Effect of Nesting on Physiological Stability and Behavioral Responses among Preterm Newborns in a Special Newborn Care Unit

Abstract

Background: Preterm newborns have immature physiological and neurobehavioral regulatory systems and are particularly susceptible to environmental stressors encountered within neonatal care settings. Frequent handling, excessive sensory stimulation, and inadequate postural support may contribute to physiological instability and behavioral disorganization. Nesting is a simple developmental supportive-care intervention that provides containment, promotes flexion and midline orientation, and may facilitate physiological and behavioral regulation.

Objective: To evaluate the effect of a structured nesting intervention on physiological stability and behavioral responses among preterm newborns admitted to a Special Newborn Care Unit.

Methods: A quantitative, pre-experimental one-group pre-test–post-test study was conducted among 50 preterm newborns admitted to the Special Newborn Care Unit of Maharaja Krishna Chandra Gajapati (MKCG) Medical College and Hospital, Berhampur, Odisha, India. Participants were recruited using non-probability purposive sampling. Eligible newborns were less than 10 days of age, born before 37 completed weeks of gestation, clinically stable, and free from major congenital anomalies. The intervention consisted of structured positioning within a soft U-shaped nest for 6 hours daily over three consecutive days. Heart rate and respiratory rate were assessed as physiological outcomes, while behavioral responses were evaluated using a structured neonatal behavioral assessment tool. Pre-test and post-test outcomes were compared using paired t-tests, and chi-square analysis was used to examine associations between post-intervention behavioral response and selected participant characteristics.

Results: Following the nesting intervention, the mean heart rate decreased from 171.3 ± 15.5 beats/min at pre-test to 148.4 ± 9.1 beats/min at post-test, with a mean reduction of 22.9 beats/min. The mean respiratory rate decreased from 64.5 ± 13.1 to 47.6 ± 9.1 breaths/min, representing a mean reduction of 16.9 breaths/min. Behavioral response scores demonstrated a substantial improvement, increasing from 7.46 ± 1.18 at pre-test to 12.84 ± 1.25 at post-test, with a mean difference of 5.38 points. The improvement in behavioral scores was statistically significant (t = 20.9, p < 0.001). No statistically significant associations were observed between post-intervention behavioral response and the selected demographic and clinical characteristics (p > 0.05).

Conclusion: Structured nesting was associated with improved physiological stability and behavioral organization among preterm newborns. Its simplicity, low resource requirements, and compatibility with routine neonatal nursing care support its potential application as a developmental supportive-care strategy for clinically stable preterm newborns. However, the findings should be interpreted in view of the pre-experimental design and absence of a comparison group. Larger randomized controlled studies are recommended to establish the independent effectiveness of nesting and determine its longer-term developmental implications.