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Effect of positioning on the breathing pattern of preterm infants
R Heimler1, J Langlois, D J Hodel
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee 53226.
Insights
Prone positioning improves respiration in preterm infants. The supine position increases apnea density and periodic breathing, suggesting central apnea risk. Always document infant position during respiratory monitoring.
Area of Science:
- Neonatal Medicine
- Respiratory Physiology
Background:
- Respiration in preterm infants is sensitive to positioning.
- Previous studies suggest prone positioning benefits gas exchange and pulmonary function.
Purpose of the Study:
- To investigate the effect of prone versus supine positioning on breathing patterns in stable preterm infants with recent clinical apnea.
Main Methods:
- Nocturnal impedance pneumograms were recorded in 14 stable preterm infants in both prone and supine positions.
- Simultaneous oximetry and nasal flow studies were conducted in 10 infants.
- Infants remained in each position for over six hours.
Main Results:
- Apnea density and periodic breathing significantly increased in the supine position compared to the prone position.
- No significant positional differences were observed for bradycardia, prolonged apnea, obstructive apnea, mixed apnea, or cyanotic spells.
- Findings suggest an increased incidence of central apnea in the supine position.
Conclusions:
- The supine position is associated with a higher incidence of central apnea and periodic breathing in preterm infants.
- Infant positioning is a critical factor to consider when interpreting pneumogram data.
- Further research into the relationship between positional changes and lung mechanics is warranted.
Abstract:
Respiration, as judged by gas exchange and pulmonary function, is improved in preterm infants kept in the prone rather than the supine position. The influence of position on the breathing pattern as documented by the pneumogram was studied in 14 stable preterm infants with recent clinical apnoea. Ten of the infants had oximetry and nasal flow studies simultaneously with the impedance pneumogram. Each infant had consecutive nocturnal pneumograms, one in the prone, one in the supine position. The infants were kept for more than six hours in the assigned position. A significant increase in apnoea density and in periodic breathing was found in the supine v the prone position (mean (SE) 4.5 (0.7)% v 2.5 (0.5)%, and 13.6 (3.2)% v 7.7 (2.2)%, respectively). There was no positional difference in the incidence of bradycardia and prolonged apnoea. The examination of obstructive apnoea, mixed apnoea, and cyanotic spells did not reveal a consistent disparity between the two positions. These findings indicate an increase in central apnoea in preterm infants kept predominantly in the supine position. Possible relations of positional changes to lung mechanics are discussed. When evaluating pneumograms, attention must be given to the position in which they were performed.