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Improving Neurodevelopmental Outcomes in NICU Patients

Painter, Leslie DNP, RNC-MNN, CCE; Lewis, Stephanie PhD, RN, CNE; Hamilton, Bernita K. PhD, RN

Section Editor(s): Dowling, Donna PhD, RN; ; Thibeau, Shelley PhD, RNC-NIC;

doi: 10.1097/ANC.0000000000000583
Original Research

Background: Premature infants experience stressors such as external stimulation with sounds, light, touch, and open positioning in NICU that negatively affect outcomes.

Purpose: The purpose of this study was to measure the effectiveness of a developmental positioning intervention on length of stay, weight gain, and tone/flexion compared with neonates without structured positioning.

Methods: Study design was quasi-experimental with nonequivalent groups. A retrospective chart review of 50 neonates with the inclusion criteria of 34 weeks of gestation or less and no anomalies provided a preintervention sample. After the education in-service on positioning, a convenience sample of 27 infants was enrolled. Infant Position Assessment Tool was used as a visual guide for positioning and scoring by the researcher for intervention fidelity. Hammersmith scoring was completed by the occupational therapist prior to discharge.

Findings: The postintervention group was younger and sicker than the control group (P < .05). The postintervention sample (M = 7.05 where 7 = 29 to <30 weeks of gestation) was younger than the preintervention sample (M = 7.22). The postintervention sample was smaller (M = 1302.15 g) than the preintervention sample (M = 1385.94 g). Results showed that the postintervention group had clinically significant weight gain and mean Hammersmith score (3.28) was higher showing positioning positively affected tone and flexion scores.

Implications for Practice: With greater structure and consistent attention to developmental positioning, outcomes are positively affected.

Implications for Future Research: Further research with larger sample sizes will identify stronger associations and relationships between positioning and outcome measures.

School of Nursing, Troy University, Montgomery, Alabama (Drs Painter and Hamilton); and School of Nursing, Troy University, Phenix City, Alabama (Dr Lewis).

Correspondence: Leslie Painter, DNP, RNC-MNN, CCE, Troy University School of Nursing, Montgomery, AL 36104 (

This study was conducted at Troy University.

The authors declare no conflicts of interest.

© 2019 by The National Association of Neonatal Nurses