Upload
judith-gardner
View
216
Download
1
Tags:
Embed Size (px)
Citation preview
THE ROLE OF DEVELOPMENTAL POSITIONING IN NEONATES
K F Lyons
Preterm Neonate
Congenital Abnormalities
5% of Neonates 95% Survive
Evidence to support developmental delay in Surgical Neonates with normal neurology
Laing S et al (2011). Early development of children with major birth defects requiring newborn surgery.
Journal of Paediatrics and Child Health. 47:140-147
118 infants with congenital abnormalities following surgery during the neonatal period
26% had motor delay, 20% global delay
Newborn• Physiological flexion• Protraction of
shoulders and posterior pelvic tilt
• Vital for development of normal body movement and control
Surgical neonate
• Ventilated• Sedated for long
periods• Muscle relaxed
Muscle weakness
Muscle imbalance• Take up surface • Lack of movement
against gravity• Stay where placed• Poor co-contraction• Head turning
preference• Poor feeding pattern
Developmentally delayed
Evidence of low central stability
Danser E et al (2013).Preschool neurological assessment in congenital diaphragmatic hernia survivors: Outcome and
perinatal factors associated with neurodevelopmental impairment. Early human dev.
89: 393-400.
CDH survivors 22% motor delay, additional 14% severe delay.
Hypotonicity was found in 33% of patients
Postures
Risk factors• Low birth weight• Critical illness• Multiple surgery• Ventilation time• Prolonged oxygen
requirement• Poor nutrition• Interrupted sleep
patterns • Prolonged
hospitalisation
Positionally and Environmentally Challenged
Extended
Floppy
Asymmetrical
• Head turning preference
• Plagiocephaly• No midline
development• Poor communication
Current Practice
Support in flexion
Positioning Aids
Z-Flo/ Tortoise
The Leckey Infant Positioning System (IPS)
Enhanced supine support
• Greater amount of containment
• Consistent flexion• Mechanical
advantage abdominals
Audit of infants requiring additional support
Poddle pod
Problem solve
Minimise abnormal postures for maximum function
• No midline development
• No self consoling• Affecting vision and
communication• Inhibiting skill
acquisition• Contracture formation
Unsupported v supported
Enable midline and symmetry
Support in consistent flexion
Support in consistent flexion
Additional support
Contain and inhibit
Additional support
Contain and inhibit
Head turning preference
Orthopaedic problems
Risk assessment
• Environment
• Support required
Check equipment
• Support when needed and allow for difficulties
Normalise Handling
Facilitate movement
Be inventive
Minimise Risk
Thanks for Listening