Therapeutic Positioning as a Nursing Intervention in the NICU: A Narrative Review of Evidence and Clinical Applications

Background and Aim Preterm infants, due to the immaturity of their organ systems, are at high risk of physiological instability, feeding difficulties, and developmental delays. Therapeutic positioning and Kangaroo Mother Care (KMC), as cornerstones of developmental care in the NICU, can potentially improve clinical outcomes. This narrative review aimed to synthesize evidence from ۲۰۱۸-۲۰۲۵ on the effects of positioning and KMC on the physiological, nutritional, and developmental outcomes of preterm infants. Methods A comprehensive search was conducted in PubMed, Scopus, Web of Science, SID, and Magiran. Two independent reviewers screened titles/abstracts and full texts, with disagreements resolved by a third reviewer. Inclusion criteria encompassed original studies (randomized, observational, or crossover), systematic/scoping reviews, and qualitative research focusing on clinical positioning (supine, side-lying, prone- particularly semi-elevated side-lying), supportive devices, and KMC. Given the narrative design, no meta-analysis was performed, and greater analytical weight was assigned to higher-quality evidence. Sample sizes of key studies ranged from ۶ to ۶۰ infants. Findings Developmentally supportive positioning was associated with improved oxygen saturation (SpO۲), reduced heart rate (HR) fluctuations, fewer apnea/bradycardia episodes, and enhanced quiet sleep. Semi-elevated side-lying during bottle-feeding improved milk intake and reduced respiratory pauses/choking episodes (small samples; n=۶-۲۰). Prone positioning under NICU monitoring improved oxygenation, reduced respiratory distress, and in some studies was linked to faster weight gain (occasionally not statistically significant in small samples). Daily KMC sessions ≥۹۰ minutes enhanced vital sign stability, reduced stress, improved sleep, and promoted weight gain, with emerging evidence suggesting modulation of skin and gut microbiome. Positioning aids (nesting, soft pads) were associated with higher SpO۲, lower HR, and reduced stress scores. Conclusion Therapeutic positioning and KMC are simple, low-cost interventions that enhance the quality of neonatal intensive care. Standardization of protocols, training for nurses and parents, and regular evaluation are recommended. Multicenter randomized controlled trials with adequate sample sizes are needed to confirm long-term benefits.

کلیدواژه ها:

Therapeutic Positioning ، Preterm Infants ، Neonatal Intensive Care Units ، Kangaroo Mother Care ، Bottle Feeding ، Suck-Swallow-Breathe Coordination