Abstract
ABSTRACTObjective: To review the effects of the hammock positioning on clinical parameters of preterm newborn infants (PTNB) admitted to the Neonatal Intensive Care Unit (NICU).Data sources: This was a systematic review performed by searching the Pubmed, Lilacs, SciELO and PEDro databases. Intervention studies in English, Portuguese and Spanish that evaluated the effects of hammock positioning on clinical parameters of PTNB admitted to the NICU were selected. Three search strategies were used: 1) hammock positioning OR patient positioning AND intensive care units AND infant, newborn; 2) hammock positioning OR patient positioning AND intensive care units; 3) hammock positioning OR patient positioning AND intensive care units, neonatal. There was no restriction on the year of publication of the articles. Methodological quality was assessed by the PEDro scale.Data synthesis: Among 597 articles, only six were included and 139 neonates with gestational ages between 26 and 37 weeks and an average gestational weight <2240g were analyzed. Four studies included patients without any associated pathology and most of them placed the PTNB supine in hammock positioning. The duration of the intervention ranged from 15 to 180 minutes and most applied it at just one moment. There was an improvement in heart rate (HR), respiratory rate (RR) and pain (3/4 studies), as well as gains in peripheral oxygen saturation (SpO2) (2/4 studies). Only one study reported worsening of SpO2 with the intervention. The methodological quality of the studies was classified as low.Conclusions: Although this review suggests improvement with hammock positioning in HR, RR and pain in PTNB, the low methodological quality makes the results inconsistent.
Highlights
The synchronous-active theory of newborn neurobehavioral organization, proposed by Heidelise Als in 1982, describes newborns’ behavioral organization and their development regarding the balance between children’s interaction with the environment and their neurobehavioral subsystems
Conclusions: this review suggests improvement with hammock positioning in HR, RR and pain in Preterm newborns (PTNB), the low methodological quality makes the results inconsistent
Preterm newborns (PTNB) admitted to the Neonatal Intensive Care Unit (NICU) may present changes in their neurobehavioral organization, as they are exposed to light, noise, handling and painful interventions
Summary
The synchronous-active theory of newborn neurobehavioral organization, proposed by Heidelise Als in 1982, describes newborns’ behavioral organization and their development regarding the balance between children’s interaction with the environment and their neurobehavioral subsystems. Preterm newborns (PTNB) admitted to the Neonatal Intensive Care Unit (NICU) may present changes in their neurobehavioral organization, as they are exposed to light, noise, handling and painful interventions This is capable of causing physiological disorganization, energy expenditure, hemodynamic instability, changes in intracranial pressure and central nervous system involvement.[3,4,5,6,7] Behavioral strategies for positioning and sensory stimulation are necessary in the NICU in order to minimize the losses triggered by these stressors and to promote comfort.[4,7]. Over the past 15 years, initiatives to humanize care within the NICU have emphasized the importance of this type of strategy, articulating the technical quality of care, welcoming technologies, support for patients and family members These initiatives have been presented in several fields, but have been implemented a priori in care for childbirth and newborns. Among these actions, humanized birth, the kangaroo method, water immersion, music therapy and hammock positioning stand out.[8,9,10,11]
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