Comparison of Three Nursing Positions for Reducing Gastric Residuals in Preterm Neonates: A Randomized Crossover Trial

ABSTRACT

Objective: To compare left lateral, right lateral, and pronenursing positions of neonate for reducing pre-feed gastricresiduals among ?34 weeks neonates.Design: Randomized crossover trial.Setting:Level-III NICU.Participants: Neonates ?34 weeks, receiving 50-150 mL/kg/day feeds through oro-gastric route.Intervention Neonates were randomized to left lateral, rightlateral and prone positions. Intervention position was given foreight hours (4 feeds, 9AM to 5PM) followed by a wash-off period of16 hours. After 24 hours, each neonate crossed over to nextposition as per randomization card to complete three positions inthree consecutive days. Gastric residuals were collected justbefore next feed.Main outcome:Pre-feed gastric residuals.Results:Sixty three neonates were randomized. Fewer neonatesin right lateral position had gastric residuals compared to leftlateral position [OR 0.09 (95% CI 0.04, 0.21), P<0.001]. Neonatesin right lateral and prone positions had comparable gastricresiduals [OR 0.90 (95% CI 0.36, 2.22), P=0.82]. Gastricresiduals, as a proportion of last feed, were highest in left lateral[6% (2, 10), maximum 28%] position. Significantly higherproportion of neonates in right lateral position had episodes ofregurgitation compared to other positions. Oxygen saturation,heart rate, time to full feeds and duration of hospital stay werecomparable in the three groups.Conclusions: Left lateral position was associated with higher butclinically non-significant pre-feed gastric residuals as comparedto right lateral position. Right lateral position was associated withsignificantly increased regurgitation episodes