The effects of white noise and swaddling methods on orogastric tube insertion-related pain in preterm infants: A randomized controlled trial.

AIM: This study aims to investigate the effects of the white noise, swaddling and white noise + swaddling methods on pain and physiological parameters associated with orogastric tube insertion procedure. METHODS: This was a randomized controlled trial. A total of 132 preterm infants were randomly assigned to four groups as white noise group (n = 33), swaddling group (n = 33), white noise + swaddling group (n = 33) and control group (n = 33). Interventions were initiated 5 min before the orogastric tube insertion procedure and continued during and up to 5 min after the procedure. RESULTS: White noise intervention alone did not have a significant effect on reducing pain associated with orogastric tube insertion (p > 0.05). Compared with the control group, the preterm infants in the swaddling group experienced 0.587 times less pain, and those in the white noise + swaddling group experienced 0.473 times less pain. CONCLUSIONS: Findings indicate the swaddling and the combination of white noise + swaddling may be a useful intervention in reducing the invasive pain experienced by preterm infants during and after orogastric tube insertion and in improving the physiological parameters associated with pain.

The effect of the swaddling method on stress levels in newborns administered nasal CPAP.

BACKGROUND: This study aims to investigate the effects of the swaddling method on the stress levels in newborns receiving nasal continuous positive airway pressure (nCPAP). METHODS: The study was conducted between 1 June 2022 and 1 October 2022 with 40 newborns who underwent nCPAP in the second-level Neonatal Intensive Care Unit (NICU) of a city hospital in the Central Anatolia Region of Turkey. Data were collected using a descriptive form, including the characteristics of newborns, a patient follow-up chart, and the Newborn Stress Scale (NSS). The descriptive form, the patient follow-up chart, and the NSS were completed by the researcher 30 min after the nCPAP was started and the first saliva sample was taken. The patient follow-up chart and NSS were completed 30 min after applying the swaddling method and the second saliva sample was collected. The data were analyzed using IBM SPSS Statistics 25.0 package software and presented with number, percentage, mean, standard deviation, min-max, and t-test. RESULTS: The study found that the mean score of the NSS after the intervention (3.52 ± 2.57) was lower than that before the intervention (10.02 ± 2.05) (p < 0.05). The mean saliva cortisol levels of the newborns after the intervention (4.99 ± 1.89) were lower than before the intervention (5.51 ± 1.65) (p < 0.05). The mean heart (135.50 ± 14.15) and respiratory rates (68.07 ± 10.16) of the newborns after the intervention were lower than those before the intervention (140.82 ± 18.11; 72.95 ± 9.06, respectively) (p < 0.05). There was no difference between the mean oxygen saturation of newborns before and after the intervention (p > 0.05). CONCLUSIONS: The study showed that the swaddling method played a role in reducing the stress levels in newborns who underwent nCPAP. It is recommended that randomized controlled trials examining the effect of swaddling on the stress levels of newborns who underwent nCPAP be conducted.

The effect of swaddling method applied to preterm infants during the aspiration procedure on pain.

PURPOSE: The study was carried out to determine the effect of the swaddling method on pain in preterm infants (between 27 and 36 weeks) hospitalized in the Neonatal Intensive Care Unit during the aspiration procedure. Preterm infants were recruited by convenience sampling from level III neonatal intensive care units in a city in Turkey. METHOD: The study was conducted in a randomized controlled trial manner. The study consisted of preterm infants (n = 70) receiving care or treatment at a neonatal intensive care unit. While swaddling was applied to the infants in the experimental group before the aspiration process. The pain was assessed before, during, and after the nasal aspiration using the Premature Infant Pain Profile. RESULTS: No significant difference was found in terms of pre-procedural pain scores whereas a statistically significant difference was detected in terms of pain scores during and after the procedure between the groups. CONCLUSION: It was determined in the study that the swaddling method reduced the pain of the preterm infants during the aspiration procedure. IMPLICATIONS FOR PRACTICE: This study emphasized that swaddling had pain-reducing during the aspiration procedure in the neonatal intensive care unit in preterm infants. It is recommended that future studies be conducted using different invasive procedures in preterm infants born earlier.

Efficacy of Skin-to-Skin Care versus Swaddling for Pain Control Associated with Vitamin K Administration in Full-Term Neonates: A Randomized Controlled Trial.

OBJECTIVE: The objective of the study was to assess the efficacy of immediate skin-to-skin care (SSC) versus swaddling in pain response to intramuscular injection of vitamin K at 30 min of birth in neonates. METHODS: Healthy full-term newborns were enrolled immediately after normal vaginal delivery and randomized in two groups, SSC and swaddling. Neonatal Infant Pain Scale (NIPS) was measured before, immediately after and at 2 min after the injection. RESULTS: Total 100 newborns were enrolled in the study (50 in each group). The mean (SD) birth weight of newborns in the SSC and swaddling group was 2668 (256) and 2730 (348) g, respectively. NIPS was comparable between the SSC and swaddling at before [1.78 (0.58) vs. 1.96 (0.83), p = 0.21], and immediately after the injection [4.82 (0.72) vs. 5.08 (0.75), p = 0.08]. NIPS at 2 min after the injection was significantly low in the SSC group compared to the swaddling group [1.38 (0.70) vs. 2.88 (1.00), p < 0.001]. At 2 min after injection, the NIPS score was significantly lower than baseline in the SSC group (p = 0.002), while it was significantly higher in the swaddling group (p < 0.001). A significantly higher proportion of newborns had a NIPS score of more than three at 2 min after injection in the swaddling group as compared to the SSC group (22% vs. 2%, p < 0.001). CONCLUSION: Immediate SSC was more efficacious as compared to swaddling as a pain control intervention while giving vitamin K injection. CLINICAL TRIAL REGISTRATION: The trial is registered with the Clinical Trial Registry of India with Registration number: CTRI/2020/01/022984.

Skin-to-skin care and swaddling are commonly used non-pharmacological measures to reduce pain perception in neonates for invasive procedures like heel prick, venipuncture and vaccination. We did this randomized control trial to compare the efficacy of immediate skin-to-skin care after birth vs. swaddling for reducing neonatal pain associated with intramuscular injection of vitamin K at 30 min after birth. We observed that the immediate skin-to-skin care, a standard of care, is more efficacious in controlling pain compared to swaddling for giving routine intramuscular vitamin K injection within one hour of birth.

The effect of three different methods applied during peripheral vascular access in prematures on pain and comfort levels.

PURPOSE: This research was carried out to determine the influence of kangaroo care, fetal position, and swaddling on pain and comfort levels in preterm infants during peripheral vascular access. DESIGN AND METHODS: The study was conducted as a randomized experimental study with a control group. It included 148 premature infants (kangaroo group = 37, swaddling group = 37, fetal position = 37, control group = 37) of 32-37 weeks of age who had peripheral vascular access in the NICU of a state hospital in eastern Turkey between December 2019 and June 2020. While the infants in the experimental group received kangaroo care, fetal position, and swaddling procedures during and after peripheral vascular access, the infants in the control group received conventional peripheral vascular access without extra intervention. "Newborn Infant Pain Scale (NIPS)" and "Premature Infant Comfort Scale (PICS)" were used to collect data. Data were analyzed using percentile, chi-square and ANOVA tests. RESULTS: Further analysis revealed that the fetal position was the most beneficial intervention for reducing NIPS scores and boosting PICS scores during and after peripheral vascular access in the experimental groups, followed by kangaroo care and lastly swaddling. CONCLUSION: It was discovered that kangaroo care, fetal position, and swaddling were useful in lowering discomfort and boosting comfort levels in premature infants during and after peripheral vascular access. PRACTICE IMPLICATIONS: Kangaroo care, fetal position and swaddling methods can be used in clinical practice in order to reduce the pain level and increase the comfort level during and after peripheral vascular access in prematures.

Traditional Mongolian swaddling and developmental dysplasia of the hip: a randomized controlled trial.

BACKGROUND: Mongolian traditional swaddling of infants, where arms and legs are extended with a tight wrapping and hips are in adduction position, may lead to abnormal maturation and formation of the hip joint; and is a contributing factor for developmental dysplasia of the hip (DDH). This hypothesis was tested in this randomized controlled trial. METHODS: Eighty newborns with one or two hips at risk of worsening to DDH (Graf Type 2a; physiologically immature hips) at birth were randomized into 2 groups at a tertiary hospital in Ulaanbaatar. The "swaddling" group (n = 40) was swaddled in the common traditional Mongolian method for a month while the "non-swaddling" group (n = 40) was instructed not to swaddle at all. All enrollees were followed up on monthly basis by hip ultrasound and treated with an abduction-flexion splint if necessary. The groups were compared on the rate of Graf's "non-Type 1" hips at follow-up controls as the primary outcome. Secondary outcomes were rate of DDH and time to discharge (Graf Type 1; healthy hips). In addition, correlation between the primary outcome and swaddling length in days and frequency of swaddling in hours per day were calculated. RESULTS: Recruitment continued from September 2019 to March 2020 and follow-up data were completed in June 2020. We collected final outcome data in all 80 enrollees. Percentages of cases with non-Type 1 hip at any follow-up examination were 7.5% (3/40) in the non-swaddling group and 40% (16/40) in the swaddling group (p = 0.001). There was no DDH case in the non-swaddling group while there were 8 cases of DDH in the swaddling group. The mean time to discharge was 5.1 ± 0.3 weeks in the non-swaddling group and 8.4 ± 0.89 weeks in the swaddling group (p = 0.001). There is a correlation between the primary outcome and the swaddling frequency in hours per day (r = 0.81) and swaddling length in days (r = 0.43). CONCLUSIONS: Mongolian traditional swaddling where legs are extended and hips are in extension and adduction position increases the risk for DDH. TRIAL REGISTRATION: Retrospectively registered, ISRCTN11228572 .

Changes in autonomic regulation due to Kangaroo care remain unaffected by using a swaddling device.

AIM: To investigate the effects of a swaddling device known as the Hugsy (Hugsy, Eindhoven, the Netherlands) towards improving autonomic regulation. This device can be used both in the incubator and during Kangaroo care to absorb parental scent and warmth. After Kangaroo care, these stimuli can continue to be experienced by infants, while in the incubator. Additionally, a pre-recorded heartbeat sound can be played. METHOD: Autonomic regulation was compared in preterm infants before, during and after Kangaroo care with and without the use of a swaddling device in a within-subject study carried out in a level III neonatal intensive care unit. Descriptive statistics and effect sizes were calculated corresponding to changes in heart rate, respiratory rate, oxygen saturation, temperature and heart rate variability on intervention versus control days. RESULTS: In this study of 20 infants with a median (interquartile range) gestational age of 28.4 (27-29.9) weeks, Kangaroo care was associated with a decrease in heart rate, respiratory rate and heart rate variability on both intervention and control days. There were no differences between intervention and control days. CONCLUSION: The use of an alternative swaddling device aimed at facilitating Kangaroo care did not enhance autonomic regulation, as measured by vital signs and heart rate variability.

When alternative female Kangaroo care is provided by other immediate postpartum mothers, it reduces postprocedural pain in preterm babies more than swaddling.

AIM: Research on alternative female Kangaroo care (KC) has been hampered by high maternal refusal rates. We assessed the efficacy of Kangaroo mother care (KMC), alternative KC provided by other postpartum mothers and swaddling for postprocedural pain relief in preterm babies. METHODS: The study was carried out in a tertiary armed forces hospital, where mothers did not have support from other female relatives and other postpartum mothers agreed to act as alternative female KC providers. We exposed 51 stable preterm neonates, with a gestational age of 30-36 weeks, to KMC, alternative female KC and swaddling for 30 minutes before heel lancing. The outcome measures included the Preterm Infant Pain Profile (PIPP) scores at 30 seconds and the time taken for the heart rate to return to baseline. RESULTS: The mean PIPP scores were lower with KMC (10.59) and alternative female KC (11.24) than swaddling (12.96) and heart rate normalisation took 111, 117 and 149 seconds respectively. The p values were <0.001 for individual groups and outcomes. KMC fared better than alternative female KC for both pain (p = 0.045) and heart rate (p = 0.013). CONCLUSION: Providing KMC and alternative female KC before heel lancing resulted in better pain relief than swaddling.

Swaddling and Infant Sleeping Practices.

Swaddling promotes quiet sleep and may be a useful strategy to encourage infant safe sleep practices. We explored the effect of a swaddling education intervention on infant sleep practices in an urban minority community. We compared a cohort of postpartum mothers who were given education about swaddling to a historical group. Breastfeeding and pacifier use were similar in both groups. Compared to the historical group (n = 121), mothers in the swaddling group (n = 40) were more likely to swaddle infants to sleep (52.5 vs. 23.1 %, p = .001) and less likely to bedshare (15.4 vs. 33.1 %, p = .042). No significant effect was reported on infant supine sleep (81.6 vs. 69.4 %, p = .212). A postpartum swaddling education intervention had a limited impact on infant safe sleeping practices in an urban minority community. A recent metaanalysis demonstrated an increased risk of sudden infant death in infants swaddled for sleep and recommended the need to avoid the prone and side sleep position, especially for swaddled infants, and to set an age and developmentally appropriate limit for the use of swaddling. Ongoing studies are needed to monitor the safety and effectiveness of swaddling as a tool to promote safe sleeping in infants.

Effect of Expressed Breast Milk versus Swaddling versus Oral Sucrose Administration on Pain Associated with Suctioning in Preterm Neonates on Assisted Ventilation: A Randomized Controlled Trial.

OBJECTIVE: The objective of our study was to assess the pain associated with suctioning in preterm neonates on assisted ventilation and comparing the use of expressed breast milk (EBM), sucrose, and swaddling to alleviate pain. METHODS: Study design: A randomized controlled clinical trial. INCLUSION CRITERIA: Preterm neonates on assisted ventilation. EXCLUSION CRITERIA: Major congenital anomalies and severe encephalopathy. STUDY DURATION AND SITE: 6 months in level III neonatal Intensive Care Unit. In the first phase, we used premature infant pain profile (PIPP) score to assess pain associated with suctioning in preterm neonates on assisted ventilation. In the second phase, the effect of EBM, swaddling, and sucrose on pain relief during suctioning in neonates on assisted ventilation was assessed. RESULTS: There was a significant increase in pain associated with suctioning in preterm neonates on assisted ventilation (preprocedure PIPP score 7.90 ± 2.50; procedural PIPP score 13.63 ± 2.57; P < 0.05). The postintervention mean procedural PIPP score was not significantly different between the EBM, swaddling, and sucrose groups (P = 0.24). CONCLUSIONS: Suctioning is painful for preterm neonates on assisted ventilation. There was no difference between EBM, swaddling, and sucrose in relieving pain associated with suctioning.

A feasibility and efficacy randomised controlled trial of swaddling for controlling procedural pain in preterm infants.

AIMS AND OBJECTIVES: This study aimed to investigate the feasibility and efficacy of swaddling to control procedural pain among preterm infants. BACKGROUND: Swaddling has been recommended for controlling neonatal pain. However, the feasibility for use is uncertain and insufficient evidence is available among preterm infants. DESIGN: A two-arm randomised controlled trial with repeated measures. METHOD: The study was conducted in a 21-bed neonatal intensive care unit of a regional hospital in Hong Kong. Preterm infants who required heelstick procedure were eligible. Fifty-four preterm infants between 30-37 gestational weeks were randomly assigned to swaddling (n = 27) and control (standard care, n = 27) groups. Pain assessment was performed pre, during, immediate, two, four, six and eight minutes after heelstick procedure using the Premature Infant Pain Profile. RESULTS: The mean Premature Infant Pain Profile scores were significantly reduced in the intervention group compared to the control group during, immediate, two, four, and six minutes after the heelstick procedure. The mean changes of heart rate and oxygen saturation in the intervention group were significantly lower than that of the control group at all measured time points. Notably, the swaddled infants quickly resumed to the baseline level at two minutes whereas the control group reached the stable state at an extended period of six minutes. CONCLUSION: The findings show that swaddling is feasible and efficacious in controlling pain for heelstick procedure among preterm infants. No adverse effects were observed. RELEVANCE TO CLINICAL PRACTICE: This article presents the feasibility and efficacy of swaddling as a non-pharmacological and non-invasive intervention to relieve pain during the heelstick procedures among preterm infants. Swaddling can contribute to control minor procedural pain in neonates as one of the simple, safe, cost effective, humanistic and natural analgesia alternatives.

Comparing the effect of swaddling and breastfeeding and their combined effect on the pain induced by BCG vaccination in infants referring to Motahari Hospital, Jahrom, 2010-2011.

BACKGROUND AND AIM: Despite the clinical importance of pain, many neonates are subjected to numerous painful invasive procedures and their complications as part of their care. This study has been designed to investigate the effect of swaddling and breastfeeding, and their combined effect on the pain induced by BCG vaccination in healthy term infants. METHOD: This randomized double-blind intervention study was performed on 131 healthy term neonates in Motahari Hospital of Jahrom. The samples were randomly assigned into three intervention groups and a control group. The infants in the swaddled group were swaddled 2 minutes before and 2 minutes after vaccination. The infants in the breastfed group were breastfed within 45 minutes before vaccination. The infants in the combination group were both breast fed before and swaddled within vaccination but the infants in the control group were vaccinated without any intervention. Heart rate and oxygen saturation level of neonates were recorded in the 3 phases of: baseline, injection and 2 minutes after injection. Furthermore, the neonates' faces were recorded using a video camera. Then pain intensity was measured by Neonatal Facial Coding System (NFCS). Mean Score of pain intensity and physiological responses of subjects were statistically analyzed using non parametrical Kruskal-Wallis test and Mann-Whitney. RESULTS: The mean of pain intensity (NFCS) and changes in the heart rate at injection time to the baseline in the three intervention groups in comparison with the control group showed statistically significant difference (p=0.003 and p=0.002 respectively). However changes in blood oxygen saturation level, were not statistically significant difference between four groups. CONCLUSION: Regarding to the significant impact of both breastfeeding and swaddling on the pain reduction of vaccination, it is recommended to take benefit of these two safe and available non-pharmacological methods in order to relief pain during painful procedures.

Efficacy of swaddling and heel warming on pain response to heel stick in neonates: a randomised control trial.

AIMS AND OBJECTIVES: To determine the efficacy of swaddling and heel warming on pain response in neonates following heel stick. BACKGROUND: Swaddling has been suggested to reduce pain response in neonates during heel stick. Heel warming is also often performed for drawing blood easily before heel stick. However, the efficacy of both on pain response is unclear. DESIGN: A randomised controlled study was used. METHODS: Twenty-five neonates were randomly assigned to each of the control, swaddling and heel-warming groups. Heart rate, oxygen saturation Neonatal Infant Pain Scale and duration of crying were used to assess pain reactivity and pain recovery. A greater heart rate and Neonatal Infant Pain Scale increase, or oxygen saturation decrease, indicated higher pain reactivity. A longer duration of heart rate and oxygen saturation changes after heel stick back to baseline indicated a longer pain recovery. RESULTS: The decrease in oxygen saturation in swaddling group was significantly greater than that in heel-warming group. The increase in the Neonatal Infant Pain Scale in control group was significantly higher than that in swaddling group. The heart rate recovery time in control group and swaddling group was significantly longer than that in heel-warming group. The oxygen saturation recovery time in control group was significantly longer than that in heel-warming group. The duration of crying in control group was significantly longer than those in swaddling group and heel-warming group. CONCLUSION: Both swaddling and heel warming decreased the pain response of neonates during heel stick. Heel warming resulted in a lower pain response than did swaddling for neonates, particularly in terms of pain recovery. RELEVANCE TO CLINICAL PRACTICE: Heel warming could become a routine practice to decrease the pain response of neonates during heel stick.

Influence of the chest wall on respiratory function at birth in near-term lambs.

Airway liquid is cleared into lung tissue after birth, which becomes edematous and forces the chest wall to expand to accommodate both the cleared liquid and incoming air. This study investigated how changing chest wall mechanics affects respiratory function after birth in near-term lambs with different airway liquid volumes. Surgically instrumented near-term lambs (139 ± 2 days) were randomized into Control (n = 7) or Elevated Liquid (EL; n = 6) groups. Control lambs had lung liquid drained to simulate expected volumes following vaginal delivery. EL lambs had airway liquid drained and 30 mL/kg liquid returned to simulate expected airway liquid volumes after elective cesarean section. Lambs were delivered, transferred to a Perspex box, and ventilated (30 min). Pressure in the box was adjusted to apply positive (7-8 cmH2O above atmospheric pressure) or negative (7-8 cmH2O below atmospheric pressure) pressures for 30 min before pressures were reversed. External negative pressures expanded the chest wall, reduced chest wall compliance (CCW) and increased lung compliance (CL) in Control and EL lambs. External positive pressures compressed the chest wall, increased CCW and reduced CL in Control and EL lambs. External negative pressure improved pulmonary oxygen exchange, reducing the alveolar-arterial difference in oxygen (AaDO2) by 69 mmHg (95% CI [13, 125]; P = 0.016) in Control lambs and by 300 mmHg (95% CI [233, 367]; P < 0.001) in EL lambs. In contrast, external positive pressures impaired pulmonary gas exchange, increasing the AaDO2 by 179 mmHg (95% CI [73, 285]; P = 0.002) in Control and by 215 mmHg (95% CI [89, 343]; P < 0.001) in EL lambs. The application of external thoracic pressures influences respiratory function after birth.NEW & NOTEWORTHY This study investigated how changes in chest wall mechanics influence respiratory function after birth. Our data indicate that the application of continuous external subatmospheric pressure greatly improves respiratory function in near-term lambs with respiratory distress, whereas external positive pressures impair respiratory function. Our findings indicate that, during neonatal resuscitation at birth, the forces applied to the chest wall should not be ignored as they can have a major impact on neonatal respiratory function.

Comparison of the Effect of Nesting and Swaddling on Sleep Duration and Arousal Frequency among Preterm Neonates: A Randomized Clinical Trial.

Introduction: Sleep contributes a pivotal part in neurological improvement of new borns. New-borns admitted to neonatal intensive care unit (NICU) perceive many sounds of monitors and this disturb their rest period. To enhance the sleep duration of neonates many non-pharmacological methods are available like placing newborn in a nest made with rolled cotton bed sheet and wrapping the baby with white cotton cloth. In this research effect of these two positions were assessed. Methods: A randomized clinical trial was carried out on 76 preterm neonates in NICU of a tertiary care center. Neonates were included in the study by random method. Sleep duration and frequency of arousal was assessed through direct observation. Physiological parameters were assessed by using cardiac monitor. The information collected were analyzed using SPSS version 21. Results: Sleep duration of nesting group showed significantly higher than swaddling group, which mean (SD) was 206.4 (28), 183.1 (34.78) minutes, respectively. Additionally, waking up was observed less frequency in the nesting group. Conclusion: Nesting enhances the duration of sleep among preterm neonates and hence this can be given priority in NICU.

Care Practices of Indian Pediatricians for the Screening and Diagnosis of Developmental Dysplasia of the Hip.

Pediatricians play a key role in identifying neonates with hip instability or at risk for developmental dysplasia of the hip (DDH); however, the clinical practices related to screening and further management in India are unknown. A web-based survey was circulated to members of the National Neonatology Forum of India (NNFI). Of the 231 eligible responses, about 92% were from an urban setup. It was noted that 38% (88/231) had not diagnosed any DDH in the past 12 mo, 8% (17/224) had diagnosed cases beyond walking age, 50% (116/231) would pursue further evaluation in children < 3 mo with risk-factors and normal hip exam, 53% (122/229) were aware of hip-safe swaddling, 30% (68/226) were comfortable with performing Ortolani and Barlow maneuvers and < 50% (107/226) were aware of the current guidelines for the management of DDH. Almost all respondents (97.3%, 220/226) felt a need for a DDH care pathway for screening and early management in India. Thus, substantial deficits and variability in screening practices for DDH amongst pediatricians in India.

Knowledge and Practices Related to Hip-Healthy Swaddling for Newborns Among Maternity Nurses.

OBJECTIVE: To assess the self-reported knowledge, education, and practices related to hip-healthy swaddling of newborns among nurses, how they teach this technique to parents, and the relationships among these factors. DESIGN: Descriptive cross-sectional exploratory survey. SETTING: Academic women and children's hospital with an average of 4,500 annual births. PARTICIPANTS: One hundred four registered maternity nurses who work primarily in the maternity unit. METHODS: At three staff meetings, we surveyed maternity nurses to determine their knowledge, education, and practices related to hip-healthy swaddling and how they teach this technique to parents. We analyzed results using descriptive statistics and chi-square and Fisher's exact tests. RESULTS: Of the 156 nurses in the maternity unit, 104 attended three staff meetings and completed the survey. Among the participants, 18.9% (18/95; 9 participants did not respond) were unable to identify the correct hip swaddling position. Overall, 64.2% (61/95; 9 participants did not respond) reported that they received education on general swaddling technique, yet 14.8% (9/61) of these participants were unable to identify the correct hip-healthy swaddling position. Among the participants, 99.0% (103/104) reported that nurses teach parents how to swaddle infants rather than other health care providers; 12.5% (13/104) of participants responded that medical doctors provide training as well. Overall, 67.0% (69/103; 1 participant did not respond) reported that they taught parents in >75% of parent interactions. CONCLUSION: Our results illustrate a gap in knowledge about hip-healthy swaddling among the maternity nurses who participated in this survey and a need for further education.

Influence of swaddling on tactile manual learning in preterm infants.

BACKGROUND AND AIM: Swaddling is a well-known technique in developmental care programs as there is some evidence that swaddling is an appropriate stress-reducing method for preterm infants in the NICU. However, no experimental study has investigated the influence of swaddling in a learning context. This study aimed to assess the impact of swaddling on tactile manual abilities in preterm infants. METHODS: Two phases were introduced for all infants: habituation (successive presentation of the same object, prism or cylinder in the left hand), followed by discrimination (presentation of a new-shaped object). The infants were assigned to one of the two conditions (swaddled; non-swaddled). RESULTS: Forty preterm infants were included (between 28 and 35 weeks' postconceptional age). First, swaddled and non-swaddled infants exhibited similar tactile habituation abilities. However, all infants needed more time and more trials to habituate to the cylinder than to the prism. Second, they all exhibited an effective discrimination, but the importance of the increase in holding time for the new-shaped object varied according to the habituated-shape and the condition. Moreover, stress intensity was higher in non-swaddled infants during tactile exploration. Finally, infants with greater previous swaddling experience during the week preceding the test took more time and more trials to habituate to the object, regardless of the condition. CONCLUSION: Swaddling preterm infants during sensory learning did not influence the tactile memorization process but would improve the use of their attentional resources. Swaddling seems to provide favorable conditions for sensory learning by improving attention to tactile stimuli. CLINICAL TRIAL REGISTRATION: This trial, EMMASENS, has been registered at www.clinicaltrials.gov (identifier NCT04315428).

Developmental Dysplasia of Hip and Post-natal Positioning: Role of Swaddling and Baby-Wearing.

INTRODUCTION: Traditional swaddling, which implies restrictive immobilisation of the infant's lower limbs with the hips in forced extension and adduction, has been shown to be a risk factor for Developmental Dysplasia of Hip (DDH). METHODS: We reviewed the literature regarding the correlation between DDH and post-natal positioning by swaddling and baby-wearing, to draw awareness of healthcare professionals towards an important risk factor for DDH that has often been overlooked. RESULTS: There is overwhelming evidence in the literature, by both experimental and clinical studies, that proves the close association between improper post-natal positioning of the baby's hips in extension-adduction and an increased incidence of DDH. On the other hand, "hip safe" swaddling which allows unrestricted flexion-abduction movements of the infants' hips, and the use of baby-wearing devices which keep the lower limbs in an attitude of hip flexion-abduction and knee flexion, is optimal for hip development. Populations which practice these "hip-safe" techniques of infant immobilisation have a lower incidence of DDH as compared to those which practice restrictive immobilisation. Furthermore, populations which have adopted "hip-safe" positioning have demonstrated a significant decrease in the incidence of DDH. Understanding this association is vital, since this is a modifiable risk factor, rectification of which can decrease the incidence of DDH. CONCLUSION: Policy makers and governments must design educational campaigns tailored to their respective populations to increase awareness regarding the benefits of "hip-safe" techniques of infant positioning, since this simple intervention has the potential of decreasing the incidence of DDH.

Swaddling Practices in an Indian Institution: Are they Hip-Safe? A Survey of Paediatricians, Nurses and Caregivers.

PURPOSE: Traditional infant swaddling or binding with hips and knees extended is a known risk factor for Developmental Dysplasia of the Hip (DDH), while 'hip-safe swaddling' with hips and knees flexed is believed to eliminate this risk. We conducted a survey to determine the prevalent practices for infant swaddling in India; why mothers practice swaddling and who teaches them; and whether Paediatricians, nurses and caregivers are aware of hip-safe swaddling. METHODS: Anonymous one-time surveys were conducted in three groups-Paediatricians, Nurses and caregivers - at a tertiary-care, urban based, paediatric and maternity hospital. RESULTS: Forty-five paediatricians, 219 nurses and 100 caregivers were surveyed. Ninety percent caregivers practiced traditional swaddling, for on average 10.2 hours a day, starting soon after birth, up to 4.2 months of life. Traditional swaddling was advocated by 99% nurses and 53% Paediatricians. Reasons for swaddling included sleep, warmth and the misbelief that the child's legs would remain bowed if not bound straight; contrarily few mothers (8%) avoided swaddling out of superstition. Mothers learnt swaddling mainly from relatives (94%) and nurses (64%). Most nurses (70%) had learnt the practice during nursing training. Only 6.6% Paediatricians, 4% caregivers and 0% nurses were aware of 'hip-safe swaddling'. CONCLUSION: Traditional swaddling of infants is a practice deeply rooted in India, born out of misbeliefs, and propagated by lack of awareness. Training in hip-safe swaddling targeted at nurses and Paediatricians would be an effective initial step in creating awareness among mothers and changing their practices.