Nested and swaddled positioning support in the prone position facilitates sleep and heart rate stability in very low birth weight infants

Hideki Kihara,¹ Tomohiko Nakamura<sup>2

1</sup>Department of Rehabilitation, Nagano Children’s Hospital, Nagano, Japan; ²Division of Neonatology, Nagano Children’s Hospital, Nagano, Japan

Abstract: The purpose of this study was to observe in very low birth weight infants (VLBWI) the effect of nested and swaddled positioning support in the prone position on heart rate, sleep distribution, and behavior state. A total of 20 VLBWI who were born at a gestational age of 26.5 ± 4 weeks with a birth weight of 709 ± 207 g were studied at an average gestational age of 37.4 ± 0.6 weeks (range 36–39) and a weight of 1590 ± 337 g (range 1192–2372). A prospective and crossover design was used. Infants were observed in the prone position with and without positioning support. Heart rate and electroencephalography were monitored during 3-hour interfeeding epochs. Heart rate and the coefficient of variation of heart rate in prone infants with positioning support were lower than in prone infants without positioning support. The percent of quiet sleep and behavior state 1 in prone infants with positioning support were higher compared to prone infants without positioning support. In conclusion, the present study demonstrated that a prone position with nested and swaddled positioning support might facilitate sleep and heart rate stability compared to prone positioning alone in VLBWI.

Keywords: positioning support, prone position, sleep, heart rate, very low birth weight infants