Effect of swaddling during paladai feeding on bradycardia, desaturation and apnea among very low birth weight neonates

Background and Objective: Swaddling is a traditional practice of covering an infant in a blanket in a particular fashion. It is known to improve the physiological parameters. Paladai feeding is a common procedure in NICU. Paladai feeds are time consuming and are associated with desaturation episodes. The aim of the present study is to assess the effect of swaddling on bradycardia, desaturation and apnea during paladai feeding among very low birth weight infants. Materials and Methods: A cross over design with simple random sampling technique was used to select 58 very low birth weight infants who fulfilled the inclusion criteria. Infants were randomized to receive either swaddling or conventional technique of intervention during paladai feeding. Episodes of desaturation, bradycardia and apnea were calculated with the help of pulse oxymeter. Parameters like volume of feed, duration of feed were also recorded. A period of 24 hours was maintained as wash out period. The next day the infants were crossed over, infants in the swaddled group were non swaddled during paladai feeding and infants in non swaddling group were swaddled during paladai feeding and the same parameters were monitored and recorded. For analyzing the data, descriptive statistics (frequency, percentage, median, mean and standard deviation) and inferential statistics (McNemar test, and Wilcoxon signed rank test) were used. All the statistical analyses were carried out at 5% level of significance and p value < 0.001 was considered as significant. Results: Comparison of episodes of desaturation showed that the mean saturation episodes in swaddled and non-swaddled group were 0.90(1.518) and 1.66(1.763) respectively and the difference in the group were statistically significant (p<0.001). Comparison of Mean episodes of bradycardia among swaddled and non-swaddled group were 0.07(0.256) and 0.22(0.650) respectively. The difference was not statistically significant as a few episodes of bradycardia were found in both groups but swaddled infants had fewer episodes of bradycardia during paladai feeding. No apneic episodes were noted in both the groups during the study. Comparison of mean duration of feeding in swaddled and non-swaddled groups were 3.79(1.587) and 4.81(2.180) respectively and the difference was statistically significant (p<0.001). The study showed that paladai feeds were associated with desaturation and bradycardia and swaddled infants were found to have fewer episodes of desaturation, bradycardia and reduced duration of feeding. Conclusion: The study concluded that swaddling is an effective intervention in reducing the episodes of desaturation and bradycardia during paladai feeding. Also swaddled infants were found to take lesser time duration for paladai feeding.