. Exactly 50% of the babies were born through normal delivery and all of them had Apgar score of 8/10 to 10/10at birth and none of them received any resuscitative measures.

Section 2: Comparison of effect of supine, lateral and prone positions on heart rate, respiratory rate and oxygen saturation among term neonates:

The mean heart rates of 40 term neonates were 128, 130.5 and 129.5 at 5^th, 15^th and 30^th minute respectively in supine position. In lateral position mean heart rate shows the values of 120.50 at 5^th minute, 126 at 15^th minute and 127 at 30^th minute. In prone position, mean heart rate of term neonates were 122,123.50 and 127 at 5^th, 15^th and 30^th minute respectively and the mean respiratory of term neonates were 42.50, 42 and 42.62 at 5^th, 15^th and 30^th minute respectively in supine position. In lateral position respiratory rate shows the values of 42 at 5^th minute, 41.75 at 15^th minute and 42.37 at 30^th minute. In prone position mean respiratory rate values of subjects were the same (42.25) at 5^th and 15^th minute, whereas it was 42.12 at 30^thminute.

Section 3: Comparison of effect of supine, lateral and prone position on physiological parameters among term neonates using weighted average:

The mean heart rate shows the values of 128.15, 122.40 and 123.33 in supine, lateral and prone positions respectively. Mean respiratory rate shows no difference in supine and prone positions with the value of 41.03, while in lateral position it is 40.92. Weighted average of oxygen saturation in supine position is 95.82%. In lateral position it is 93.38% and 92.54% in prone position.

Section 4: Association of effect of positions on physiological parameters with selected variables:

In supine position oxygen saturation shows a low positive correlation with the value of 0.038, whereas heart rate and respiratory rate shows a low negative correlation with the value of -0.130 and -0.200 respectively. In lateral position heart rate and oxygen saturation shows a low negative correlation with the values of -0.008 and -0.139 respectively while respiratory rate shows a positive correlation with neonatal age with the value of 0.112. In prone position all the selected physiological parameters represents a low negative correlation.

DISCUSSION:

A study was conducted in the Neonatal Intensive Care Unit, at Kottayam among fifty term neonates with supine, right lateral and supine with 30⁰head end elevation showed that there was statistically significant difference between physiological parameters and different positions. In the present study the results showed that the higher mean heart rate (128.15) and the highest average oxygen saturation (95.82) were found in supine position and the higher mean respiratory rate (41.03) was found in both supine and prone position. The study also revealed that majority of the subjects maintained the optimum physiological parameters in all the positions at 30^th minute.⁵

A study conducted by Leipala JA (2003) on the effect of posture on respiratory function in twenty prematurely born infants reported that higher tidal volume and lower respiratory rate was found in prone position compared to that of supine position.¹⁰But in the present study the mean respiratory rate (41.03) was same in both supine and prone positions and slightly lower in lateral position.

In the present study it was found that the mean oxygen saturation (95.82%) was highest in the supine position. The finding is supported by a descriptive study (2011) on relationship between nursing procedure and oxygen saturation of preterm infants conducted by EL Sayed proved that 96% of neonates had normal oxygen saturation in supine position.¹⁷The study results of Shen XM, Zhoa W and Huang DS on the effect of positioning on pulmonary function in healthy full-term neonates reported that healthy newborn should be in supine position for optimal ventilation and supports the present study.¹¹

The findings of the present study identified that the neonates maintained the optimum normal range of selected physiological parameters (heart rate, respiratory rate and oxygen saturation) in supine position when compared to lateral and prone positions. This finding was supported by a study conducted by Dimetriou G among twenty infants with median gestational age of thirty- four weeks and ten infants with gestational age of thirty- three weeks and proved that greater respiratory muscle strength in supine position.¹²

Similarly, the analysis showed that oxygen saturation (r=0.250) increases, heart rate (r= -0.277) and respiratory rate (r=-0.073]) decrease in supine position as the gestational age in weeks of the neonates increases. A study was done by Indu AS and Valsamma Joseph (2008) on the effect of selected positions on physiological parameters of neonates admitted with respiratory problems in neonatal intensive care unit, Institute of Child Health, Kottayam showed that there was no significant relationship between the selected physiological parameters and weeks of gestation among neonates with respiratory problems.⁸

CONCLUSIONS:

Appropriate care of the newborn forms the foundation for the subsequent life. Along with the technological advancements, simple interventions such as positioning can be practiced as one of the neonatal interventions. Positioning can affect physiological parameters, stability and comfort. Hence each infant must be observed for the effects of any position or repositioning. This study is significant in the sense that it could be beneficial to identify the effect of supine, lateral and prone positions among term neonates. It was found that the highest oxygen saturation was maintained in supine position. This knowledge could be applied in Neonatal Intensive Care Unit while providing care to term neonates and instructions could be given to parents related to positioning of term neonates at home. This study has given an insight for the researcher regarding the needs for providing correct body positioning to term neonates.

REFERENCES:

1. Kumar D, Verma A, Sehgal VK. Neonatal mortality in India. Rural and remote health online. 2007; 7:833. Available from: http://www.rrh.org.au

2. Baqui AH, Williams EK, Darmstadt GL, Kumar V, Kiran TV. Newborn care in rural Uttar Pradesh. Indian Journal of paediatrics.2007; 74:241-7.

3. Brundtland GH. Director General, plenary address delivered at United Nations General Assembly special session on children. New York: May 9, 2005. Available from:http://www.iisd.ca/ymb/mdg/summit2010/html/ymbvol 153 num9e.html.

4. Arvind R. Principles and practice of neonatology.1st ed. New -Delhi: BI Livingstone pvt.ltd; 2001.

5. Hockenberry, Wilson. Wong’s nursing care of infants and children.8th ed. India: Mosby Elsevier publishers; 2007.

6. Dipak K Guha. Practical New-born Critical Care Nursing.1st ed. New Delhi: Jay pee publishers; 2006.

7. ParulDatta. Paediatric Nursing. 2nd ed. New Delhi: Medical publishers; 2007.

8. Indu AS, Valsamma Joseph. Effect of selected positions on physiological parameters of neonates admitted with respiratory problems. The Journal of Nursing Research.2008; September, 3[2]: 5.

9. Anju Pandey. Positioning premature babies, which position is best? Nightingale Nursing Times.2005; March, 5: 24-7.

10. Leipala JA, Bhat RY, Rafferty GF, Hannam S, Greenough A. Effect of posture on respiratory function and drive in preterm infants prior to discharge. Paediatric pulmonology.2003; October, 36[4]:295-300p. Available from:www.ncbi.nlm. nih.gov/pubmed/12950041

11. Dimitriou G, Greenough A, Pink L, Mcghee A, Hickey A, Rafferty GF. Effect of posture on oxygenation and respiratory muscle strength in convalescent infants. Archives of disease in childhood, foetal and neonatal edition.2002; 86: 147-150p. Available from: www.ncbi.nlm.nih.gov/pubmed/11978742

12. Shen XM, Zhoa W, Huang DS, Lin FG, WuSM. Effect of positioning on pulmonary functions of new-borns. Comparison of supine and prone position. Paediatric pulmonology. 1996; 21: 167-170p. Available from: www.ncbi. nlm.nih.gov/pubmed/7970915

Received on 24.06.2021 Modified on 29.12.2021

Int. J. Nur. Edu. and Research. 2022; 10(2):141-143.

DOI: 10.52711/2454-2660.2022.00033