الفهرس 
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Abstract
Preterm neonates are more likely to develop anatomical or functional immaturity-related problems. Since they missed the womb’s muscle tone development, and because of their immaturity, they are more likely to have oral feeding problems. Therefore, they can not coordinate sucking, swallowing, respiration, and esophageal functions.Preterm neonates are still at risk for long-term behavioral issues and poor health despite medical advances. Early developmental supportive care improves the neurobehavioral development throughout this critical brain growing phase.
Hence, the developmental care techniques like nesting and swaddling can help preterm neonates to sleep better and cry less. It improves heart rate, respiratory rate, oxygen saturation, self-regulation during handling,saves energy,allows spine and limb flexion, promotes neutral posture postioning skills, maximizes preterm neonate’s stability, and helps faster weight gain. The aim of this study is to: Determine the effect of nesting and Swaddledposition on behavioral readiness and feeding progression of preterm neonates.
Materials and method
Settings: This study was conducted at the Neonatal Intensive Care Unit (NICU) of Kirkuk Pediatric Hospital in Iraq.
Subjects: A convenient sample of 80 preterm neonates whose gestational age < 37 weeks at birth, their birth weight was more than 1500 grams, and they were free from any congenital anomalies, especially those that interfere with feeding progression, neonatal sepsis, neurological problems, and congenital heart disease. They were randomly assigned to two equal groups. Each group comprises 40 preterm neonates: the control groupwere subjected to hospital routine care, and the study group were subjected to nesting and swaddling positions in addition to the hospital routine care.
Tools of data collection: Three tools were used to collect the necessary data:
Tool One: characterstics and Clinical Data of Preterm Neonates Assessment Record:-
This tool was used to assess the characteristics and the clinical data of preterm neonates.
Tool Two: Feeding Behavioral Readiness Skills Assessment Record
This tool was Used to assess a neonate’s early oral feeding behavioral readiness skills. It include two parts.
Part I: -Oral Feeding Behavioral Readiness Prior to Feeding.
Part II: -Oral Feeding Behavioral Readiness Skills During Feeding:
Which include:
Preterm neonates ability to maintain their engagement in feeding, their ability to organize oral-motor functioning, their ability to coordinate swallowing, and their ability to maintain physiologic stability.
Tool Three: Preterm Neonates Feeding Progression Assessment Record:
This tool was Used to assess preterm neonate’s feeding progression. It include theamount of consumed milk during the study weeks and the weight of preterm neonates.
The researcher assessed oral feeding behavioral readiness and feeding progression during feeding through four consecutive weeks in the morning and in the evening.
The Data were fed to the computer and analyzed by using IBM SPSS software package version 20.
The main results obtained were as follow:
a. Socio-demographic characteristics
• Almost less than half of preterm neonates ( 47.5%) of preterm neonates in the study group had 36 weeks of gestation, compared to (40%) of preterm neonates in the control group.
• Males constituted (52%) of preterm neonates in the study group and (60%) in the control group.
• Two-thirds (60%) and (62.5%)of preterm neonates were delivered by caesarean section in the study and in the control groups, respectively.
• Half of preterm neonates (52.5%) in the study group had respiratory distress syndrome compared to two third (65%) in the control one.
• Statistical significant differenceswere reveaiedwithin the two groups regarding the preterm neonatesoral feeding behavioral readiness prior and during feeding.
• For oral feeding behavioral readiness skills during feeding,there were statisticalsignificant differences between the two groups regarding preterm neonates ability to maintain their engagement in feeding, their ability to organize oral-motor functioning, their ability to coordinate swallowing, and their ability to maintain physiologic stability.
• None of the preterm neonates used a pacifier prior to feeding in the first week for both groups, It was regarded that (100%) in the study group compared to (67.5%) in the control group used a pacifier prior to feeding.Thereforethere was statistical significant differencesfound (p <0.001).during the fourth week.
• None of preterm neonates had rooting reflex before feeding and during the first week found among both groups. The preterm neonates rooting reflex completely progressed to (100%) in the study group compared to (60%) in the control group. during the fourth week as there was statistical significant differences found(p <0.001).
• Sucking reflex was absent for the preterm neonates prior to feeding during the first week in both groups, their sucking reflex improved to (87.5%)of them in the study group compared to (57.5%)in the control group by the fourth week.
• None of the preterm neonates exhibit a tongue-descending reflex prior to feeding in the first week among both groups. Those preterm neonates tongue-descending reflex progressed by the fourth week (to 87.5%)compared to (57.5%) among the study and the control groups, respectively. There were statistical significant differences found (p= 0.003) during the fourth week.
• The Majority of preterm neonates had more sleep and less crying (65%)in the study group compared to only a third of them(32%) in the control group prior to and during feeding.
• Two-thirds (62.5%)of preterm neonates maintain a flexed body position, compared to only one third of them(30%) in the control group prior to and during feeding
• There was improvement in the ability of preterm neonates to organize oral-motor functioning and coordinate swallowing in the study group compared to the control group by the fourth week during feeding.
• The Majority of preterm neonates had the ability to maintain physiological stability (87.5%)such as oxygen saturation, heart rate, stopping sucking to breathe, respiratory rate, and behavioral state cues in the study group compared to half of them(50%) in the control group during feeding.
• The mean weekly weight progress for the study group was (312.87 ± 53.05)compared to (194.50 ± 20.37)among the control group. The difference in weight was statistical significant(p <0.001).
• None of preterm neonates were able to consume (150 ml)of milk during the first week among the study and the control groups. Their abilityto consume (150 ml)of milk reached to (40%) among the study group compared to (5%) among the control one during the fourth week. It was found that there was a statistical significant difference regarding the amount of milk consumed for both groups in respect to the first and fourth weeks (p<0.001).
• Conclusion
Based on the finding of the present study results, it can be concluded that:
Preterm neonates who are supported by nesting and swaddledposition exhibit organized behavioral readiness regarding their oralebehavioral cuse, general state, their ability to maintain engagment in feeding, as well as to organize oral-motor functioning, coordinate swallowing and to maintain physiological stability, prior and during feeding than those who do not. Moreover, they exhibit more feeding progression, weight gain and increses amount of consumed milk than those without positioning.
The main recommendations included the following:
Based on the findings of the present study it is recommended that:
1- Conduct a similar study with a larger sample size.
2- Improve the understanding and the practice of NICU nurses regarding the developmental supportive positioning, and the educational programs.
3- Focus on future studies that emphasize the difference between the effect of nesting and the effect of swaddling on behavioral readiness and feeding progression.
4- Concentrate on the long-term effects of nesting and swaddling on preterm neonates’ musculoskeletal, neurobehavioral development, and requirement for physical therapy in future researches.
5- Place a strong emphasis on the significance of using the nesting position and the swaddling for all preterm neonates that are being cared for in NICUs as a regular form of developmental care.