1. THE ROLE OF DEVELOPMENTAL POSITIONING IN NEONATES
K F Lyons

2. Preterm Neonate

3. Congenital Abnormalities
5% of Neonates % Survive

4. 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:
118 infants with congenital abnormalities following surgery during the neonatal period
26% had motor delay, 20% global delay

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

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

7. 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

8. 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:
CDH survivors 22% motor delay, additional 14% severe delay.
Hypotonicity was found in 33% of patients

9. Postures

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

11. Positionally and Environmentally Challenged

12. Extended

13. Floppy

14. Asymmetrical Head turning preference Plagiocephaly
No midline development
Poor communication

15. Development
Medically stable
Posture
Feeding
Communication
Sensory
Cognitive

16. Current Practice

17. Support in flexion

18. Positioning Aids

19. Z-Flo/ Tortoise

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

21. Audit of infants requiring additional support

22. Poddle pod

23. Problem solve

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

25. Unsupported v supported

26. Enable midline and symmetry

27. Support in consistent flexion

28. Support in consistent flexion

29. Additional support
Contain and inhibit

30. Additional support
Contain and inhibit

31. Head turning preference

32. Orthopaedic problems

33. Risk assessment
Environment
Support required

34. Check equipment
Support when needed and allow for difficulties

35. Normalise Handling

36. Facilitate movement

37. Be inventive

38. Minimise Risk

39. Thanks for Listening