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Regional oxygenation, perfusion and body and/or head position: Are preterm infants adversely impacted? A systematic
Pranav Jani1, Hannah Skelton2, Traci-Anne Goyen3
1Westmead Hospital, Department of Neonatology, Westmead, Australia; The University of Sydney, Sydney, Australia.
Insights
Body positioning in preterm infants does not negatively impact cerebral oxygenation or perfusion. Further research is needed to clarify the effects of head rotation on these vital measures.
Area of Science:
- Neonatal physiology
- Neurodevelopmental outcomes
Background:
- Understanding regional oxygenation and perfusion in preterm infants is crucial for optimizing neurodevelopmental outcomes.
- Body positioning, including head rotation, may influence cerebral blood flow and oxygenation in vulnerable preterm neonates.
Approach:
- A systematic review of MEDLINE, Embase, and Scopus databases up to July 2021 was conducted.
- Fifteen prospective, observational studies with moderate risk of bias were included, analyzing regional oxygenation and perfusion in preterm infants across different body positions.
Key Points:
- Non-supine positioning (side lying or prone) in preterm infants transiently reduced cardiac output and stroke volume, but did not affect heart rate or blood pressure.
- Regional, particularly cerebral, oxygenation and perfusion were not adversely affected by side lying or prone positions.
- The impact of head rotation on regional oxygenation and perfusion in preterm infants remains inconclusive.
Conclusions:
- Current evidence suggests that side lying or prone positioning is safe regarding regional oxygenation and perfusion in preterm infants.
- Further investigation is warranted to elucidate the specific effects of head rotation on cerebral oxygenation and perfusion and its long-term neurodevelopmental implications.
Abstract:
This review addresses regional oxygenation and perfusion changes for preterm infants and changes with body position, with or without head rotation. Future directions for improving neurodevelopmental and clinical outcomes are suggested. The MEDLINE, Embase and Scopus databases were searched up to July 2021. Fifteen out of 470 studies met the inclusion criteria. All were prospective, observational studies with a moderate risk of bias. Significant variation was found for the baseline characteristics of the cohort, postnatal ages, and respiratory support status at the time of monitoring. When placed in a non-supine position, preterm infants showed a transient reduction in cardiac output and stroke volume without changes to heart rate or blood pressure. No studies reported on long-term neurodevelopmental outcomes. Overall, side lying or prone position does not appear to adversely affect regional, and specifically cerebral, oxygenation or cerebral perfusion. The effect of head rotation on regional oxygenation and perfusion remains unclear.
