Breathe-Easy

Acceptability and feasibility of a new postural management night-time intervention to improve respiratory health of children with complex neurodisability acceptability and feasibility of a new postural management night-time intervention to improve respiratory health of children with complex neurodisability.

This research provided us with important information about the experiences of children with complex neurodisability along with their families when they used a new postural management night-time intervention.

The study was carried out by a research team from Sussex Community NHS Foundation Trust and Brighton and Sussex University Hospitals Trust, with funding from the British Academy of Childhood Disability and the Chartered Society of Physiotherapy. For more information about the study, please take a look at the clinical trials database.

Background

This research concerns children with complex neurodisability. Damage to the developing brain leads to lifelong disturbances in motor control, seizures, cognition, communication, eating and drinking, and behaviour. Children with complex neurodisability are dependent upon others to move and position them. Children commonly experience chronic lung disease, leading to frequent hospitalisation, medical interventions, and premature death. Respiratory illness may be triggered by aspiration, for example when saliva, food, liquid, or stomach contents enter the lungs. Aspiration risks increase at night-time when supervision is limited and children are positioned on their backs. Some children experience repeated breathing complications requiring prolonged hospital stays, including respiratory support in intensive care.

Consultant respiratory paediatrician Akshat Kapur and physiotherapist Hilda Perry developed a new night-time intervention to improve respiratory health of children with complex neurodisability. Dr Kapur and his team found that this intervention can help reduce respiratory illness and time spent in hospital for some children. This acceptability and feasibility study helped us to find out if this new intervention is something that children with complex neurodisability and their families are happy (that is, it is acceptable) and able (that is, it is feasible) to do.

What is the new night-time intervention?

The intervention involves positioning children safely on their fronts in a semi-side lying position using pillows to support their body under the shoulder and hip, and with the head slightly lowered so that gravity can help drain secretions from their mouth. This is different to current night-time positioning which recommends either lying children on their backs or side. The new intervention also involves, where possible, the draining of children's stomach contents overnight via an existing feeding tube to prevent aspiration of stomach contents.

The Research Team

The research was led by Dr Sarah Crombie, an experienced research physiotherapist. Other members of the team included:

• Dr Diane Sellers, Research Speech and Language Therapist
• Dr Jessica Baskerville, Clinical Researcher
• Ms Gaby Hillman, Paediatric Physiotherapist (neuro-disability and respiratory)
• Dr Akshat Kapur, Consultant Respiratory Paediatrician
• Professor Stephen Bremner, Senior Statistician, Brighton and Sussex Medical School
• Professor Chris Morris, Peninsula Child Health Research Unit, University of Exeter