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Randomised crossover trial of different postural interventions on bradycardia and intermittent hypoxia in preterm
C Reher1, K D Kuny, T Pantalitschka
1Department of Neonatology, University Children's Hospital, Tuebingen, Germany. christian-f.poets@med.uni-tuebingen.de
Insights
Altering infant posture did not significantly reduce apnea events. Three positions, including head-up tilt, showed no advantage over standard horizontal positioning for premature infants. Further research may be needed.
Area of Science:
- Neonatal medicine
- Pediatric respiratory care
- Infant physiology
Background:
- Apnoea of prematurity is a common concern in preterm infants.
- Previous studies suggest postural changes can influence apnoea events.
Purpose of the Study:
- To evaluate the impact of three distinct prone positions on bradycardia and desaturation events in premature infants.
- To compare horizontal, head-up tilt, and Kinaesthetics three-level positions.
Main Methods:
- 18 infants (gestational age ≤32 weeks) with apnoea of prematurity were studied.
- Recordings included breathing, ECG, heart rate, SpO2, and video.
- Infants were placed in random order in horizontal, 15° head-up tilt, or three-level positions.
Main Results:
- The median combined event rate of desaturations (SpO2 <85%) and bradycardias (heart rate <80 bpm) did not differ significantly between positions (HP: 26.7/h, TP: 25.2/h, 3P: 21.2/h).
- The duration of body movements also showed no significant difference across the three postural interventions.
Conclusions:
- No significant benefit was observed for head-up tilt or three-level positions compared to the standard horizontal position in managing apnoea of prematurity.
- Current postural interventions do not offer a confirmed advantage in reducing cardiorespiratory events.
Background:
Apnoea of prematurity has been shown to respond to changes in posture.
Objective:
To investigate the effect of three postural interventions on the rate of bradycardia and desaturation events.
Methods:
18 infants (< or =32 weeks' gestational age; 11 boys) with apnoea of prematurity underwent recordings of breathing movements, electrocardiogram and instantaneous heart rate, pulse oximeter saturation (SpO2), photoplethysmographic waveforms and digital video frame while in one of three different prone positions. The following interventions were applied in random order: horizontal position (HP), 15 degrees head-up tilt position (TP) and three-level position (3P) according to Kinaesthetics Infant Handling. The primary study variable was the combined event rate of desaturations (SpO2 <85%) and bradycardias (heart rate <80 bpm). One secondary study variable was the duration of body movements.
Results:
The median (range) combined event rate was 26.7/h (0.3-72.7) in HP, 25.2/h (0.3-70.5) in TP and 21.2/h (0-66.3) in 3P (p>0.05). The median (range) duration of body movements was 10.8 s/h (0-48.2) in HP, 7.1 s/h (0-72.4) in TP and 7.0 s/h (0-47.7) in 3P (p>0.05).
Conclusions:
No significant advantage of a head-up tilt or a three-level position over a standard horizontal position could be confirmed.