Neutral Head Positioning in Premature Infants for Intraventricular Hemorrhage Prevention: An Evidence-Based Review

Abstract

With the advancement of neonatal medicine during the past several decades, premature and critically ill infants are living past the neonatal period and surviving. The survival of these infants at smaller birth weights and younger gestational ages puts them at an increased risk for intraventricular hemorrhages (IVHs). Although shifts in cerebral perfusion have been linked to the development of these brain bleeds, many seemingly benign care activities have been linked to changes in cerebral blood flow patterns, possibly contributing to IVHs. The purpose of this article is to evaluate the current evidence to determine if the practice of midline positioning for infants born less than 32 weeks gestation for possible IVH prevention is supported by the literature. Many of the researchers involved in these studies attributed the consequential venule leakage of blood to occlusion of the jugular venous drainage system following a turn in the position of the head. Additionally, the articles that examined the connection between the effects of head tilting on brain hemodynamics attributed changes on the infants' potential inability to autoregulate cerebral blood flow adequately. Both of these findings were linked to the development of IVHs. Based on physiologic data and expert opinion, the authors found support in the literature and recommend implementing a plan of care that includes midline head positioning for premature infants.

Head Position Change Is Not Associated with Acute Changes in Bilateral Cerebral Oxygenation in Stable Preterm Infants during the First 3 Days of Life

“…Neutral head-positioning in the very preterm infants during early transitional periods is being explored as a potential method for IVH prevention 14-16,29 . In this cohort of relatively stable very preterm infants during the first three days of life, we describe the normal, bilateral regional SctO2 levels with the head in midline.…”

Clinical Competence and Its Related Factors of Nurses in Neonatal Intensive Care Units

“…1 Along with the increasing complexity of technology and the development of the NICU wards, the survival of these newborns have improved. Currently, the number of neonatal intensive care units in hospitals has met a rise; however, more complex diseases and preterm infants requiring critical care are also increasing.…”

Defining the nature and implications of head turn preference in the preterm infant

“…At the study site, methods to promote midline orientation in the first week of life to potentially stabilize cerebral perfusion are current standard of care. However, these practices were not instituted until after this cohort was enrolled [33]. Finally, this was an exploratory study that investigated multiple outcome variables without correcting for multiple comparisons.…”