Repositioners or Redistribution Surfaces for Neonates Protection Status

by Ivy Razmus, RN, PhD, CWOCN


Neonatal patients have unique skin properties compared with older patient populations. However, there is little evidence reported for neonates who receive pressure injury (PI) prevention interventions and the related occurrence of PIs compared with adults. The use of a pressure redistribution surface is intended to decrease pressure and thereby reduce PIs. The Institute for Healthcare Improvement 1 guidelines recommend a support surface that meets the patient’s need for pressure redistribution based on the level of immobility and inactivity to reduce shear and change microclimate; additional factors for type of surface include size and weight of the patient and whether there are existing PIs. Consequently, knowledge about selection and use of pressure redistribution surfaces for neonatal patients is needed.

To have a better understanding of PI practices, a survey was sent out to neonatal nurses electronically, and 252 neonatal intensive care unit (NICU) nurses completed the survey.2 The nursing experience of the participants ranged from 1 to over 20 years, and most of these nurses primarily worked in the United States. In addition, the majority worked in level III and IV NICUs with more than 30 beds.

Survey Results

At the time of this survey, there were no known studies that evaluated pressure redistribution surface use in neonates. Of the 252 participants who responded, the majority reported “yes,” they use a pressure redistribution surface in practice. Types of redistribution surfaces included standard, crib, adult, overlays, and multiple other responses. The highest response for redistribution surface type was for rolled blanket and a small soft object, whereas 36% used a pressure redistribution surface such as neonatal mattress overlays (17%), sheepskin (19%), foam (13%), and “other” (33%). Other responses were free texted, and they included the following: non-powered fluidized positioners, 15%; lightweight positioning, swaddle aid, 5%; and gel pad, mats, and pillows (manufacturer not listed), 7%. There was a 1% response listed for a fluidized positioner that did not designate type or name. Some of surfaces are marketed as repositioners/positioners and not as pressure redistribution surfaces.2

Findings from the use of pressure redistribution surfaces revealed that rolled blankets and soft objects were used most often. This study suggests that participants did not differentiate positioners from pressure redistribution surfaces, a finding suggesting these products are being used as both a positioning/repositioning device and a pressure redistribution surface. This is not surprising because it seems that there is ambiguity regarding positioners and pressure redistribution surfaces.


Currently, evidence-based knowledge of the use of a particular type of pressure redistribution surface or positioner/repositioner in the NICU is limited. Future studies are recommended to evaluate how redistribution surface types are related to hospital-acquired PIs among neonatal patients.

To learn more about the products used, read the original article, found at


  1. How-to guide: prevent pressure ulcers — pediatric supplement. Institute for Healthcare Improvement. Updated 2007. Accessed April 11, 2021.
  2. Razmus IS Keep SM. Neonatal intensive care nursing pressure injury prevention practices: a descriptive survey. J Wound Ostomy Continence Nurs. 2021;48(5):394-402.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.

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