THE ROLE OF DEVELOPMENTAL POSITIONING IN NEONATES K F Lyons

Preterm Neonate

Congenital Abnormalities 5% of Neonates 95% Survive

26% had motor delay, 20% global delay Evidence to support developmental delay in Surgical Neonates with normal neurology Laing S et al (2011). Early development of children with major birth defects requiring newborn surgery. Journal of Paediatrics and Child Health. 47:140-147 118 infants with congenital abnormalities following surgery during the neonatal period 26% had motor delay, 20% global delay

Newborn Physiological flexion Protraction of shoulders and posterior pelvic tilt Vital for development of normal body movement and control

Surgical neonate Muscle weakness Ventilated Sedated for long periods Muscle relaxed Muscle weakness

Developmentally delayed Muscle imbalance Take up surface Lack of movement against gravity Stay where placed Poor co-contraction Head turning preference Poor feeding pattern Developmentally delayed

Evidence of low central stability Danser E et al (2013).Preschool neurological assessment in congenital diaphragmatic hernia survivors: Outcome and perinatal factors associated with neurodevelopmental impairment. Early human dev. 89: 393-400. CDH survivors 22% motor delay, additional 14% severe delay. Hypotonicity was found in 33% of patients

Postures

Risk factors Low birth weight Critical illness Multiple surgery Ventilation time Prolonged oxygen requirement Poor nutrition Interrupted sleep patterns Prolonged hospitalisation

Positionally and Environmentally Challenged

Extended

Floppy

Asymmetrical Head turning preference Plagiocephaly No midline development Poor communication

Development Medically stable Posture Feeding Communication Sensory Cognitive

Current Practice

Support in flexion

Positioning Aids

Z-Flo/ Tortoise

The Leckey Infant Positioning System (IPS) Enhanced supine support Greater amount of containment Consistent flexion Mechanical advantage abdominals

Audit of infants requiring additional support

Poddle pod

Problem solve

Minimise abnormal postures for maximum function No midline development No self consoling Affecting vision and communication Inhibiting skill acquisition Contracture formation

Unsupported v supported

Enable midline and symmetry

Support in consistent flexion

Support in consistent flexion

Additional support Contain and inhibit

Additional support Contain and inhibit

Head turning preference

Orthopaedic problems

Risk assessment Environment Support required

Check equipment Support when needed and allow for difficulties

Normalise Handling

Facilitate movement

Be inventive

Minimise Risk

Thanks for Listening