The Effects of Different Nursing Positions During Preterm Infants Feeding on Gastric Residual Volume and Emptying Rate: A Systematic Review and Network Meta-Analysis

Abstract

Background and objectives: Preterm infants need nutritional support due to their premature digestive system, undeveloped anatomy and functional limitations. Neonatal positioning in the proper position is one of the nurses' main principles that affect the residual volume. We performed our systematic review and network meta-analysis to determine the best feeding position for preterm infants in reducing gastric residual volume and increasing the rate of gastric emptying.

Methods: We systematically searched PubMed, Cochrane, CINHAL, Scopus and Web of Science from their inception to August 2023. We included studies that assess the effect of different feeding positions for preterm infants on gastric residuals. The Cochrane risk of bias tool (ROB2) appraised the included clinical trials. Cohort studies were assessed by the NIH tool and quasi-experimental studies by the relevant items from (Downs and Black) checklist. RevMan Version 5.4 was used for analysing the pooled data. Our study included a frequentist network meta-analysis of the aggregate data to obtain network estimates for the outcomes of interest. Network meta-analysis was done using R software.

Results: We included 16 studies with 1139 premature infants, comparing six preterm feeding positions. The pooled MD and 95% CI for GRV at 30 min for right lateral, prone, right anterior oblique and left lateral compared to supine position were as follows: (-12.08 [-20.09, -4.07]), (-11.14 [-18.26, -4.01]), (-9.02 [-21.66, 3.61]) and (-0.18 [-7.87, 7.5]), respectively. Moreover, the pooled MD and 95% CI for GRV at 180 min for right lateral, prone and left lateral compared to supine position were as follows: (-0.69 [-1.29, -0.09]), (-0.56 [-1.22, 0.1]) and (0.09 [-0.63, 0.81]), respectively. Nevertheless, the pooled MD and 95% CI for GRV at 120 min for right anterior oblique, prone, right lateral and left lateral compared to supine position were as follows: (-6.09 [-11.33, -0.86]), (-5.07 [-7.71, -2.43]), (-3.08 [-5.89, -0.27]) and (-0.44 [-3.41, 2.53]), respectively.

Conclusion: We concluded that the best nursing position after preterm infants feeding for lower gastric residuals and higher gastric emptying rate is the right lateral position after 30 and 180 min post-feeding. Also, the right anterior oblique was the best after 120 min. Although the prone position can lower the GRV better than the left lateral and supine positions, it is not advisable to use this position because it raises the SIDS risk. Our results could help healthcare professionals to provide the appropriate positioning of preterm infants.

Keywords: emptying rate; feeding position; gastric residual; meta‐analysis; preterm infants; systematic review.