Transitioning the premature infant from nonsupine to supine position prior to hospital discharge: Exploring current practice and examining clinical outcomes
McMullen, Sherri L.
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Background . Supine sleep after hospital discharge reduces sudden infant death syndrome (SIDS); however, neonatal intensive care infants are primarily positioned nonsupine. It is unknown if or when nurses transition premature infants. In addition, there is no empirical data describing the physiological impact of transitioning premature infants. Objectives . The purpose of this retrospective chart review is to document the practice and effect of supine transitioning in premature infants. Method . A retrospective chart review was conducted in two tertiary level neonatal intensive care units in Upstate New York. Results . Infants were transitioned (n=241) supine prior to hospital discharge (89%) and the difference between transition and discharge was one± one week. The overall mean postmenstrual age at transition was 35.7±1.2 weeks. There is a quadratic relationship between gestational age at birth and the postmenstrual age at transition. The youngest and oldest gestational ages at birth had the highest postmenstrual age at transition with the vertex at 30 weeks. Statistical differences were found between sites for the percentage of infants' transitioned supine, postmenstrual age at supine transition, the timing of transition and the Score for Neonatal Acute Physiology-II (SNAP-II) score, p<0.05. Discussion . The majority of premature infants were transitioned supine prior to hospital discharge, but not as early as experts recommend. Results support that it is physiologically safe (as weight gain & head growth were not compromised) to transition infants at 35 weeks. Continued research is needed to determine the ideal time to transition premature infants supine to reduce SIDS while supporting physiological and neurological development.