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Evidence-Based Practice Beliefs:Positioning After Feedings: What Is the Evidence to Reduce Feeding Intolerances?
Heather E. Elser MSN, RN, NNP-BC, CNS
Jacqueline McGrath

Advances in Neonatal Care
June 2012 
Volume 12  Number 3
Pages 172 - 175
  PDF Version Available!

Each feeding of a high-risk neonate is essential for growth and development. When feedings are disrupted because of feeding intolerance, nurses will often use positioning to enhance digestion1 and ward off unwanted radiographs, held feedings, and the nothing-by-mouth status. Most feeding intolerances result in gastroesophageal reflux (GER) and increased gastric residuals.2Gastroesophageal reflux occurs when gastric content reenters the esophagus from the stomach via a relaxed lower esophageal sphincter.3 It is predicted that more than half of all newborns experience GER during their first few months of life with premature infants at an even higher rate.3 Although GER is considered physiologically normal and is often described as wet burps in full-term infants, repeated GER episodes can result in a loss of significant caloric intake that high-risk infants cannot afford to miss.3In addition to GER, premature infants have a higher probability of episodes of reduced gastric motility due to decreased and uncoordinated gastrointestinal contractions.4,5 Reduced gastric motility may be identified when nasogastric tubes are checked for placement and feeding residuals are found prior to a feeding. In many cases, gastric residuals that exceed 25% to 50% of the entire previous total feeding draw concern for decreased gastric motility and can ultimately keep the infant from receiving current and possibly future feedings. Missed feedings potentially keep premature infants from achieving adequate growth and, if frequent, result in greater concern by care providers often leading to the infant becoming NPO (nothing by mouth) and requiring parenteral feedings.Positioning infants is a noninvasive, nonpharmacological intervention that originates from an understanding of human anatomy and nursing experience. Many nurses believe that positioning an infant on his or her right side is the ideal position to avoid feeding intolerance such as GER and increased gastric residuals. Yet, what is

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