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Elevated Midline Positioning During Diaper Change in Preterm Infants
Sponsor: Akdeniz University
Summary
Diaper changing is one of the most frequent routine care procedures in the neonatal intensive care unit (NICU) and is known to cause physiological instability and behavioral stress responses in preterm infants. During a conventional diaper change the infant is often kept in a side-lying position with the head turned to one side, which may impair jugular venous drainage. In contrast, 30-degree head-of-bed elevation with the head kept in the midline has been shown to lower intracranial pressure and is a core component of intraventricular hemorrhage prevention care bundles. No randomized controlled trial has yet examined the effect of this position during diaper change. The purpose of this randomized controlled trial is to determine whether 30-degree elevated midline positioning during a routine diaper change, compared with standard care (diaper change in a flat, side-lying position), reduces oxygen desaturation and bradycardia episodes, lowers pain/stress scores measured with the Neonatal Infant Pain Scale (NIPS), and shortens the time needed for heart rate and oxygen saturation to return to baseline in stable preterm infants born at 28-34 weeks of gestation. Eighty infants (40 per group) in the level III NICU of Antalya City Hospital, Türkiye, will be randomly assigned to one of the two groups. Each infant will be evaluated during a single diaper change performed after 96 hours of postnatal age.
Official title: Effect of 30-Degree Elevated Midline Positioning During Routine Diaper Change on Physiological Stability and Comfort Behaviors in Preterm Infants: A Randomized Controlled Trial
Key Details
Gender
All
Age Range
4 Days - Any
Study Type
INTERVENTIONAL
Enrollment
80
Start Date
2026-11-01
Completion Date
2027-06-30
Last Updated
2026-10-08
Healthy Volunteers
No
Interventions
30-Degree Elevated Midline Positioning
Nursing positioning intervention applied during a single routine diaper change: 30-degree head-of-bed elevation without hip flexion; head kept in the midline with bilateral rolled supports and a neutral neck position; diaper changed by the log-roll technique, turning head, trunk and pelvis as one unit by about 15-30 degrees to each side without lifting the legs by the ankles. Performed by a trained neonatal nurse with at least one year of NICU experience, assisted by a second nurse who keeps the head in the midline.
Standard Lateral Position Diaper Change
Routine diaper change performed according to the unit's current standard practice, with the infant in a side-lying (lateral) position on a flat bed (0 degrees). No additional positioning manoeuvres (midline positioning, head-of-bed elevation or log-roll technique) are applied.