Developmentally Supportive Positioning in Preterm Newborns: A Quality Improvement Initiative

Area of Science:

• Neonatal care
• Quality improvement in healthcare
• Infant development

Background:

• Preterm infants require specific positioning for optimal development.
• Current acceptable positioning rates in Neonatal Intensive Care Units (NICUs) can be low.
• The Infant Positioning Assessment Tool (IPAT) is a validated measure for assessing infant positioning.

Purpose of the Study:

• To significantly increase the proportion of preterm infants achieving acceptable positioning (IPAT Score ≥8) in the NICU.
• To achieve a target of ≥75% acceptable positioning within 6-9 months.
• To implement and evaluate a quality improvement initiative for infant positioning.

Main Methods:

• A quality improvement initiative was conducted in a tertiary teaching hospital's NICU.
• Preterm infants (<37 weeks) were assessed daily using the IPAT (0-12).
• Sequential Plan-Do-Study-Act (PDSA) cycles incorporated staff training, positioning aids, and supportive supervision.

Main Results:

• Acceptable positioning improved from 6.0% at baseline to 88.6% in the sustenance phase.
• The median IPAT score increased from 4 to 9.
• Over 1000 IPAT observations were collected across 210 infants.

Conclusions:

• A stepwise, team-led approach can effectively improve and sustain acceptable infant positioning.
• Hands-on training combined with simple, locally-made positioning support is key.
• This strategy is effective even in resource-constrained NICU settings.