Neuromotor development and the physiologic effects of positioning in very low birth weight infants

The objective of this work was to provide a comprehensive literature review of neuromotor development and related physiologic effects of positioning in very low birth weight infants. MEDLINE, CINHAL, Health Star, Current Contents, and the Australian Medical Index (1966-2000) databases were searched. Unpublished studies (e.g., dissertations, conference proceedings) and all relevant references listed in articles also were examined. One hundred and eighty theoretical writings, research studies, and clinical papers related to neuromotor development, the physiologic effects of positioning, and interventions to minimize or prevent short- and long-term effects of positioning in very low birth weight infants were reviewed. Studies were assessed for scientific rigor, evidence of theoretical foundation, and clinical relevance. Comparisons were made across data sources to determine the most reliable, valid, and consistent findings. Three compelling results emerged: (a) The development of posture and mobility in newborn infants requires an optimal balance between active and passive muscle tone, (b) the prone position is physiologically more beneficial for the preterm infant than supine and lateral positions, and (c) the prone position can lead to short- and long-term postural and associated developmental problems. The conclusion of this study is that use of empirically tested postural interventions appropriate for an infant's gestational age, health status, and overall organizational capacity is recommended