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Updated: Sep 17, 2025

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
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Tiny Infants, Positional Head Deformity, Developmental Positioning and Neonatal Nursing Practice

Vicki Bradfield1, Leslie McKeon

  • 1Author Affiliations: Neonatal Intensive Care, University of Tennessee Medical Center, Knoxville, Tennessee, (Mrs Bradfield); and Division of Nursing, University of Tennessee Medical Center, Knoxville, Tennessee (Dr McKeon).

Advances in Neonatal Care : Official Journal of the National Association of Neonatal Nurses
|July 3, 2025
PubMed

Insights

Positional head deformity (PHD) is common in premature infants, yet often underreported in clinical notes. Improved documentation is crucial for tracking infant head shape and ensuring proper developmental support.

Area of Science:

  • Neonatal care
  • Developmental pediatrics
  • Medical device engineering

Background:

  • Low-birth weight infants face neurodevelopmental risks.
  • Prolonged ventilation and endotracheal intubation can lead to positional head deformity (PHD).
  • Reported PHD prevalence ranges from 22%-66%, but internal audits suggest underreporting.

Purpose of the Study:

  • To determine the prevalence of PHD in preterm infants within the neonatal intensive care unit (NICU).
  • To assess current neurodevelopmental positioning practices in the NICU.

Main Methods:

  • A sample of 50 NICU preterm infants ( >72 hours old) were assessed for PHD at discharge.
  • Infant positioning was observed using the Infant Positioning Assessment Tool (IPAT).
  • Data collected included gestational age, birth weight, length of stay, and head shape assessment.

Main Results:

  • PHD prevalence was 12%, contrasting with normal findings in clinician notes.
  • Infants with PHD had lower gestational age, smaller head circumference at discharge, and longer NICU stays.
  • Therapeutic positioning was observed in 84% of 572 observations, with hand positioning scoring lowest.

Conclusions:

  • PHD prevalence in low-birth weight infants is likely underestimated.
  • The IPAT's hand positioning component may require validation for extremely low birth-weight infants.
  • Enhanced documentation structures are necessary for accurate infant head shape tracking and trend analysis.
Abstract

Keywords:
developmental positioningdevelopmentally supportive positioningextremely low birth weightlow birth-weight infantpositional head deformity

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