ORIGINAL RESEARCH PAPER
Effects of two different positions on stress, pain and feeding tolerance of preterm infants during tube feeding
Sibel Serap Ceylan PhD, RN,
Züleyha Keskin RN,
Corresponding Author
Sibel Serap Ceylan PhD, RN
Department of Pediatric Nursing, Faculty of Health Sciences, Pamukkale University, Kınıklı Campus, Denizli, Turkey
Correspondence
Sibel Serap Ceylan, Faculty of Health Sciences, Pamukkale University, Kınıklı Campus, Denizli 20070, Turkey.
Email: [email protected]
Search for more papers by this authorZüleyha Keskin RN
Chief Nurse
Neonatal Intensive Care Unit, Denizli State Hospital, Denizli, Turkey
Search for more papers by this authorSibel Serap Ceylan PhD, RN,
Züleyha Keskin RN,
Corresponding Author
Sibel Serap Ceylan PhD, RN
Department of Pediatric Nursing, Faculty of Health Sciences, Pamukkale University, Kınıklı Campus, Denizli, Turkey
Correspondence
Sibel Serap Ceylan, Faculty of Health Sciences, Pamukkale University, Kınıklı Campus, Denizli 20070, Turkey.
Email: [email protected]
Search for more papers by this authorZüleyha Keskin RN
Chief Nurse
Neonatal Intensive Care Unit, Denizli State Hospital, Denizli, Turkey
Search for more papers by this authorAbstract
Aims
This study aims to investigate the effects of semi-elevated right lateral and semi-elevated supine positions on feeding tolerance, stress severity and pain levels among premature infants during tube feeding.
Methods
This was a randomized cross-over clinical trial. A total of 34 premature infants who were fed via orogastric tube were included in this study. Feeding tolerance was assessed by abdominal circumference measurements and checking gastric residuals; this assessment was single blinded. Physiological values were evaluated before, during and after tube feeding. The stress severity and pain levels of the infants were also evaluated independently by the researchers before, during and after tube feeding. A significance level of .05 was accepted for all statistical analyses.
Results
There were no difference between infants' vital signs, stress and pain scores according to feeding positions before tube feeding (p > .05). By feeding positions, a statistically significant difference was found between infants' vital signs, abdominal circumference and gastric residuals of infants during tube feeding. Pain and stress levels of infants were found to be significantly higher in the semi-elevated supine position during tube feeding (p < .05).
Conclusions
Use of the semi-elevated right lateral position during tube feeding was found to have a more helpful effect in reducing stress and pain among premature infants when compared with the use of the semi-elevated supine position.
CONFLICT OF INTEREST
No conflict of interest has been declared by the authors.
REFERENCES
- Abdeyazdan, Z., Nematollahi, M., Ghazavi, Z., & Mohamadizadeh, M. (2015). Investigation of oxygenation in premature infants under mechanical mentilation in supine position compare to side lying. Journal of Holistic Nursing and Midwifery, 25(1), 18–25.
- Als, H. (1982). Toward a synactive theory of development: Promise for the assessment and support of infant individuality. Infant Mental Health Journal, 3(4), 229–243. https://doi.org/10.1002/1097-0355(198224)3:4<229::AID-IMHJ2280030405>3.0.CO;2-H
10.1002/1097-0355(198224)3:4<229::AID-IMHJ2280030405>3.0.CO;2-H Google Scholar
- Altimier, L., & White, R. D. (2014). The neonatal intensive care (NICU) environment. In C. Kenner & J. Wright (Eds.), Compherensive neonatal nursing care ( 5th ed.) (pp. 722–738). Newyork, NY: Springer.
- Anderson, D. M. (2014). Nutrition management of premature infants. In C. Kenner & J. Wright (Eds.), Compherensive neonatal nursing care ( 5th ed.) (pp. 530–544). Newyork, NY: Springer.
- Anderson, M. S., Wood, L. L., Keller, J. A., & Hay, W. W. (2011). Enteral nutrition. In S. L. Gardner, B. S. Carter, M. Enzman-Hines, & J. A. Hernandez (Eds.), Merenstein & Gardner's handbook of neonatal intensive care ( 7th ed.) (pp. 399–433). St. Louis, MO: Mosby.
- Bingham, P. M., Ashikaga, T., & Abbasi, S. (2011). Relationship of behavioral state and tube-feeding to non-nutritive sucking in premature infants. Journal of Neonatal Nursing, 17(4), 150–157. https://doi.org/10.1016/j.jnn.2010.07.023
10.1016/j.jnn.2010.07.023 Google Scholar
- Carbajal, R., Rousset, A., Danan, C., Coquery, S., Nolent, P., Ducrocq, S., … Lenclen, R. (2008). Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA, 300(1), 60–70. https://doi.org/10.1001/jama.300.1.60
- Carter, B. M. (2012). Feeding intolerance in preterm infants and standard of care guidelines for nursing assessments. Newborn and Infant Nursing Reviews, 12(4), 187–201. https://doi.org/10.1053/j.nainr.2012.09.007
10.1053/j.nainr.2012.09.007 Google Scholar
- Ceylan, S. S., & Bolışık, B. (2017a). Examining psychometric properties of newborn stress scale. Acibadem University Health Sciences Journal, 2, 97–103.
- Ceylan, S. S., & Bolışık, B. (2017b). Validity and reliability of ALPS-Neo Pain and Stress Assessment Scale in newborns. Pamukkale Medical Journal, 10(1), 45–52. https://doi.org/10.5505/ptd.2017.07769
10.5505/ptd.2017.07769 Google Scholar
- Chen, S. S., Tzeng, Y. L., Gau, B. S., Kuo, P. C., & Chen, J. Y. (2013). Effects of prone and supine positioning on gastric residuals in preterm infants: A time series with cross-over study. International Journal of Nursing Studies, 50(11), 1459–1467. https://doi.org/10.1016/j.ijnurstu.2013.02.009
- Cohen, J. (1988). Statistical power analysis for the behavioral sciences. New York: Lawrence Erlbaum Associates.
10.1046/j.1526-4610.2001.111006343.x Google Scholar
- Cohen, S., Mandel, D., Mimouni, F. B., Solovkin, L., & Dollberg, S. (2004). Gastric residual in growing preterm infants: Effect of body position. American Journal of Perinatology, 21(3), 163–166. http://doi.org/10.1055/s-2004-823778
- Cong, X., Wu, J., Vittner, D., Xu, W., Hussain, N., Galvin, S., … Henderson, W. A. (2017). The impact of cumulative pain/stress on neurobehavioral development of preterm infants in the NICU. Early Human Development, 108, 9–16. https://doi.org/10.1016/j.earlhumdev.2017.03.003
- Coughlin, M. (2011). Age-appropriate care of the prematures and critically ill hospitalized infant: NANN guideline for practice. Glenview, IL: National Association of Neonatal Nurses.
- Coughlin, M. E. (2014). Transformative nursing in the NICU: Trauma-informed age-appropriate care. New York, NY: Springer.
10.1891/9780826196583 Google Scholar
- Ditzenberger, G. R. (2010). Nutritional management. In M. T. Verklan & M. Walden (Eds.), Core curriculum for neonatal intensive care nursing. AWHONN ( 4th ed.) (pp. 183–203). St. Louis, MO: Saunders.
- Dsilna, A., Christensson, K., Gustafsson, A. S., Lagercrantz, H., & Alfredsson, L. (2008). Behavioral stress is affected by the mode of tube feeding in very low birth weight infants. The Clinical Journal of Pain, 24(5), 447–455. http://doi.org/10.1097/AJP.0b013e3181633fd6
- Dutta, S., Singh, B., Chessell, L., Wilson, J., Janes, M., McDonald, K., … Watson, J. (2015). Guidelines for feeding very low birth weight infants. Nutrients, 7(1), 423–442. https://doi.org/10.3390/nu7010423
- Faye, P. M., De Jonckheere, J., Logier, R., Kuissi, E., Jeanne, M., Rakza, T., & Storme, L. (2010). Newborn infant pain assessment using heart rate variability analysis. The Clinical Journal of Pain, 26(9), 777–782. https://doi.org/10.1097/AJP.0b013e3181ed1058
- Fritz, C. O., Morris, P. E., & Richler, J. J. (2012). Effect size estimates: Current use, calculations, and interpretation. Journal of Experimental Psychology, 141(1), 2–18. https://doi.org/10.1037/a0024338
- Gardner, S. L., Goldson, E., & Hernandez, J. A. (2016). The neonate and the environment impact on development. In S. L. Gardner, B. S. Carter, M. Enzman-Hines, & J. A. Hernandez (Eds.), Merenstein & Gardner's handbook of neonatal intensive care ( 7th ed.) (pp. 263–314). St. Louis, MO: Mosby.
- Grenier, I. R., Bigsby, R., Vergara, E. R., & Lester, B. M. (2003). Comparison of motor self-regulatory and stress behaviors of preterm infants across body positions. American Journal of Occupational Therapy, 57(3), 289–297. https://doi.org/10.5014/ajot.57.3.289
- Grunau, R. E. (2013). Neonatal pain in very preterm infants: Long-term effects on brain, neurodevelopment and pain reactivity. Rambam Maimonides Medical Journal, 4(4).
- Kültürsay, N., Bilgen, H., & Türkyılmaz, C. (2018). Turkish Neonatal Society guideline on enteral feeding of the preterm infant. Türk Pediatri Arşivi, 53(Supp: 1), 109–118. http://doi.org/10.5152/TurkPediatriArs.2018.01811
- Liaw, J. J., Yang, L., Lo, C., Yuh, Y. S., Fan, H. C., Chang, Y. C., & Chao, S. C. (2012). Caregiving and positioning effects on preterm infant states over 24 hours in a neonatal unit in Taiwan. Research in Nursing & Health, 35(2), 132–145. https://doi.org/10.1002/nur.21458
- Lucchini, R., Bizzarri, B., Giampietro, S., & De Curtis, M. (2011). Feeding intolerance in preterm infants. How to understand the warning signs. The Journal of Maternal-Fetal & Neonatal Medicine, 24(sup1), 72–74. https://doi.org/10.3109/14767058.2011.607663
- Lundqvist, P., Kleberg, A., Edberg, A. K., Larsson, B. A., Hellstrom-Westas, L., & Norman, E. (2014). Development and psychometric properties of the Swedish ALPS-Neo pain and stress assessment scale for newborn infants. Acta Paediatrica, 103, 833–839. https://doi.org/10.1111/apa.12672
- Mills, E. J., Chan, A. W., Wu, P., Vail, A., Guyatt, G. H., & Altman, D. G. (2009). Design, analysis, and presentation of crossover trials. Trials, 10(27), 1–6. https://doi.org/10.1186/1745-6215-10-27
- Moore, T. A., Wilson, M. E., Schmid, K. K., Anderson-Berry, A., French, J. A., & Berger, A. M. (2013). Relations between feeding intolerance and stress biomarkers in preterm infants. Journal of Pediatric Gastroenterology and Nutrition, 57(3), 356–362. http://doi.org/10.1097/MPG.0b013e3182953093
- Newnham, C. A., Inder, T. E., & Milgrom, J. (2009). Measuring preterm cumulative stressors within the NICU: The Neonatal Infant Stressor Scale. Early Human Development, 85(9), 549–555. https://doi.org/10.1016/j.earlhumdev.2009.05.002
- Nist, M. D., Harrison, T. M., & Steward, D. K. (2019). The biological embedding of neonatal stress exposure: A conceptual model describing the mechanisms of stress-induced neurodevelopmental impairment in preterm infants. Research in Nursing & Health, 42(1), 61–71. https://doi.org/10.1002/nur.21923
- Özdel, D., & Sarı, H. Y. (2020). Effects of the prone position and kangaroo care on gastric residual volume, vital signs and comfort in preterm infants. Japan Journal of Nursing Science, 17(1), e12287. https://doi.org/10.1111/jjns.12287
- Pádua, G. D., Martinez, E. Z., & Brunherotti, M. A. D. A. (2009). Cardiorespiratory effects of the body position in premature newborns submitted to the increase of the gastric volume. Arquivos de Gastroenterologia, 46(4), 321–327. https://doi.org/10.1590/S0004-28032009000400014
- Peng, N. H., Chen, L. L., Li, T. C., Smith, M., Chang, Y. S., & Huang, L. C. (2013). The effect of positioning on preterm infants' sleep–wake states and stress behaviours during exposure to environmental stressors. Journal of Child Health Care, 18(4), 314–325. https://doi.org/10.1177/1367493513496665
- Poets, C. F., Langner, M. U., & Bohnhorst, B. (1997). Effects of bottle feeding and two different methods of gavage feeding on oxygenation and breathing patterns in preterm infants. Acta Paediatrica, 86(4), 419–423. https://doi.org/10.1111/j.1651-2227.1997.tb09034.x
- Republic of Turkey Ministry of Health, General Dırectorate of Publıc Health. (2018). Program statistics, Premature Births. https://hsgm.saglik.gov.tr/depo/birimler/cocuk_ergen_db/dokumanlar/istatistikler/premature.pdf (last accessed 16 June 2020)
- Rezae, J., Kadivarian, H., Abdi, A., Rezae, M., Karimpour, K., & Rezae, S. (2018). The effect of body position on gavage residual volume of gastric in intensive care units patients. Iran Journal of Nursing, 30(110), 58–67.
10.29252/ijn.30.110.58 Google Scholar
- Sajadi, M., Akbari, M., Alinejad, S., & Khosravi, S. (2019). Comparison of effect of prone and right lateral positions on gastric residual volume in preterm newborns. Iranian Journal of Neonatology IJN, 10(2), 55–60. http://doi.org/10.22038/ijn.2019.34332.1501
- Sangers, H., De Jong, P. M., Mulder, S. E., Stigter, G. D., Van Den Berg, C. M., Te Pas, A. B., & Walther, F. J. (2013). Outcomes of gastric residuals whilst feeding preterm infants in various body positions. Journal of Neonatal Nursing, 19(6), 337–341. https://doi.org/10.1016/j.jnn.2012.12.003
10.1016/j.jnn.2012.12.003 Google Scholar
- Savaşer, S. (2008). Nutrition of the newborn. In T. Dağoğlu & G. Görak (Eds.), Basic neonatology and nursing principles. (Turkish): İstanbul:Nobel Tıp Kitabevleri.
- Turan, T., & Erdoğan, Ç. (2018). Supporting the development of premature babies in neonatal intensive care unit. JAREN, 4(2), 127–132.
- Valeri, B. O., Holsti, L., & Linhares, M. B. (2015). Neonatal pain and developmental outcomes in children born preterm: A systematic review. The Clinical Journal of Pain, 31(4), 355–362. https://doi.org/10.1097/AJP.0000000000000114
- Valizadeh, S., Hosseini, M. B., & Asghari Jafarabadi, M. (2015). Comparison of the effect of nutrition in kangaroo mother care and supine positions on gavage residual volume in preterm infants. Evidence Based Care, 5(1), 17–24.
- van Wijk, M. P., Benninga, M. A., Dent, J., Lontis, R., Goodchild, L., McCall, L. M., … Omari, T. (2007). Effect of body position changes on postprandial gastroesophageal reflux and gastric emptying in the healthy premature neonate. The Journal of Pediatrics, 151(6), 585–590. https://doi.org/10.1016/j.jpeds.2007.06.015
- Wang, Y., Zhu, W., & Luo, B. R. (2019). Continuous feeding versus intermittent bolus feeding for premature infants with low birth weight: A meta-analysis of randomized controlled trials. European Journal of Clinical Nutrition, 74, 1–9. https://doi.org/10.1038/s41430-019-0522-x
- World Health Organization. (2018). Preterm birth. https://www.who.int/news-room/fact-sheets/detail/preterm-birth (last accessed 16 June 2020).
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