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Effect of position on oxygen saturation and requirement in convalescent preterm infants
Dawn E Elder1, Angela J Campbell, Duncan Galletly
1Department of Paediatrics, University of Otago Wellington, New Zealand. dawn.elder@otago.ac.nz
Insights
For convalescent preterm infants, sleep position does not significantly impact oxygen saturation. Postmenstrual age and residual respiratory disease are more critical factors affecting oxygenation than infant positioning.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Sleep Medicine
Background:
- Preterm infants often experience challenges with oxygenation and respiratory support post-extubation.
- Understanding factors influencing oxygen saturation is crucial for safe discharge planning.
Purpose of the Study:
- To investigate the impact of sleep position (prone vs. supine) on oxygen saturation and oxygen requirements in convalescent preterm infants.
- To identify key determinants of oxygenation in this vulnerable population.
Main Methods:
- Nap polysomnography was used to assess twelve preterm infants (born 24-32 weeks gestation) in both prone and supine positions.
- Measurements included mean and minimum oxygen saturation (SpO2), and time spent with SpO2 < 90% during active sleep.
- Studies were conducted twice weekly until infant discharge.
Main Results:
- Oxygen saturation varied significantly with postmenstrual age (PMA), but not with sleep position.
- Infants with chronic lung disease (CLD) or on respiratory support exhibited lower SpO2, independent of position.
- No increased oxygen requirement was observed when transitioning to a supine position from 36 weeks PMA.
Conclusions:
- Postmenstrual age and the presence of residual respiratory disease are more influential on preterm infant oxygenation than sleep position.
- A supine sleep position is considered safe and not disadvantageous for preterm infants nearing discharge.
Aims:
To document the effect of position on oxygen saturation and changes in oxygen requirement in convalescent preterm infants.
Methods:
Twelve infants born ≥24 and ≤32 weeks gestation, extubated and without congenital anomaly were studied using nap polysomnography in prone and supine, twice weekly until discharge. Mean oxygen saturation (SpO(2)), minimum SpO(2) , mean minimum SpO(2) and time with SpO(2) < 90% were measured in active sleep.
Results:
Eight male and four female infants [median gestation 28 (24-31) weeks and median birthweight 1059 (715-1840) g] had 39 studies. For 21 of 39 studies, the infant was on respiratory support. Four infants had chronic lung disease (CLD). SpO(2) varied with postmenstrual age (PMA) (p = 0.003) but not with position (p = 0.36), and PMA did not influence the effect of position on SpO(2) (p = 0.19). SpO(2) was lower for those with CLD (p < 0.0001) and those on respiratory support (p < 0.001), but there was no effect of position (p = 0.97 and p = 0.67, respectively). From 36 weeks PMA, a change to supine did not increase oxygen requirement.
Conclusion:
In preterm infants, PMA and residual respiratory disease have greater effects on oxygenation than position. A supine sleep position is not disadvantageous for preterm infants at discharge.
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