Tiny Infants, Positional Head Deformity, Developmental Positioning and Neonatal Nursing Practice.

Background: Low-birth weight infants are at risk for neurodevelopmental complications. Prolonged mechanical ventilation and endotracheal tube stability can compromise developmentally supportive positioning and result in positional head deformity (PHD). Nationally, PHD prevalence is 22%-66%, yet an internal audit of 93 neonatal intensive care unit (NICU) discharge summaries found normal head assessments.

Purpose: To evaluate PHD prevalence among NICU preterm infants and neurodevelopmental positioning practice.

Methods: A convenience sample of 50 NICU preterm infants >72 hours of life discharged alive were selected to establish PHD prevalence. Positioning was observed on all active NICU infants. Infants with other deformities or receiving palliative care were excluded. Measures included gender, gestational age (GA) and birth weight, length of stay (LOS), positioning using the Infant Positioning Assessment Tool (IPAT), and the investigator's head shape assessment at discharge.

Results: The prevalence of PHD was 12% (n = 6) though clinician notes reported normal findings. Infants with PHD had a significantly lower GA at birth (P = .010), and at discharge, had a smaller head (P = .027) and a longer LOS (P = .008). Positioning was observed on 78 infants over 4 consecutive weeks; mean GA = 31.29 ± 0.41 weeks; weight = 1713.56 ± 83.70 g. Of the 572 observations, 84% were therapeutic; hand positioning had the lowest scores.

Implications for practice and research: The PHD prevalence rate for low birth-weight infants is likely underreported. The IPAT hand position element may need validation for extremely low birth-weight infants. Better documentation structures are needed to accurately describe and trend infant head shape.