EFFECTS OF HAMMOCK POSITIONING ON CLINICAL PARAMETERS IN PRETERM INFANTS ADMITTED TO A NEONATAL INTENSIVE CARE UNIT: A SYSTEMATIC REVIEW

Menger, Janaina de Lima; Mafaldo, Letícia Reck; Schiwe, Daniele; Schaan, Camila Wohlgemuth; Heinzmann-Filho, João Paulo

doi:10.1590/1984-0462/2021/39/2019399

Brasil

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REVIEW ARTICLE • Rev. paul. pediatr. 39 • 2021 • https://doi.org/10.1590/1984-0462/2021/39/2019399 linkcopy

EFFECTS OF HAMMOCK POSITIONING ON CLINICAL PARAMETERS IN PRETERM INFANTS ADMITTED TO A NEONATAL INTENSIVE CARE UNIT: A SYSTEMATIC REVIEW

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: To review the effects of the hammock positioning on clinical parameters of preterm newborn infants (PTNB) admitted to the Neonatal Intensive Care Unit (NICU).

Data sources: This was a systematic review performed by searching the Pubmed, Lilacs, SciELO and PEDro databases. Intervention studies in English, Portuguese and Spanish that evaluated the effects of hammock positioning on clinical parameters of PTNB admitted to the NICU were selected. Three search strategies were used: 1) hammock positioning OR patient positioning AND intensive care units AND infant, newborn; 2) hammock positioning OR patient positioning AND intensive care units; 3) hammock positioning OR patient positioning AND intensive care units, neonatal. There was no restriction on the year of publication of the articles. Methodological quality was assessed by the PEDro scale.

Data synthesis: Among 597 articles, only six were included and 139 neonates with gestational ages between 26 and 37 weeks and an average gestational weight <2240g were analyzed. Four studies included patients without any associated pathology and most of them placed the PTNB supine in hammock positioning. The duration of the intervention ranged from 15 to 180 minutes and most applied it at just one moment. There was an improvement in heart rate (HR), respiratory rate (RR) and pain (3/4 studies), as well as gains in peripheral oxygen saturation (SpO2) (2/4 studies). Only one study reported worsening of SpO2 with the intervention. The methodological quality of the studies was classified as low.

Conclusions: Although this review suggests improvement with hammock positioning in HR, RR and pain in PTNB, the low methodological quality makes the results inconsistent.

Keywords: Premature newborn; Patient positioning; Neonatal Intensive Care Units

Authors	Country	Sample Size	Outline	Purpose of the study
Ribas et al.²³	Brazil	26	RCT	Evaluate the effects of hammock positioning on reducing pain and improving sleep/wakefulness and vital signs
Jesus et al.⁴	Brazil	28	Quasi-experimental	Evaluate the effects of hammock positioning on behavioral status, pain and vital signs
Queiroz et al.¹⁴	Brazil	20	Quasi-experimental with cross-over	Verify the use of hammocks and prone positioning for pain relief and vital sign behavior
Costa et al.⁸	Brazil	30	Quasi-experimental with cross-over	Compare the effects of hammock positioning and the nest on the level of pain, posture and organizational status
Keller et al.¹⁹	Israel	20	RCT	Examine the effects of hammock positioning on growth, autonomic stability and neuromuscular maturity
Zanardo et al.²⁴	Italy	15	Quasi-experimental	Evaluate the effects of hammock positioning on peripheral oxygen saturation

Authors	Age (weeks)	Birth weight (g)	Associated pathologies	Variables evaluated	Moment of evaluation
Ribas et al.²³	30 to 37	1620±0.51*	None	Pain, HR, RR, SpO₂ and sleep/wake	10 minutes before and after the intervention
Jesus et al.⁴	28 to 36	<1500	None	Pain, HR, RR, SpO₂ and behavioral status	10 minutes before and throughout the intervention (2, 20, 40, 60 minutes) and after 10 minutes
Queiroz et al.¹⁴	32⁺	1932^$	RDS and BPD	Pain, HR, RR, SpO₂, SBP, DBP, MAP and body temperature	Before and after the intervention^#
Costa et al.⁸	32 to 35	1400-1800	None	Pain, flexing posture and organizational status	After changing diapers^#
Keller et al.¹⁹	26 to 30	<1500	None	HR, RR, weight gain and neuromuscular maturation	Before, during, and after the intervention^#
Zanardo et al.²⁴	27 to 30	970-2240	BPD	SpO₂	15 minutes before, during, and after the intervention

Authors	Type of intervention	Frequency	Duration	Statistical analysis	Pain	HR	RR	SpO₂	Other outcomes
Ribas CG et al.²³	Hammock positioning in LD Nesting position in LD	5 days	120 minutes	Intergroups	↓	↓	↓	↑	↑ Sleep and wake
Jesus VR et al.⁴	Hammock positioning in supine	1 moment	60 minutes	Intra-groups	↔	↓	↓	↔	↑Behavioral status
Queiroz CMB et al.¹⁴	Hammock positioning in RLD Nesting position in RLD	1 moment	40 minutes	Intra-groups	↓ ↓	↔ ↔	↔ ↔	↑ ↑	↔ SPB, DBP, MAP ↔ Body temperature ↔ SPB, DBP, MAP ↔ Body temperature
Costa KSF et al.⁸	Hammock positioning in supine Nest positioning in prone	1 moment	40 minutes	Intergroups	↓	-	-	-	↑ Flexor posture ↑ Organizational status
Keller et al.¹⁹	Hammock positioning in supine Nest positioning in prone	10 days	180 minutes	Intergroups	-	↓	↓	-	↑ Neuromuscular maturation ↔ Body weight
Zanardo V et al.²⁴	Hammock positioning in supine	1 moment	15 minutes	Intra-groups	-	-	-	↓	-

Evaluated criteria	Ribas CG et al.²³	Jesus VR et al.⁴	Queiroz CMB et al.¹⁴	Costa KSF et al.⁸	Keller et al. ¹⁹	Zanardo V et al.²⁴
Eligibility criteria*	+	+	+	+	+	+
Random allocation	+	-	-	-	+	-
Hidden allocation	-	-	-	-	-	-
Similar groups	+	-	-	-	+	-
Blind participants	+	+	+	+	+	+
Blind therapists	-	-	-	-	-	-
Blind evaluators	+	-	-	-	-	-
Adequate follow-up	+	+	+	+	+	+
Intention to treat analysis	+	+	+	+	+	-
Between group comparisons	+	-	+	+	+	-
Point estimates and variability	+	+	+	+	+	+
Total score	8/10	4/10	5/10	5/10	7/10	3/10

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[TFN1] RCT: Randomized Controlled Trial