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Developmentally Supportive Positioning in Preterm Newborns: A Quality Improvement Initiative

Aditya Hemendra Bhatt1, Dipen Vasudev Patel2, Somashekhar Marutirao Nimbalkar1,3

  • 1Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Gokalnagar, Karamsad, Anand, Gujarat, 388325, India.

Indian Journal of Pediatrics
|July 8, 2026
PubMed

Insights

Improving infant positioning in the Neonatal Intensive Care Unit (NICU) is crucial. A quality improvement initiative successfully increased acceptable infant positioning from 6% to over 88% using training and simple support methods.

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.
Abstract

Keywords:
Developmental careIPATNeonatal positioningPDSA cyclesPreterm infantQuality improvement

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