Use of a Midliner Positioning System for Prevention of Dolichocephaly in Preterm Infants

Dana B. McCarty, Shannon O'Donnell, Ricki F. Goldstein, P. Brian Smith, Kimberley Fisher, William F. Malcolm

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Purpose: The purpose of this study was to determine effectiveness of a midliner positioning system (MPS, Tortle Midliner) for preventing dolichocephaly. Methods: This was a nonrandomized, prospective study of 30 premature infants (study cohort, SC) using an MPS compared with a retrospective study cohort (RSC) of 65 infants who received standard of care intervention. Results: RSC baseline cranial index (CI) of 80% and final CI of 77% significantly decreased over an average 5.5 weeks (P <.0001). The SC baseline CI and the final CI were both 79% over an average 5.7 weeks, indicating no significant difference between CI measures (P =.6). Gestational age, birth weight, reflux, time on continuous positive airway pressure, and time in a supine position were not associated with dolichocephaly. Conclusions: The SC developed less cranial molding (ie, had greater CI), compared with the RSC. A larger randomized study is needed to recommend routine use of MPS for prevention and/or treatment of cranial molding in premature infants.

Original languageEnglish
Pages (from-to)126-134
Number of pages9
JournalPediatric Physical Therapy
Issue number2
StatePublished - Apr 1 2018

Bibliographical note

Publisher Copyright:
© 2018 Lippincott Williams and Wilkins. All rights reserved.


  • Dolichocephaly
  • Tortle Midliner
  • cranial index
  • cranial molding
  • premature infants
  • preterm infants

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Physical Therapy, Sports Therapy and Rehabilitation


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