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Effect of posture on respiratory function and drive in preterm infants prior to discharge
J A Leipälä1, R Y Bhat, G F Rafferty
1Children Nationwide Regional Neonatal Intensive Care Centre, Golden Jubilee Wing 4th Floor, King's College Hospital, London SE5 9RS, UK.
Insights
Prone positioning improved breathing in premature infants before discharge, increasing tidal volume and reducing respiratory rate. This finding highlights the importance of posture for respiratory function in vulnerable newborns.
Area of Science:
- Neonatal Physiology
- Respiratory Medicine
Background:
- Premature infants often experience respiratory challenges.
- Optimizing respiratory function before discharge is crucial for infant health.
Purpose of the Study:
- To investigate the impact of prone versus supine positioning on respiratory function and drive in premature infants nearing discharge.
- To assess how posture affects key respiratory parameters like tidal volume, respiratory rate, and muscle strength.
Main Methods:
- Twenty premature infants (median gestational age 29 weeks) were studied at a median postconceptional age of 36 weeks.
- Infants were assessed in both supine and prone positions for 3 hours each, on successive days, with randomized order.
- Respiratory function was measured, including tidal volume (Vt), respiratory rate, minute ventilation, and respiratory drive (P(0.1)), alongside maximal inspiratory pressure (Pimax).
Main Results:
- Prone positioning resulted in significantly higher tidal volume (Vt) and lower respiratory rate compared to the supine position.
- Respiratory drive (P(0.1)) and maximal inspiratory pressure (Pimax) were significantly lower in the prone position.
- Oxygen-dependent infants showed higher minute volume in the prone position.
Conclusions:
- Posture significantly influences respiratory function and drive in premature infants prior to neonatal unit discharge.
- Prone positioning appears beneficial for improving certain aspects of respiratory mechanics in this population.
- These findings underscore the importance of considering infant positioning for optimizing respiratory outcomes.
Abstract:
Our objective was to determine the effect of posture on respiratory function and drive in prematurely born infants immediately prior to discharge. Twenty infants (6 oxygen-dependent), median gestational age 29 weeks (range, 25-32), were studied at a median postconceptional age (PCA) of 36 weeks (range, 33-39). On 2 successive days, infants were studied both supine and prone; each posture was maintained for 3 hr. The order on each day in which postures were studied was randomized between infants. At the end of each 3-hr period, tidal volume (Vt), inspiratory (Ti) and expiratory (Te) time, respiratory rate, and minute ventilation were measured. In addition, respiratory drive was assessed by measuring the pressure generated in the first 100 msec of an imposed airway occlusion (P(0.1)), and respiratory muscle strength was assessed by recording the maximum inspiratory pressure (Pimax) generated against an occlusion which was maintained for at least five breaths. Overall, tidal volume was higher (P < 0.05), but respiratory rate (P < 0.05), P(0.1) (P < 0.05), and Pimax (P < 0.05) were lower in the prone compared to the supine position. There were no significant differences in Ti or Te between the two postures. In oxygen-dependent infants only, minute volume was higher in the prone position (P < 0.05). In conclusion, posture-related differences in respiratory function are present in prematurely born infants studied prior to neonatal unit discharge.