Infant Positioning Research Articles

Changes in cardiac output and cerebral oxygenation during prone and supine sleep positioning in healthy term infants

ObjectiveTo investigate the changes in systemic and cerebral haemodynamics between supine and prone sleep in healthy term infants during the early postnatal period.Design/methodsHealthy term infants without congenital anomalies, patent ductus...

Infant Positioning, Baby Gear Use, and Cranial Asymmetry

Objectives This study aimed to identify predictors of cranial asymmetry. We hypothesize that among infants diagnosed with cranial asymmetry in the sampled region, there is an association between exposure to more time in baby gear and less awake time in prone and side-lying than in infants who do not present with this condition. Methods The study employed a cross sectional survey of caregivers of typically developing infants and infants diagnosed with cranial asymmetry. Results A mutivariable model reveals that caregivers of children who are diagnosed with cranial asymmetry report their children spending significantly less time in prone play than those children without a diagnosis of cranial asymmetry. Side-lying and time spent in baby gear did not attain statistical significance. Conclusions for Practice Occupational therapists, physical therapists, pediatricians, nurses and other health care professionals must provide parents with early education about the importance of varying positions and prone play in infancy and address fears and concerns that may serve as barriers to providing prone playtime.

Update on Phototherapy in Jaundiced Neonates.

Even relatively low serum bilirubin concentrations can cause neurodevelopmental impairment in extremely low birth weight (EBWL) infants, while sequelae from hyperbilirubinemia in late preterm and term infants are rare and occur only at very high serum bilirubin levels. Phototherapy is the current treatment of choice. To present an update on the most important issues involved in phototherapy for jaundiced infants. Light absorption by bilirubin in the skin transforms the native Z,Z-bilirubin to conformational photoisomers Z,E-bilirubin and E,Z-bilirubin and structural photoisomers E,Z-lumirubin and E,E-lumirubin. Formation and excretion of Z,E-bilirubin and E,Z-lumirubin are both important routes of elimination of bilirubin through bile and urine, although the precise contributions of the various photoisomers to the overall elimination of bilirubin are unknown. It appears that the photoisomers of bilirubin are predominantly formed in the plasma, and the rate of formation is affected by the hemoglobin concentration. Phototherapy lights with an emission spectrum of 460-490 nm provide the most efficient bilirubin-reducing light. LEDs should replace fluorescent tubes and halogen spotlights as the preferred light sources. Recent data raise concerns that sick ELBW infants under prolonged phototherapy may have an increased risk of death, though survivors may benefit from reduced rates of neurodevelopmental impairment. Comparison of the efficacy of cycled vs. continuous phototherapy has given divergent results. Changing the infant's position does not increase the efficacy of phototherapy. During the last decade, we have made progress in our understanding of how and where phototherapy works and in its practical applications.

Impact of Parent Practices of Infant Positioning on Head Orientation Profile and Development of Positional Plagiocephaly in Healthy Term Infants

ABSTRACTAims: The influence of infant positioning on the development of head orientation and plagiocephaly is not clear. This study explored the relationship between infant body and head positioning, with the development of asymmetrical head orientation and/or positional plagiocephaly. Methods: Clinician measurement of head orientation profile and parent-reported infant positioning data were collected for 94 healthy term infants at 3, 6, and 9 weeks of age. Plagiocephaly was measured at 9 weeks with the modified Cranial Vault Asymmetry Index. Results: More severe plagiocephaly was associated with longer supine-sleep-maximum (p = 0.001) and longer supine-lying-total (p = 0.014) at 6 weeks. Prone positioning was not associated with plagiocephaly. Parent-reported head asymmetry during awake and sleep time at 3 weeks identified infants with clinician-measured head asymmetry at 9 weeks. Better symmetry in head turning was associated with more side-lying-total time by 9 weeks (p = 0.013). Conclusions: Our results showed that infant positioning is associated with early head orientation and plagiocephaly development. Early parent-reported asymmetry during awake and sleep time is an important indicator for the need for professional assessment and advice. A Plagiocephaly Prevention Strategy and Plagiocephaly Screening Pathway are provided for clinicians and parents.

Safe sleeping positions: practice and policy for babies with cleft palate

Guidance recommends ‘back to sleep’ positioning for infants from birth in order to reduce the risk of sudden infant death. Exceptions have been made for babies with severe respiratory difficulties where lateral positioning may be recommended, although uncertainty exists for other conditions affecting the upper airway structures, such as cleft palate. This paper presents research of (i) current advice on sleep positioning provided to parents of infants with cleft palate in the UK; and (ii) decision making by clinical nurse specialists when advising parents of infants with cleft palate. A qualitative descriptive study used data from a national survey with clinical nurse specialists from 12 regional cleft centres in the UK to investigate current practice. Data were collected using semi-structured telephone interviews and analysed using content analysis. Over half the regional centres used lateral sleep positioning based on clinical judgement of the infants’ respiratory effort and upper airway obstruction. Assessment relied upon clinical judgement augmented by a range of clinical indicators, such as measures of oxygen saturation, heart rate and respiration.Conclusion: Specialist practitioners face a clinical dilemma between adhering to standard ‘back to sleep’ guidance and responding to clinical assessment of respiratory effort for infants with cleft palate. In the absence of clear evidence, specialist centres rely on clinical judgement regarding respiratory problems to identify what they believe is the most appropriate sleeping position for infants with cleft palate. Further research is needed to determine the best sleep position for an infant with cleft palate.Whatis Known• Supine sleep positioning reduces the risk of sudden infant death in new born infants.• There is uncertainty about the benefits or risks of lateral sleep positioning for infants with upper airway restrictions arising from cleft palate.What is New• Variability exists in the information/advice provided to parents of infants with cleft palate regarding sleep positioning.• Over half the national specialist centres for cleft palate in the UK advise positioning infants with CP in the lateral position as a routine measure to reduce difficulties with respiration.

Ultrasonography for endotracheal tube position in infants and children.

US for ETT verification appears to be well tolerated in infants and children and may augment determination of proper ETT position in combination with other ETT verification modalities. Further studies are needed regarding technique and training. What is Known: • Point-of-care ultrasonography is realizing increased availability and use in several pediatric specialties. • Ultrasonography has been shown to be effective for verifying ETT position in adults but have been less studied in infants and children. What is New: • Ultrasonography for endotracheal tube verification appears to be well tolerated in infants and children. • Ultrasonography may augment determination of proper endotracheal tube position in combination with other verification modalities such as radiography and capnography in the pediatric population.

Body positioning for spontaneously breathing preterm infants with apnoea

It has been proposed that body positioning in preterm infants, as compared with other, more invasive measures, may be an effective method of reducing clinically significant apnoea.To determine effects of body positioning on cardiorespiratory parameters in spontaneously breathing preterm infants with clinically significant apnoea.Subgroup analyses examined effects of body positioning of spontaneously breathing preterm infants with apnoea from the following subgroups.• Gestational age < 28 weeks or birth weight less than 1000 grams.• Apnoea managed with methylxanthines.• Frequent apnoea (> 10 events/d).• Type of apnoea measured (central vs mixed vs obstructive)We used the standard search strategy of the Cochrane Neonatal Review Group (CNRG) to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 10), MEDLINE via PubMed (1966 to 14 November 2016), Embase (1980 to 14 November 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 2016 November 14). We also searched clinical trials databases and conference proceedings for randomised controlled trials and quasi-randomised trials.Randomised and quasi-randomised controlled clinical trials with parallel, factorial or cross-over design comparing the impact of different body positions on apnoea in spontaneously breathing preterm infants were eligible for our review.We assessed trial quality, data extraction and synthesis of data using standard methods of the CNRG. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence.The search conducted in November 2016 identified no new studies. Five studies (N = 114) were eligible for inclusion. None of the individual studies nor meta-analyses showed a reduction in apnoea, bradycardia, oxygen desaturation or oxygen saturation with body positioning (supine vs prone; prone vs right lateral; prone vs left lateral; right lateral vs left lateral; prone horizontal vs prone head elevated; right lateral horizontal vs right lateral head elevated, left lateral horizontal vs left lateral head elevated).We found insufficient evidence to determine effects of body positioning on apnoea, bradycardia and oxygen saturation in preterm infants. No new studies have been conducted since the original review was published. Large, multi-centre studies are warranted to provide conclusive evidence, but it may be plausible to conclude that positioning of spontaneously breathing preterm infants has no effect on their cardiorespiratory parameters.

Yenidoğan Yoğun Bakım Ünitesinde Mekanik Ventilasyon Uygulanan Prematüre Bebeklere Pozisyon Verme

Yenidoğan Yoğun Bakım Ünitesinde Mekanik Ventilasyon Uygulanan Prematüre Bebeklere Pozisyon Verme

Comparative Survey of Holding Positions for Reducing Vaccination Pain in Young Infants.

Background. Infant holding position may reduce vaccination pain. However, the optimal position for young infants remains controversial. Objectives. To compare the effectiveness of holding infants in the supine position and the effectiveness of holding infants in upright position for relieving acute pain from vaccine injection. Methods. This prospective cohort study enrolled 6–12-week-old healthy infants. We examined infant pain responses by evaluating the following three categories: (1) crying, (2) irritability, and (3) facial expression. Results. In total, 282 infants were enrolled, with 103 and 179 held in the supine and upright positions, respectively. At 30 s after vaccination, the infants in the supine position showed a larger decrease in crying (p < 0.001), irritability (p = 0.002), and pained facial expression (p = 0.001) than did those in the upright position. However, there was no significant difference in pain response between two groups at 180 s after intervention. Conclusion. In 2-month-old infants, the supine position may reduce acute pain more effectively than does the upright position. Our findings provide a clinical strategy for relieving vaccination pain in young infants.

The Effectiveness of Developmentally Supportive Positioning on Preterm Infants&amp;apos; Pain Response at Neonatal Intensive Care Units

Preterm infants are exposed to serious health problems that require advanced highly specialized nursing skills in order to sustain their life. Developmental positioning is one of an essential skill for neonatal intensive care unit nurses. This study aimed to investigate the effectiveness of developmentally supportive positioning on preterm infants' pain responses at NICU. A Quasi experimental design was used to conduct the study at neonatal intensive care unit on a sample of (56)preterm infants who admitted through nine months and were equally divided randomly into the study and control group after fulfilling the inclusion criteria using demographic characteristics of Preterm infants. Infant Position Assessment Tool (IPAT) and Preterm Infant Pain Profile (PIPP) Tool. The results indicated that all the preterm infants (100%) had an unacceptable positioning in both groups, and none of preterm infants in both groups had no- or- minimal pain at baseline assessment. While after one week of intervention about two third (64.3%) of the infants were placed in an acceptable position in the study group and only less than one quarter (21.4%) of the preterm infants in the control group were placed in an acceptable position. Regarding pain response at day seven of intervention five minutes after morning routine care, about half (53.6%) of infants in the study group had no-or-minimal pain while none of infants in the control group had no-or-minimal pain and about one third (32.1%) of infants in the control group had severe pain and none of the infants in the study group had severe pain. The present study concluded that preterm infants who were placed in developmentally supportive positioning had acceptable position and exhibited less pain scores. It is recommended to replicate the present study on a larger sample.

Ultrasonography for Verification of Endotracheal Tube Position in Neonates and Infants.

Objective Ultrasonography (US) has been shown to be effective for verifying endotracheal tube (ETT) position in adults and older children but has been less studied in the neonates and infants. The literature regarding US utility for ETT positioning in this population is reviewed. Study Design A literature search was conducted using the EMBASE, Google Scholar, MEDLINE, Ovid, and Scopus databases with search terms regarding US relating to ETT intubation and positioning in neonates and infants. Result Nine relevant studies were included for review. All studies report > 80% visualization of the ETT tip by US. US interpretation of the ETT position correlated with the radiography position in 73 to 100% of cases when the ETT tip was visible. There were variations in technique, sonographer, and sonographer training between studies. Conclusion US appears to be well tolerated by neonates and infants and may augment the determination of proper ETT position. Further studies are needed regarding optimal technique and sonographer training.

Infant position in neonates receiving mechanical ventilation.

In patients of various ages undergoing mechanical ventilation (MV), it has been observed that positions other than the standard supine position, such as the prone position, may improve respiratory parameters. The benefits of these positions have not been clearly defined for critically ill newborns receiving MV.This is an update of a review first published in 2005 and last updated in 2013. Primary objectiveTo assess the effects of different positioning of newborn infants receiving MV (supine vs prone, lateral decubitus or quarter turn from prone) in improving short-term respiratory outcomes. Secondary objectiveTo assess the effects of different positioning of newborn infants receiving MV on mortality and neuromotor and developmental outcomes over the long term, and on other complications of prematurity. We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8), MEDLINE via PubMed (1966 to 22 August 2016), Embase (1980 to 22 August 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 22 August 2016). We also searched clinical trials databases, conference proceedings and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. Randomised and quasi-randomised clinical trials comparing different positions in newborns receiving mechanical ventilation. Three unblinded review authors independently assessed trials for inclusion in the review and extracted study data. We used standard methodological procedures as expected by The Cochrane Collaboration and assessed the quality of the evidence using the GRADE approach. If the meta-analysis was not appropriate owing to substantial clinical heterogeneity between trials, we presented review findings in narrative format. We included in this review 19 trials involving 516 participants. Seven of the included studies (N = 222) had not been evaluated in the previous review. Investigators compared several positions: prone versus supine, prone alternant versus supine, prone versus lateral right, lateral right versus supine, lateral left versus supine, lateral alternant versus supine, lateral right versus lateral left, quarter turn from prone versus supine, quarter turn from prone versus prone and good lung dependent versus good lung uppermost.Apart from two studies that compared lateral alternant versus supine, one comparing lateral right versus supine and two comparing prone or prone alternant versus the supine position, all included studies had a cross-over design. In five studies, infants were ventilated with continuous positive airway pressure (CPAP); in the other studies, infants were treated with conventional ventilation (CV).Risks of bias did not differ substantially for different comparisons and outcomes. This update detects a moderate to high grade of inconsistency, similar to previous versions. However, for the analysed outcomes, the direction of effect was the same in all studies. Therefore, we consider that this inconsistency had little effect on the conclusions of the meta-analysis. When comparing prone versus supine position, we observed an increase in arterial oxygen tension (PO2) in the prone position (mean difference (MD) 5.49 mmHg, 95% confidence interval (CI) 2.92 to 8.05 mmHg; three trials; 116 participants; I2= 0). When percent haemoglobin oxygen saturation was measured with pulse oximetry (SpO2), improvement in the prone position was between 1.13% and 3.24% (typical effect based on nine trials with 154 participants; I2= 89%). The subgroup ventilated with CPAP (three trials; 59 participants) showed a trend towards improving SpO2 in the prone position compared with the supine position, although the mean difference (1.91%) was not significant (95% CI -1.14 to 4.97) and heterogeneity was extreme (I2= 95%).Sensitivity analyses restricted to studies with low risk of selection bias showed homogeneous results and verified a small but significant effect (MD 0.64, 95% CI 0.26 to 1.02; four trials; 92 participants; I2= 0).We also noted a slight improvement in the number of episodes of desaturation; it was not possible to establish whether this effect continued once the intervention was stopped. Investigators studied few adverse effects from the interventions in sufficient detail. Two studies analysed tracheal cultures of neonates after five days on MV, reporting lower bacterial colonisation in the alternating lateral position than in the supine posture. Other effects - positive or negative - cannot be excluded in light of the relatively small numbers of neonates studied. This update of our last review in 2013 supports previous conclusions. Evidence of low to moderate quality favours the prone position for slightly improved oxygenation in neonates undergoing mechanical ventilation. However, we found no evidence to suggest that particular body positions during mechanical ventilation of the neonate are effective in producing sustained and clinically relevant improvement.

Ultrasound Screening for Posterior Shoulder Dislocation in Infants with Brachial Plexus Birth Palsy: Level 4 Evidence

▴This presentation will discuss Materialise computer planning in skeletally immature patients. Clinical examination may fail to detect posterior shoulder dislocation in infants with brachial plexus birth palsy (BPBP).1Pöyhiä T.H. Lamminen A.E. Peltonen J.I. Kirjavainen M.O. Willamo P.J. Nietosvaara Y. Brachial plexus birth injury: US screening for glenohumeral joint instability.Radiology. 2010; 254: 253-260Crossref PubMed Scopus (42) Google Scholar The purpose of this study was to determine the prevalence of shoulder dislocation in this population on ultrasound (US) and to determine whether physical examination (PE) measurements correlate with US findings. Infants presenting to our BPBP clinic receive serial shoulder US exams until age 1 year. We retrospectively reviewed data for infants with concurrent physical exam and US prior to 1 year of age, but before any surgical intervention. PE consisted of Active Movement Scale (AMS) and passive external rotation of the shoulder in adduction (PERAdd) and abduction (PERAbd). US measurements included percentage of humeral head displaced posterior to the axis of the scapula (PHHD) and the alpha angle (intersection of posterior scapular margin with a line tangential to the humeral head through the glenoid).2Vathana T. Rust S. Mills J. Wilkes D. Browne R. Carter P.R. et al.Intraobserver and interobserver reliability of two ultrasound measures of humeral head position in infants with neonatal brachial plexus palsy.J Bone Joint Surg Am. 2007; 89: 1710-1715Crossref PubMed Scopus (31) Google Scholar Shoulder dislocation was defined as both PHHD > 0.5 and alpha angle > 30 degrees. PE results were compared between infants demonstrating dislocation at some time versus infants with no evidence of dislocation. We used receiver operating characteristic (ROC) analysis to evaluate the association between PE and concurrent US results. Sixty-six infants contributed a total of 118 ultrasound examinations (mean 1.8, range 1-5). Nineteen (28.8%) demonstrated shoulder dislocation, first detected at a range of 2.1-10.5 months of age. Of these, 14 (74%) presented with a dislocated shoulder at their first ultrasound. Infants with a dislocated shoulder demonstrated significantly less mean PERAdd (mean 46 versus 71 degrees) and a greater difference between internal rotation and external rotation scores on the AMS scale (mean 5.5 point versus 3.3 point difference) than those with a reduced shoulder (Table 1). PERAdd was better able to discriminate between concurrent evidence of dislocation and no dislocation (area under ROC curve [AUC] 0.89) than was the shoulder rotation difference (AUC = 0.73). A cut-off of 60 degrees for PERAdd yielded a sensitivity of 94% and a specificity of 69% for predicting dislocation on US (Figure 1). •Twenty-nine percent of infants seen in a BPBP specialty clinic had a shoulder dislocation during their first year of life.•Limited PERAdd and a large internal rotation - external rotation (IR-ER) difference on the AMS were associated with dislocation.•US shoulder screening is recommended for infants with BPBP, especially those with limited PERAdd.•US screening when PERAdd is = 60 degrees would identify an estimated > 90% of dislocations with a false positive rate < 30%.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Kangaroo supported diagonal flexion positioning: New insights into skin-to-skin contact for communication between mothers and very preterm infants

Skin-to-skin contact shows benefits in the relationship developed between a mother and her premature infant. In the skin-to-skin session, face-to-face exchanges are impossible in vertical infant positioning. We therefore undertook an observational, prospective, single-center study using kangaroo "supported diagonal flexion" (SDF) positioning. The first aim was to evaluate the safety of kangaroo SDF positioning compared to the usual vertical positioning. The second aim was to evaluate SDF positioning on early communication between the mother and her infant and to improve their well-being. Fifteen mothers and their very premature infants (birth 26<32 weeks' gestation) were assigned to one of the two kangaroo positioning modes, either the current vertical positioning (n=7) or SDF positioning (n=8). Physiological variables and critical events were recorded before, during, and after ten successive skin-to-skin contact sessions. The first and last sessions were videotaped to allow later behavioral measurements. Mothers' risk for depression and feelings about the way they experienced communication with their infant were assessed through questionnaires. In terms of the infant's physiology, no negative effects were associated with SDF positioning in comparison with the usual vertical positioning. SDF positioning led to fewer disorganized gestures, negative vocalizations, and drowsiness, in favor of more deep sleep. SDF led to more mother-infant eye-to-eye contact as well as maternal vocalizations, smiles, and caressing, although these differences did not reach significance. The score for the risk of postnatal depression decreased significantly between the first and the last session in the SDF group, whereas it did not change in the vertical positioning group. These results support the idea that the kangaroo SDF positioning technique is physiologically safe, has obvious immediate benefits on mothers' infant-directed communicative behaviors, and respects the baby's naturally flexed and asymmetrical tonic neck posture. It is an innovative, inexpensive, easy-to-use technique in daily practice, by all healthcare professionals working in a neonatal intensive care unit. These data suggest that the current kangaroo positioning technique could be improved. More studies are needed to confirm the benefits and safety of the kangaroo SDF positioning in larger groups of preterm infants.

Effect of sleeping position on arousals from sleep in preterm infants.

To evaluate the frequency of preterm infant positions during sleep, and to investigate the association among positions, arousals, sleep patterns, and time of day. This observational study was conducted in a neonatal unit with 10 preterm infants. Polysomnographic and video recordings during 24 hr identified sleep positions, arousals, sleep patterns, and time of day. Preterm infants were placed most frequently in the supine position (58.4%), followed by right side (24.9%), left side (15.5%), and prone (1.2%). The longest amount of time spent sleeping, and the most frequent number of arousals, occurred in the supine position, followed by prone, left-side, and right-side positions. After controlling for length of time spent in each position, the number of arousals per hour was the greatest in the supine position (13.562 ± 0.732) and least in the prone position (11.56± 4.754; p< .001). There were no significant differences in arousals according to position and sleep pattern (indeterminate, quiet, active sleep) or position and time of day (morning, afternoon, twilight, night). Nurses should evaluate the frequency of preterm infant arousals in each position, and use more often those positions that lead to a lower frequency of arousals and better sleep quality.

Infant positioning in daily life may mediate associations between physiotherapy and child development—video-analysis of an early intervention RCT

BackgroundPaediatric physiotherapy (PPT) in high-risk infants comprises family involvement, but it is unclear whether parents mediate the intervention effect. We demonstrated in a randomized controlled trial in high-risk infants comparing the family centred programme Coping and Caring for infants with special needs (COPCA) and Traditional Infant Physiotherapy (TIP) that process evaluation revealed associations between COPCA-characteristics and outcome. AimsTo assess whether PPT affects how parents position their infant during bathing and whether this is associated with child outcome. Methods and procedures21 infants received COPCA and 25 TIP between 3 and 6 months corrected age. Bathing sessions were videotaped at 3, 6 and 18 months. Time spent with specific infant positions was correlated with quantified PPT-actions and functional mobility at 18 months measured with the Paediatric Evaluation of Disability Inventory (PEDI). Outcomes and resultsAt 3 and 18 months bathing position was similar in both groups, but differed at 6 months (time spent on sitting: COPCA 77.7%, TIP 39.2%; median difference 32.0% (95% CI: 10.6–50.5%). Sitting-time at 6 months was associated with higher PEDI functional mobility scores. Conclusions and implicationsEarly PPT may affect parental behaviour, such as infant positioning during bathing, which, in turn, may affect child development.

Interventions to Improve Safe Sleep Among Hospitalized Infants at Eight Children's Hospitals.

Within hospital pediatric units, there is a lack of consistent application or modeling of the American Academy of Pediatrics recommendations for safe infant sleep. The purpose of this study was to improve safe sleep practices for infants in nonneonatal pediatric units with implementation of specific interventions. This multi-institutional study was conducted by using baseline observations collected for sleep location, position, and environment (collectively, "safe sleep") of infants admitted to pediatric units. Interventions consisted of: (1) staff education, including a commitment to promote safe sleep; (2) implementing site-generated safe sleep policies; (3) designating supply storage in patient rooms; and/or (4) caregiver education. Postintervention observations of safe sleep were collected. Eight hospitals participated from the Inpatient FOCUS Group of the Children's Hospital Association. Each site received institutional review board approval/exemption. Safe sleep was observed for 4.9% of 264 infants at baseline and 31.2% of 234 infants postintervention (P<.001). Extra blankets, the most common of unsafe items, were present in 77% of cribs at baseline and 44% postintervention. However, the mean number of unsafe items observed in each sleeping environment was reduced by >50% (P=.001). Implementation of site-specific interventions seems to improve overall safe sleep in inpatient pediatric units, although continued improvement is needed. Specifically, extra items are persistently left in the sleeping environment. Moving forward, hospitals should evaluate their compliance with American Academy of Pediatrics recommendations and embrace initiatives to improve modeling of safe sleep.

A community based assessment study of positioning, attachment and suckling during breastfeeding among 0-6 months aged infants in rural area of Gandhinagar district, Gujarat, India

Background: Effective breastfeeding is a function of the proper positioning of mother and baby and attachment of child to the mother's breast. Integrated Management of Neonatal and Childhood Illness (IMNCI) strategy recommended systematic assessment of breastfeeding and emphasized counselling of the mother on proper positioning and attachment of infant to the breast. Objective of the study was to assess the correct position, attachment and effective suckling in the breastfeeding of infants as practiced by mothers in rural community . Methods: An observational, descriptive study was done at field practice area of rural health training centre, Dabhoda, from January 2013 to December 2013. One hundred twenty mothers of 0-6 months of aged infant were interviewed and observed for baby's position, attachment and effective suckling using pre-tested semi-structured questionnaire through random selection. Grading of positioning, attachment and suckling was done according to the score of various characteristics. Data thus collected were analyzed using MS Excel 2007 and also Epi info. Results: There was poorer positioning among primipara (41.7%) than multipara (20.9%) mothers. Poorer attachment was also more evident among primipara (45.8%) compared to multipara (10.9%) mothers. Parity was significantly linked with poor positioning of infant (P value = 0.001) and attachment (P value <0.001). Maternal occupation was also significantly associated with attachment (p value = 0.028) and positioning (p value = 0.009). Preterm delivery was significantly associated with poor attachment (P value = 0.023) and poor effective suckling (P value <0.0001) . Conclusions: Primipara mothers require help and support for correct breastfeeding techniques as poor positioning and attachment was found among primipara mothers.

Effect of mother-infant pair's latch-on position on child's health: A lesson for nursing care.

Background:Effective breastfeeding is a function of the proper positioning of mother and baby and attachment of child to the mother's breast. Positioning of the baby's body is important for good attachment and successful breastfeeding. The study was planned to assess mother–infant pair latch on position and its impact on health status of the child.Materials and Methods:It was community-based cross-sectional study conducted among 1267 children between age group of 0–24 months in the urban and rural field practice areas of the Department of Community Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana. A self-designed semi-structured questionnaire along with the WHO criteria for assessment of correct latch on position was used in this study.Results:Out of 1267 mothers, only 29.9% mothers initiated breastfeeding within 1 h of delivery. Mothers who had high parity had better positioning scores as compared to mothers with low parity. About 83.7% mothers who had parity >2 had excellent scores as compared to those mothers having one child or two children. About 56.8% and 62.7% children who suffered from diarrhea and acute respiratory infection (ARI), respectively, had mothers with poor positioning and this difference was statistically significant (P < 0.001).Conclusion:It was concluded that mothers who had higher parity had better positioning and attachment scores and also mothers with excellent positioning scores, their children suffered less from diarrhea and ARI. Each mother should be observed for mother's and infant's positioning and attachment at the onset of breastfeeding and if needed given counseling on correct positioning and attachment.

Outcome of attempted vaginal delivery after a previous vacuum extraction: a population-based study.

Few studies have investigated long-term effects of a first vaginal instrumental delivery on subsequent mode of delivery. We investigated risks of repeat vacuum extraction and risk factors associated with a repeat vacuum extraction delivery. This is a population-based register study including 391 160 women with two consecutive singleton term (≥37 weeks) live births in cephalic presentation between/within the time period of 1992-2010 in Sweden. Rates and risk ratios of mode of delivery in second pregnancy in relation to primary mode of delivery were calculated using descriptive analyses and generalized linear models. Risk of repeat vacuum extraction was adjusted for maternal age and height, interpregnancy interval, gestational length, birthweight, induction, sex and occiput posterior position. Compared with women with a primary spontaneous vaginal delivery, women with a primary vacuum extraction had an almost five-fold risk of vacuum extraction delivery and nearly a three-fold risk of emergency cesarean section at second delivery. For women with a primary emergency cesarean section, corresponding risks were substantially higher. Risk factors for a repeat vacuum extraction were increasing maternal age and an interpregnancy interval >4 years, decreasing maternal stature, increasing gestation length and birthweight, induction, giving birth to a male infant and occiput posterior position. Nine of ten women who attempted a vaginal birth after a primary vacuum extraction succeeded in having a spontaneous vaginal delivery at second delivery. Compared with women with a primary spontaneous vaginal delivery, women with a primary vacuum extraction were at increased risk of repeat vacuum extraction and emergency cesarean section in subsequent delivery although their risk was not as high as that of women with a primary emergency cesarean section.