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The latest evidence for practice

Una Adderley
Community Tissue
Viability Prescribing
Nurse

Does swaddling combined with a regular routine reduce excessive crying in healthy babies?
The crying of a tiny baby is one of the most stress-inducing noises and many techniques are recommended to comfort the child and thus calm the parents.  Swaddling of infants is a centuries-old technique that is believed to be comforting to the baby and promote restful sleep. However, the effectiveness of this intervention had not been robustly researched.
This Dutch randomised controlled trial studied whether healthy babies who received a regime of a regularised routine including stimulus reduction and swaddling cried less. A total of 398 babies aged 12 weeks and under, who were reported to cry excessively, were randomly allocated into two groups. All babies received a recurrent pattern of infant care from their parents, which consisted of a sequence of sleeping, feeding, positive interaction with the infant, and time with the infant awake and alone in a playpen. In addition to this, half the babies, upon signs of tiredness, were swaddled before being put to bed. The study found that adding swaddling to usual care did not reduce excessive crying.
A commentary notes that the results of this study contradict other studies that found that swaddling supported sleep continuity and reduced spontaneous arousal from quiet sleep.  However, it notes that the normal pattern of crying in infants is known to be worst in the first three months, peaking around six weeks and usually declining from around 12 weeks. Therefore in any trial of crying it is important to incorporate this knowledge in the trial design. In this trial, this age factor was evenly balanced across both arms of the trial and so is unlikely to have influenced the results, which suggest that swaddling is ineffective for reducing crying.

Reference
Van Sleuwen BE, L'Hoir MP, Englberts C, et al. Comparison of behaviour modification with and without swaddling as interventions for excessive crying. Paediatr 2006;149;512-7.
Commentary
Long T. Evid Based Nurs 2007;10:42.

Do support surfaces, nutritional supplements and topical agents help prevent pressure ulcers?
This systematic review sought randomised controlled trials that had evaluated interventions for preventing pressure ulcers. Fifty-one randomised controlled trials that had evaluated interventions for impaired mobility were found. These interventions included static mattresses, dynamic mattresses, rotating support surfaces, repositioning, exercise and incontinence care.
Several trials supported the use of static or dynamic mattresses and one trial supported turning patients every four hours. One trial supported nutritional supplementation and two trials supported the use of topical agents applied to sacral skin.
A commentary notes that although this review usefully includes some additional studies, the conclusions add little to existing knowledge with regard to the use of pressure redistributing equipment and nutrition. However, the additional focus on skin care highlights the need for further research in this area.

Reference
Reddy M, Gill SS, Rochon PA. Preventing
pressure ulcers: a systematic review.
JAMA 2006;296:974-84.

Commentary
Dealey C. Evid Based Nurs 2007;10:54