Comparison of Three Nursing Positions for Reducing Gastric Residuals in Preterm Neonates: A Randomized Crossover Trial

Abstract

To compare left lateral, right lateral, and prone nursing positions of neonate for reducing pre-feed gastric residuals among ≤34 weeks neonates. Randomized crossover trial. Level-III NICU. Neonates ≤34 weeks, receiving 50-150 mL/kg/day feeds through oro-gastric route. Neonates were randomized to left lateral, right lateral and prone positions. Intervention position was given for eight hours (4 feeds, 9AM to 5PM) followed by a wash-off period of 16 hours. After 24 hours, each neonate crossed over to next position as per randomization card to complete three positions in three consecutive days. Gastric residuals were collected just before next feed. Pre-feed gastric residuals. Sixty three neonates were randomized. Fewer neonates in right lateral position had gastric residuals compared to left lateral position [OR 0.09 (95% CI 0.04, 0.21), P<0.001]. Neonates in right lateral and prone positions had comparable gastric residuals [OR 0.90 (95% CI 0.36, 2.22), P=0.82]. Gastric residuals, as a proportion of last feed, were highest in left lateral [6% (2, 10), maximum 28%] position. Significantly higher proportion of neonates in right lateral position had episodes of regurgitation compared to other positions. Oxygen saturation, heart rate, time to full feeds and duration of hospital stay were comparable in the three groups. Left lateral position was associated with higher but clinically non-significant pre-feed gastric residuals as compared to right lateral position. Right lateral position was associated with significantly increased regurgitation episodes.