Hacer YAPICIOĞLU, Adnan BARUTÇU, Ülker GÜLCÜ, Ferda ÖZLÜ, Meral LEVENTELİ

Destekleyici Konumlandırmanın Preterm Yenidoğanlarda COMFORT Ölçek Puanlarına Etkisi

Amaç: Prematüre bebekler, çevresel stres faktörlerine karşı özellikle yaşamın ilk haftalarında daha savunmasızdır. Bu süre zarfında, özellikle bebeklerin etrafında kullanılan destekleyici konumlandırma, kendilerini uterus içinde olduğu gibi daha iyi hissetmelerini sağlar. Bu çalışmanın amacı, yenidoğan yoğun bakım ünitesinde destekleyici konumlandırmanın; prematüre bebeklerin kilo alımı, yaşamsal belirtileri, beslenme intoleransları, ventilasyon süreleri, hastanede kalış süreleri ve konfor ölçeği puanları üzerine etkisini değerlendirmektir. Gereç ve Yöntemler: Çalışmaya rastgele olarak seçilen, 25'i desteklenen grupta ve 25'i kontrol grubunda olmak üzere toplam 50 prematüre bebek dahil edildi. Desteklenen gruptaki bebekler pozisyon malzemesi olarak yumuşak örtüler ve yastıklarla yuvalandı. Kontrol grubunda yuvalama ya da kundaklama yoktu. Bebeklerin demografik özellikleri, konfor ölçeği skorları, kalp hızı, solunum hızı ve oksijen satürasyonu kaydedildi ve karşılaştırıldı. Bulgular: Desteklenen grup ve kontrol grubunun sırasıyla ortalama gestasyonel haftaları 32,9±2,5 (26-36) ve 32,7±2,8 (26-36) hafta (p=0,791), ortalama doğum ağırlıkları ise 1554±492 (680-2380) ve 1772±439 (590-2375) gramdı (p=0,105). Kilo alımı, ventilatör günleri ve hastanede kalış günleri gruplar arasında benzerdi, ancak ortalama oksijen satürasyonu ve derin sedasyon gösteren konfor ölçeği skorları desteklenen grupta günlük bakım sonrası daha yüksekti (sırasıyla; p=0,024, p<0,001). Sonuç: Destekleyici konumlandırmanın hastanede kalış süresi, ventilasyon ve kilo alımı üzerine etkisi olmamakla birlikte prematüre bebeklerin ortalama oksijen satürasyonu ve konfor ölçeği puanları üzerinde olumlu etkisi vardır ve yenidoğan bakımında önerilmektedir.

Anahtar Kelimeler:

Hemşirelik bakımı, yoğun bakım üniteleri, yenidoğan, erken doğum, hasta konforu

Effect of Supportive Positioning on COMFORT Scale Scores in Preterm Newborns

Aim: Premature babies are vulnerable to environmental stress factors mostly in the first weeks of life. During this time, supportive positioning, especially used all-around the baby, makes them feel better as if they are in utero. The aim of the study was to evaluate the effect of supportive positioning on weight gain, vital signs, feeding intolerance, duration of ventilation, duration of hospitalization and comfort scale scores of the premature babies in neonatal intensive care unit. Material and Methods: A total of 50 premature infants were recruited into the study randomly, 25 in the supported group and 25 in the control group. The babies in the supported group were nested with soft blankets and pillows as position material. There was no nesting or swaddling in the control group. Demographic findings, comfort scale scores, heart rate, respiratory rate and oxygen saturation of infants were recorded and compared. Results: Mean gestational weeks and birth weights of the supported and control groups were 32.9±2.5 (26-36) vs. 32.7±2.8 (26-36) weeks (p=0.791) and 1554±492 (680-2380) vs. 1772±439 (590-2375) g (p=0.105), respectively. Weight gain, ventilator days and days of hospitalization were similar in groups, however mean oxygen saturation and comfort scale scores showing deep sedation were higher in the supported group (p=0,024, p<0,001, respectively) after daily care. Conclusion: Although supportive positioning does not have an effect on duration of hospitalization, ventilation and weight gain, it has a positive effect on mean oxygen saturation and comfort scale scores of premature infants and recommended in newborn care.

Keywords:

Nursing care, intensive care units, neonatal, preterm birth, patient comfort,

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Caljouw MAA, Kloos MAC, Olivier MY, Heemskerk IW, Pison WCR, Stigter GD, et al. Measurement of pain in premature infants with a gestational age between 28 to 37 weeks: validation of the adapted COMFORT scale. J Neonatal Nurs. 2007;13(1):13-8.
Shepherd KL, Yiallourou SR, Horne RSC, Wong FY. Prone sleeping position in infancy: Implications for cardiovascular and cerebrovascular function. Sleep Med Rev. 2018;39:174-86.
Valizadeh L, Ghahremani G, Gharehbaghi MM, Jafarabadi MA. The effects of flexed (fetal tucking) and extended (free body) postures on the daily sleep quantity of hospitalized premature infants: A randomized clinical trial. J Res Med Sci. 2016;21:124.
Hallsworth M. Positioning the pre-term infant. Paediatr Nurs. 1995;7(1):18-20.
Riddell RP, Racine N, Turcotte K, Uman L, Horton R, Din Osmun L, et al. Nonpharmacological management of procedural pain in infants and young children: An abridged Cochrane review. Pain Res Manag. 2011;16(5):321-30.
Witt N, Coynor S, Edwards C, Bradshaw H. A guide to pain assessment and management in the neonate. Curr Emerg Hosp Med Rep. 2016;4(1):1-10.
Cignacco E, Schenk K, Stevens B, Stoffel L, Bassler D, Schulzke S, et al. Individual contextual factors in the validation of the Bernese pain scale for neonates: protocol for a prospective observational study. BMC Pediatr. 2017;17(1):171.
Ambuel B, Hamlett KW, Marx CM, Blumer JL. Assessing distress in pediatric intensive care environments: the COMFORT scale. J Pediatr Psychol. 1992;17(1):95-109.
Maaskant J, Raymakers‐Janssen P, Veldhoen E, Ista E, Lucas C, Vermeulen H. The clinimetric properties of the COMFORT scale: A systematic review. Eur J Pain. 2016;20(10):1587-611.
Çakıcı M, Mutlu B. Effect of body position on cardiorespiratory stabilization and comfort in preterm infants on continuous positive airway pressure. J Pediatr Nurs. 2020;54:e1-8.
Coughlin M, Gibbins S, Hoath S. Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice. J Adv Nurs. 2009;65(10):2239-48.
Warren I. The nursery environment. In: Warren I, Bond C, editors. Guide to infant development in the newborn nursery. 7th ed. London: Winnacot Baby Unit; 2015.
Picheansathian W, Woragidpoonpol P, Baosoung C. Positioning of preterm infants for optimal physiological development: a systematic review. JBI Libr Syst Rev. 2009;7(7):224-59.
Cole P, Gavey J. Are they lying comfortably? A direct observational study examining current practices of infant positioning in the neonatal unit. J Neonatal Nurs. 2001;7(1):25-8.
Halder P, Bera D, Banerjee A. Developmentally supportive care in neonatal intensive care unit (NICU): a review. Indian J Med Res Pharm Sci. 2015;2(2):17-23.
Buehler DM, Als H, Duffy FH, McAnulty GB, Liederman J. Effectiveness of individualized developmental care for low-risk preterm infants: behavioral and electrophysiologic evidence. Pediatrics. 1995;96(5 Pt 1):923-32.
El-Nagger NSM, Bayoumi OR. Effect of applying nesting technique as a developmental care on physiological functioning and neurobehavioral organization of premature infants. Life Sci J. 2016;13(1s):79-92.
Brunherotti MA, Martinez EZ, Martinez FE. Effect of body position on preterm newborns receiving continuous positive airway pressure. Acta Paediatr. 2014;103(3):e101-5.
Yin T, Yuh YS, Liaw JJ, Chen YY, Wang KW. Semi-prone position can influence variability in respiratory rate of premature infants using nasal CPAP. J Pediatr Nurs. 2016;31(2):e167-74.
Gouna G, Rakza T, Kuissi E, Pennaforte T, Mur S, Storme L. Positioning effects on lung function and breathing pattern in premature newborns. J Pediatr. 2013;162(6):1133-7.e1.
Halverson K. The effects of positioning on premature infant development. Pediatrics CATs. 5. 2010. http://commons.pacificu.edu/otpeds/5
van Sleuwen BE, Engelberts AC, Boere-Boonekamp MM, Kuis W, Schulpen TW, L'Hoir MP. Swaddling: a systematic review. Pediatrics. 2007;120(4):e1097-106.
Prasopkittikun T, Tilokskulchai F. Management of pain from heel stick in neonates: an analysis of research conducted in Thailand. J Perinat Neonatal Nurs. 2003;17(4):304-12.
Comaru T, Miura E. Postural support improves distress and pain during diaper change in preterm infants. J Perinatology. 2009;29(7):504-7.
Campos RG. Soothing pain-elicited distress in infants with swaddling and pacifiers. Child Dev. 1989;60(4):781-92.
McNair C, Campbell-Yeo M, Johnston C, Taddio A. Nonpharmacologic management of pain during common needle puncture procedures in infants: current research evidence and practical considerations: An update. Clinics Perinatol. 2019;46(4):709-30.
Özdel D, Sarı HY. Effects of the prone position and kangaroo care on gastric residual volume, vital signs and comfort in preterm infants. Jpn J Nurs Sci. 2020;17(1):e12287.