Scope of study
"..we evaluated the influence of positioning and particularly a containing position in a hammock compared with the supine position, on the respiration of the newborn."
We studied 50 babies admitted to the Neonatal Intensive Care Unit (N. I.C.U.) of the University of Padova. 33 were males ; 17 females; gestational ages were 29-40 weeks (means 33.9 weeks) and the birth weights 1060-4280 g (mean 2198.4 g). 40 babies were admitted to the N.I.C.U. as premature (less than 38 weeks of gestational age); 11 with hyaline membranes disease (HMD); 8 with perinatal asphyxia; 6 were small for gestational age (SGA); 1 had hypoglycaemia; 1 had necrotizing enterocolitis and 1 was hypotonic. 10 full term babies were admitted : 3 because of asphyxia at birth; 4 with respitory problems; 2 with non-cyanotic heart disease and 1 with severe polycythemia. 12 of the 50 babies were in the respirator at the time of transcutaneous oxygen level recording, both in the supine and the hammock position"
Summary of Findings and Assumptions
" in our opinion, one of the main points of this care is "containment". In fact the preterm loses prematurely the containing action of the maternal utero. Probably because of this lack of holding, the so called primary dystonic phase, charaterised by the dominant influence of the Assymetrical Tonic Neck Reflux (ATNR) and the startle reaction arises so early and conditions powerfully and for a long time the neuromotor evolution of the premature newborn. These dominant reflexes overcharge the autonomic system of the neonate determining tachycardia, alterations of breathing pattern and so on; they also determine the alteration of the biological rhythms (sleep-waking; cry-still) and so delay the baby's recovery process.
In our experience a little hammock inside the incubator gives the preterm better chances of being correctly contained: the baby maintains a more flexed position similar to the utero ; the total flexion pattern is also stimulated and can better counteract the ATRN and startle patterns which cause the onset of the dystonic phase.
In our experience all these problems may be counteracted by an incubator for newborns and especially prematures, containing a hammock. This offers the following advantages:
(1) It inhibits or at least shortens the dystonic phase, while the baby remains in a fetal position for a longer postnatal period.
(2) It facilitates bringing the hands to the middle pattern, one of the basic milestones of neuromotor development of the baby in the first year of life.
(3) By maintaining the baby's head in the mid-line, it stimulates visual exploration of the environment.
(4) The tilted position of the hammock counteracts possible regurgitation; the risk of milk aspiration into the bronchi is therefore greatly reduced.