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Neutral head positioning in premature infants for intraventricular hemorrhage prevention: an evidence-based review
1Level III NICU, St. Louis Children's Hospital, MO, USA. sheilakm@bjc.org
Insights
Midline head positioning may help prevent intraventricular hemorrhages (IVH) in premature infants. Studies suggest head tilting can disrupt cerebral blood flow, increasing the risk of brain bleeds in vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Clinical Practice Guidelines
Background:
- Neonatal medicine advancements increase survival rates for premature and critically ill infants.
- Infants born at younger gestational ages and lower birth weights face higher risks of intraventricular hemorrhages (IVH).
- Cerebral perfusion shifts and routine care activities are implicated in IVH development.
Purpose of the Study:
- To evaluate existing evidence on midline positioning for IVH prevention in infants under 32 weeks gestation.
- To determine if current literature supports the practice of midline head positioning for premature infants.
Main Methods:
- Literature review of studies investigating the relationship between infant positioning and IVH.
- Analysis of research linking head position to cerebral blood flow and jugular venous drainage.
- Examination of studies on head tilting effects on cerebral hemodynamics and autoregulation.
Main Results:
- Research indicates head turning can occlude jugular venous drainage, leading to blood leakage.
- Head tilting may alter cerebral blood flow due to impaired autoregulation in infants.
- Both mechanisms are associated with an increased risk of intraventricular hemorrhages.
Conclusions:
- Physiologic data and expert opinion support the use of midline head positioning.
- A plan of care including midline head positioning is recommended for premature infants.
- Midline positioning is a potential strategy for IVH prevention in high-risk neonates.
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.
