Comfort to the pre-and dysmature newborn in bed .
The difference between the freely back positioning and the supported back positioning in a moulder.

The 'Guideline Prevention of the Sudden Infant Death Syndrom' , which has been
achieved by the National Government Institution and and the 'Youth Health Care'
( 2009) has determined a statistic significant prove for the reduce of the
number of babies with Sudden Infant Death Syndrom
( SIDS). This measure prescribes , that all neonates, pre- and dysmature babies
included, have to be positioned in a freely supine position .
Besides to that, the advice has been given never to use loose particles and
tools like pillow-and towelnests, side-position pillows and toys in bed, which
has to be ment to support the baby.

After the publishing of the Guidelinde , however, a lot of babies show a lack
of comfort in the freely supine position These expressions of discomfort
manifest themselves as:
- autonomic reactions ( disregulation of heart/ lung , gastro/intestinal and
bloodcirculation )
- motor control ( dysregulation of the patterns, asymmetry and plagiocephaly )
- the 'state' ( a lack of sleep, cry-behaviour )
- awareness ( avoiding contact and a lack of interaction and a high
irritability ) ( consequences for the well-being of the parents, which possible
can lead tot unsafe circumstances between parents and baby .

The result of these reactions is that parents, caregivers and other persons an
organisations who are involved , such as district nurse- services,
children-physiotherapists, Extern Nursing Teams and Video Interaction Teams are
looking for a solution to achieve more comfort for the baby. Sometimes they
make a choice for old alternatives, like a loose towel-roll ( a nest ), a gel
and grainmattress and a side-position pillow. The utilazation of a cradle
-packet has been raised explosively since the Guideline of 2009.In a first view
a cradle-packet offers more comfort to the baby by his deep pressure (
Sensoric Integration ), but it is ineffective to the auto-regulation of the
baby; he's not capable to stay in a tucked ( foetus) position and not capable
to keep his hands near his face .

The objective of the study has the intention to prove that a pre-and dysmature
baby in a supported back-position, by the use of a controlled moulder, shows
more signs of comfort than a specific baby in a freely supine position.

We are basing ourselves on the assumption that a two and a half years of
experience with the use of a moulder shows an improved comfort of the baby .
However this positive experience has the need of a statistical prove.

From our information, calimities, such as spontaneously turning to a side -or
prone position of the baby within the moulder, didn't took place.
Evenso cases of emergency and Sudden Infant Death Syndrom didn't occur.

In case of statistic significance ( Evidence Based ) of the more -comfort of
the moulder, there is a need of a further development of this basic system in
cooperation with TNO, because the system of the moulder has to be tested on
safety-factors. The distribution of the moulder is in hands of the hosptitals
and District Care Authourities. In the future probably aterm babies are
considered for promotion to be positioned in a moulder in the first few weeks
after birth .. In this scenario there's a need of a different size..

Therapeutic Intervention

randomized control trial, open label and intervention caracter

- research group :40 babies in a moulder, supine position and hypotenuse supine
position ( left / right)
- control group: 40 babies in a freely supine position

Primary variable: Test of Infant Motor Performance (TIMP)

parents questionnairy = appendix ( 2 data, 2 identical questionnary's )

on behalf of the reasearchgroup : 40 moulders.

Presumable, the burden en risks are concerning the control-group : 40
participants in a freely supine positioning ( conform the Guideline Prevention
Sudden Infant Death Syndrom 2009 ) Signs of discomfort* K1
In this case, from ethical reasons, we offer the baby a moulder, as we should
do, originating from the experience in the foreign three years.
The criteria, which are decided seperately or combined :

- > 3 hours a day of crying
- Dysregulation of motor control, persistant asymmetry of posture and
movement, possibly accompanied with plagiocephalie
- bowelcramps and/ or reflux in between the feedings of the baby * (
Resarch Protocol )
- a combination as mentioned above