THE ROLE OF DEVELOPMENTAL POSITIONING IN NEONATES K F Lyons

Preterm Neonate

Congenital Abnormalities
5% of Neonates 95% Survive

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
• Ventilated • Sedated for long periods • Muscle relaxed
Muscle weakness

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

Cognitive Sensory Medically stable Posture Development Communication Feeding

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