Cerebral Oxygenation and Perfusion when Positioning Preterm Infants: Clinical Implications

Area of Science:

• Neonatal physiology
• Respiratory medicine
• Pediatric neurology

Background:

• Preterm infants, especially those with bronchopulmonary dysplasia (BPD), are at risk for cerebral hypoxemia.
• Optimal positioning strategies are crucial for improving outcomes in this population.

Purpose of the Study:

• To investigate the impact of prone versus supine positioning on cerebral tissue oxygenation (cTOI) and cerebral perfusion.
• To assess these effects in preterm infants with and without BPD.

Main Methods:

• Sixty preterm infants (born <32 weeks gestation) were studied, with 30 diagnosed with BPD.
• Cerebral perfusion, cTOI, and polysomnography were measured in both supine and prone positions.
• Infants with major intraventricular hemorrhage or congenital abnormalities were excluded.

Main Results:

• Cerebral perfusion remained unaffected by position or BPD status.
• In infants with BPD, prone positioning led to significantly higher mean cTOI (3.27% increase, P=.03).
• The burden of cerebral hypoxemia was significantly lower in the prone position for the BPD group (23% vs 29%, P<.001).

Conclusions:

• Prone positioning enhances cerebral oxygenation and mitigates cerebral hypoxemia in preterm infants with BPD.
• These findings suggest that prone positioning may be beneficial for clinical practice.
• Further research is warranted to determine the long-term developmental impact of positioning.