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Improved oxygenation with prone positioning in neonates: stability of increased transcutaneous PO2
T M Baird1, J B Paton, D E Fisher
1Department of Pediatrics, Michael Reese Hospital and Medical Center, Chicago, Illinois.
Insights
Prone positioning significantly improves oxygenation in premature infants with respiratory disease. This beneficial effect on oxygen levels remains stable for extended periods, aiding in infant care.
Area of Science:
- Neonatal Medicine
- Respiratory Physiology
Background:
- Premature infants often experience respiratory distress.
- Optimizing oxygenation and ventilation is critical for managing neonatal respiratory disease.
Purpose of the Study:
- To assess the sustained impact of prone positioning on oxygenation and ventilation in neonates with respiratory issues.
- To compare prone versus supine positions over a 6-hour period.
Main Methods:
- Utilized transcutaneous monitoring (tcPO2 and tcPCO2) in preterm infants (median gestational age 29 weeks).
- Compared prone and supine positions over a 6-hour interval in 14 studies involving seven infants.
- Infants had respiratory disease secondary to prematurity and received supplemental oxygen.
Main Results:
- Prone positioning led to a significant increase in transcutaneous oxygen pressure (tcPO2) from 63 to 71 mm Hg (P < .05).
- The improvement in tcPO2 was stable for up to 2 hours in the prone position.
- No significant changes in transcutaneous carbon dioxide pressure (tcPCO2) were observed.
- Infants spent more time sleeping in the prone position (75% vs 33%, P < .05).
Conclusions:
- Prone positioning offers a stable and significant improvement in oxygenation for sick preterm infants.
- This body position may be a beneficial intervention for managing respiratory compromise in neonates.
- Prone positioning may also promote sleep, a crucial factor in infant development.
Abstract:
To evaluate the effect of body position on oxygenation and ventilation in neonates over a prolonged period, infants with respiratory disease were followed by transcutaneous (tc) monitoring for alterations in tcPO2 and tcPCO2 with position changes. In 14 studies of seven patients, prone positioning was compared with supine positioning over a 6-hour interval. All patients were premature, were receiving supplemental oxygen, and had respiratory disease secondary to prematurity. The median gestational age was 29 weeks; all infants were 2 months old or less at the time of the study. Prone positioning resulted in a significantly higher tcPO2; mean (+/- SD) tcPO2 increased from 63 (+/- 11.6) mm Hg to 71 (+/- 14.6) mm Hg, and decreased to 65 (+/- 11.2) mm Hg when the infant was returned to supine (P less than .05). This increase in tcPO2 was stable throughout 2 hours in the prone position. No significant change in tcPCO2 was detected. Infants were also found to spend a greater proportion of time sleeping when prone (75% +/- 13% vs 33% +/- 14%; P less than .05). These finding suggest that improvement in oxygenation with the prone position is stable over an extended period in the sick preterm infant.