Beruflich Dokumente
Kultur Dokumente
1 2 3 4
Emriye Hilal Yayan, Sibel Kucukoglu, Yeliz Suna Dag, and Nazlı Karsavuran Boyraz
Abstract
Background: Body position affects the gastric emptying rate and hence the amount of gastric residue.
Objective: This study aims to analyze the effect of the post-feeding position of preterm infants on gastric
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residue.
Materials and Methods: This experimental study was conducted in the neonatal intensive care unit (NICU) of a
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university hospital (Inonu University Turgut Ozal Medical Center) in Eastern Turkey. The study included 40 preterm
infants weighing less than 2,000 g, who were fed orogastrically. The preterm infants were sequentially placed in
four positions and were fed before each change of position. The infants were sequentially placed in the right lateral,
left lateral, supine, and prone positions; their gastric residues were measured with a nasogastric tube. The gastric
residue was recorded in percentages at 30, 60, 120, and 180 minutes. Ethical principles were applied in all phases of
the study. Results: The lowest mean gastric residue level was observed in the right lateral position at 30 minutes
(58.16 – 12.71%) and 60 minutes (33.97 – 15.00%). The prone position showed the lowest mean gastric residue
level (1.74 – 1.08%), followed by the right lateral (3.06 – 1.97%), supine (3.53 – 2.18%), and left lateral position
(5.14 – 1.85%) at 120 minutes. The final measurements were taken at 180 minutes with the right lateral position
showing the lowest mean gastric residue level (0.38 – 0.34%).
Conclusion: The premature infants had similar lower levels of gastric residue in the right lateral and prone positions
and higher levels of gastric residue in left lateral and supine positions. The gastric emptying rate was found to be
highest in the right lateral position at 30, 60, and 180 minutes and in the prone position at 120 minutes.
1
Department of Child Health Nursing, Health Sciences of Faculty, Ino¨nu¨ University, Malatya, Turkey.
2
Department of Child Health Nursing, Nursing Faculty, Atatu¨rk University, Erzurum, Turkey.
3
Department of Child Health Nursing, Health Sciences of Faculty, Ino¨nu¨ University, Malatya, Turkey.
4 ¨ University, Malatya, Turkey.
Turgut Ozal Tıp Merkezi, Inonu¨¨
438
FEEDING POSITION EFFECT ON GASTRIC RESIDUE 439
Conversely, inability of premature infants to tolerate feeding in the supine position. Another randomized controlled exper-
12 13
increases mortality and morbidity for different positions. imental study was conducted by Cohen with 31 infants. The
The most important factor affecting nutrition in premature gastric residue levels of these infants were measured in four
11,12
infants is gastric emptying. Some studies have shown different positions (right lateral, left lateral, supine, and prone)
that body position affects the gastric emptying rate and hence at the first and third hour after feeding, and their gastric emp-
7,8,13,14 13
the amount of gastric residue. Cohen studied the tying rates were examined. The highest gastric emptying rate
effect at the end of the first hour of four different positions on occurred in the right lateral position, followed by the prone,
infants after feeding and found no difference between the supine, and left lateral positions in that order.
gastric residue in infants placed in prone and supine posi-
tions. On the other hand, he found a significantly lower level Materials and Methods
of gastric residue in the infants placed in the left lateral and
8 Design
right lateral positions. Chen analyzed two different positions
after feeding (prone and supine) and reported that the prone A semi-experimental study design was utilized in this study.
position was more effective for gastric emptying.
Most of the studies on this subject have shown contradictory Study sample
results: one study reported that the supine and left lateral po-
sitions were not helpful for gastric emptying and recommended This experimental study was conducted in the neonatal in-
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12
that nurses use these positions less often. Some studies showed tensive care unit of Ino¨nu¨ University Turgut Ozal Medical Center in
no difference between breast milk and formula in terms Eastern Turkey. The neonatal intensive care unit was a primary level
15,16 intensive care unit with 20 beds. A total of 20 nurses work shifts in
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supine, and prone positions, and stayed in each position for three were placed while they were fed to find the position at
hours. The gastric residue levels were measured at 30, 60, 120, which the gastric emptying rate was better. The gastric
and 180 minutes after each feeding. The amount of breast milk residue level was determined by calculating the proportion
given to the infants, which ranged between 20 and 42 mL, was of the breast milk given to the infants to the amount of milk
recorded at each time point. The gastric residue was calculated by remaining in the stomach at the hour of measurement
comparing the amount given to the infant versus the amount (gastric residue percentage = the amount taken at the hour
consumed (gastric residue level = amount consumed at the hour of measure-ment·100/(nutrition provided+prior gastric
8 residue). The amount of gastric residue was analyzed for
of measurement·100/nutrition given + previous gastric resi-due).
Measurement was measured with nasogastric tube. The gastric each position at specific time intervals.
residue was recorded in percentage. The infants’ vital signs during The first measurement was taken 30 minutes post-feeding.
the process were monitored. During the procedure, the process A statistically significant difference was found between the
would be ended if any problem occurred. No problems were positions at 30 minutes; Tukey analysis was used to deter-
observed in the infants, and the processes were completed as mine which positions caused the difference. The lowest mean
planned. The entire process was recorded by a researcher and the gastric residue level was observed in the right lateral position
primary nurse caring for the infant. at 30 minutes; the level was almost half of the infants’ feeding
(58.16 – 12.71%). No significant difference in residue levels
Assessment of data was found between the right lateral and prone positions ( p =
0.120); however, a significant difference was found be-tween
Assessment of data obtained as the result of the study residue levels in the left lateral ( p = 0.000) and supine ( p =
was conducted using the SPSS (Statistical Package for
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a
M – SD, mean – standard deviation.
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The final measurements were taken at 180 minutes after The most effective position was the right lateral position at
feeding. The right lateral position showed the lowest mean 30 and 60 minutes: this position produced the highest gastric
gastric residue level (0.38 – 0.34%), followed by the prone emptying rate. Measurements in the prone position were close
(0.41 – 0.38%), supine (1.13 – 0.90%), and left lateral posi- to those in the right lateral position at both times. The
tions (1.41 – 1.22%), respectively. The right lateral position advanced analysis showed no significant difference in gastric
was not found to be significantly different from the supine and emptying between the right lateral position and the prone
prone positions in terms of gastric residue. However, position. Results in the left lateral position and supine posi-
significant differences were found between the right lateral tion were similar to each other, both indicating slower gastric
and left lateral positions ( p = 0.006) and between the left emptying. Higher gastric emptying was observed in the first
lateral and prone positions ( p = 0.008) (Table 2 and Fig. 1). 30 minutes. The above-mentioned results were also observed
at the end of the first hour after feeding. The right lateral and
prone positions showed faster gastric emptying after feeding
Discussion compared to the supine and left lateral positions. Cohen et
13
al. analyzed the gastric residue levels of preterm infants at
This study analyzed the effect of the preterm infants’ post-
the end of the first and third hours in these four positions.
feeding position on gastric residue. Although the literature
These researchers also found that right lateral position yiel-
contains insufficient data on this subject, previous studies
ded the lowest level of gastric residue and that the volume of
have partially analyzed the positional differences. In this
gastric residue was significantly different from the left lateral
study, four measurements were taken at four positions to
position. They also reported that results in the prone position
analyze the effect of positioning on gastric residue.
were similar to those in the right lateral position and that place premature infants in the right lateral or supine positions for the
gastric emptying in the prone position was significantly dif- first 30 minutes or one hour after feeding them. This study may be a
ferent from that in the left lateral position. In their study, the guide to neonatal intensive care unit nurses with respect to
supine position yielded similar results to left lateral position at appropriate positioning of preterm infants. But we recommend that
the end of the first hour. The first-hour results of the Cohen et studies be conducted in preterm groups that receive only breast milk
13
al. study were close to the first-hour results of the present or only formula and that the results be compared. Further studies
study, indicating that the highest gastric emptying occurred in should be conducted to better un-derstand the effect of infant
right lateral and prone positions. Another important point here positioning on gastric residue.
is that the slowest gastric emptying in the first hour occurred
in supine position in the present study. Relevance to clinical practice
8
Chen et al. analyzed the gastric emptying rate by mea- Nurses can preferably use right lateral and prone positions
suring the gastric residue in supine and prone positions at 30- particularly in the first 30 minutes or one hour when posi-
minute intervals after feeding was provided in two sepa-rate tioning premature infants after feeding. The gastric residue
volumes (50 and 100 mL/kg/day). They reported that the amounts in infants placed in the right lateral and prone po-
gastric emptying rate was higher in the prone position at 30 sitions and in those placed in the left lateral and supine po-
and 60 minutes, similar to the results of the present study. The
sitions after feeding were similar in the present study. This
other studies also indicated that gastric emptying rate in the
finding suggests that the right lateral and prone positions and
right lateral position was not lower than that of the other
the left lateral and supine positions can be used as an alter-
positions and that the infants seemed more comfortable in native to each other when positioning infants after feeding in
5,13,18,19
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this position after being fed. The most important clinics. However, considering that the number of studies
finding in this study is that the prone and right lateral posi- conducted on this subject is limited, it is recommended that
tions and the supine and left lateral positions showed the findings of the present study be supported with other
similar amounts of gastric residue. studies conducted with larger samples.
In the present study, the gastric residue levels measured at
the second and third hours were similar in the right lateral, Limitations of the Study
prone, and supine positions. Significant differences were
found between the left lateral and right lateral positions and A limitation of the study was the inadequate number of
8
between the prone and supine positions. Chen et al. found infants who met the inclusion criteria. The study was con-
that gastric residuals were significantly lower in the prone ducted for a longer period than planned because the prema-
than in the supine position at the five measurement points; ture infants were generally admitted to the neonatal
measurements were taken at 30, 60, 90, 120 and 150 min. In intensive care unit with an accompanying problem.
the present study, however, the advanced analysis showed no Another limitation was the requirement that the infants be
significant difference in gastric residue between the supine breastfed only. In the clinic’s routine, infants are supported
and prone positions at the second and third hour. Although with formula when breast milk is insufficient, thus
13
Cohen et al. did not find a significant difference between the excluding these infants from meeting the study criteria.
positions at the third hour, the present study revealed sig-
nificant differences between the positions both at the second Authors’ Contributions
and the third hour. Another study on preterm infants, con-
12 E.H.Y. conceived of the intervention and its design, was
ducted by Sangers et al. , found that, like the results of our
the principal investigator, and directed the writing process.
study, the lowest amount of residue was observed in the right
lateral and prone positions.
E.H.Y. and S.K. provided the intervention and drafted the
17 initial manuscript. E.H.Y. conducted data collection and
Malhotra et al. compared the gastric residue of formula analysis, carried out revisions of the manuscript and
and breast milk feedings in the prone and supine position. The assisted with the intervention. E.H.Y., Y.S.D and N.K.B
authors reported that the prone position yielded better results contributed to the intervention and interpretation of the
than did the supine position; however, they found no differ-
17 work. All authors contributed to the writing process and
ence between the gastric residue of formula and breast milk. approved the final manuscript.
Some studies that analyzed the effect of infants fed either
breast milk or formula on gastric emptying found no
Disclosure Statement
difference between the groups and reported that breast milk or
7,15–17,19 No competing financial interests exist.
formula feedings did not affect gastric emptying.
The present study included infants who were breastfed
only. It is recommended that the effect of breast milk and References
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