Background: Gastroesophageal reflux occurs frequently in pre-term infants and results in longer hospital stays and greater expense. Aversive behaviors such as gagging, arching, and irritability are common and can interfere with the infant’s ability to consume the volume needed to meet nutritional needs. Non-pharmaceutical treatment approaches including positioning are recommended for the treatment of gastroesophageal reflux disease. Episodes of gastroesophageal reflux are dependent upon positioning, with fewer episodes occurring when infants are placed in a left sidelying position versus a semi-upright position.
Method: This study was conducted in an 84-bed, level III neonatal intensive care unit of a large, regional hospital in the southeastern United States. Three infants were enrolled in this study. There were two males and one female with an average birth age of 30.4 (+/- 4.1) weeks gestation. Age at time of investigation was 38.2 (+/- 3.5) weeks corrected gestation. A single neonatal certified speech language pathologist fed each infant for eight feeding sessions using an alternating design with randomization of feeding position. Two observers recorded all incidents of facial grimace, head/trunk rotation, lower extremity bracing, decrease in heart rate and oxygen desaturation. Trend, slope and percentage of non-overlapping data were calculated for each participant and compared across participants to determine inter-subject replication.
Results: Data were not supportive of positioning as an effective factor in volume consumption in preterm infants with clinical signs of GERD. In two of the three participants, percentage of non-overlapping data showed an equal degree of effectiveness for both the left sidelying position and the semi-upright position. Results do not support positioning as an effective factor in physiological stability during oral feeds in the population studied. No participants had an episode of decreased heart rate. One of three participants had a single episode of oxygen desaturation. The data for aversive behaviors did support positioning as an effective factor during oral feeds for preterm infants with clinical signs of GERD. The left sidelying position was shown to be superior in the reduction of the aversive behaviors defined in this study for all three participants.
Conclusion: Use of positioning may not be the definitive solution but evidence suggests that it may be beneficial while creating no harm. Implementation of a left sidelying position during oral feeds has no cost and requires no specialized skills, making it a safe and reasonable choice as an initial treatment intervention.