Effect of Nursing in the 'Three-Stair-Position' according to Kinaesthetic Infant Handling on the Incidence of Apnea Episodes in Preterm Infants

Abstract

Objective: We investigated the effect of nursing in the three-stair-position (TSP) according to Kinaesthetic Infant Handling (KIH) on the incidence of apnea in preterm infants, compared to the horizontal position (HP) and the head elevated tilt position (HETP), respectively. Methods: Twenty spontaneously breathing preterm infants with idiopathic recurrent apnea were studied in a randomized controlled crossover trial. Each infant spent a total of 24 hours in the HP, the HETP and the TSP in random order. Transcutaneous arterial oxygen-saturation and heart rate were recorded continuously. The frequency of overall apnea episodes (defined as arterial saturation <85%), mild and severe apnea episodes, as well as the frequency of bradycardic events was analyzed without knowledge of the allocated position. Results: In total, there were significantly (p < .05) fewer bradycardic and/or apnea episodes observed, when infants where nursed in the TSP compared to the HP. The mean decrease was 25 events/24 hours, equal to a reduction of 13.3% (p=0.04). No significant reduction was seen when comparing HETP with TSP (p=0.108), with a mean decrease of 10 events/24 hours, equal to 5.7%. Conclusion: Nursing in the 'three-stair-position' according to kinaesthetic infant handling has a statistically significant, small effect on apnea-episodes in preterm infants. TSP is about equally effective as the HETP, yet better tolerated than HETP. It is easy to apply, quickly reversible and can be combined with CPAP and drugs. ABBREVIATIONS: TSP, three-stair-position; HETP, head elevated tilt position; HP, horizontal position.