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The effect of head positioning on brain tissue oxygenation in preterm infants: a randomized clinical trial study
Zeinab Rabbani Mohamammadie1, Monir Ramezani2,3, Mohammad Heidarzadeh4
1Department of Neonatal & Pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
Head positioning affects brain oxygenation in preterm infants. Avoid rotating the head in the first 48 hours after birth to maintain optimal brain tissue oxygen saturation.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Medical Engineering
Background:
- Central nervous system (CNS) injury is a major cause of mortality and morbidity in preterm infants.
- Routine care events can impact cerebral perfusion and oxygenation in these vulnerable infants.
- While head positioning is used to improve brain oxygenation, robust clinical evidence is lacking.
Purpose of the Study:
- To investigate the impact of different head positions on brain tissue oxygenation in preterm infants.
- To establish evidence-based guidelines for head positioning in the neonatal intensive care unit.
Main Methods:
- A randomized clinical trial involving 39 preterm infants within 48 hours of birth.
- Infants were placed in a supine position with continuous head rotation every 2 hours across six randomized modes.
- Brain tissue oxygenation was monitored using near-infrared spectroscopy (NIRS) during each position change.
Main Results:
- Significant differences in brain tissue oxygen saturation were observed across various head positions (P < 0.001).
- Specific positions, including a 45-60 degree right rotation, showed significantly lower oxygen saturation compared to baseline and other positions.
- Head rotation in the second position also resulted in lower oxygen saturation compared to the first position.
Conclusions:
- Head positioning significantly influences brain tissue oxygenation in preterm infants during the initial 48 hours post-birth.
- It is recommended to avoid rotating the infant's head during this critical period when the head of the bed is at 0 degrees.
- These findings provide crucial evidence for optimizing neonatal care protocols to improve brain oxygenation.
Background:
CNS injury in preterm infants is still one of the leading causes of mortality and morbidity. Routine care events might affect the perfusion and cerebral oxygenation of preterm infants. Although positioning the infant's head in a particular condition to improve brain oxygenation is included in many institutions, there is no robust clinical evidence to support this intervention's effectiveness.
Objective:
The present study aimed to determine the effect of head positioning on brain tissue oxygenation in preterm infants.
Methods:
This study is a randomized clinical trial. In the first 48 h after birth, 39 infants who met the study inclusion criteria underwent head positioning intervention. In this case, the infants were placed in the supine position, and every 2 h, the head position was changed continuously to one of six randomized modes [using random modes generated by SPSS]. During each head positioning, brain tissue oxygenation was recorded by NIRS.
Results:
The findings showed a significant difference in brain tissue oxygen saturation among these positions (P < 0.001). Dunn's test showed that the brain tissue oxygen saturation in the third position (head rotates 45-60 degrees from the midline to the right and the head of the bed is zero degrees) was significantly lower than the baseline (P = 0.029; Mean difference = 2.3). Also, in the third position, compared to the first position (P = 0.002; Mean difference = 1.9) and compared to the fourth position (P = 0.003; Mean difference = -2.1), and in the second position compared to the first position (P = 0.046; Mean difference = 1.3), the brain tissue oxygen saturation of the infants was lower.
Conclusion:
Based on the results of the present study, head positioning was effective on brain tissue oxygenation in preterm infants in the first 48 h after birth; Therefore, it is recommended when possible, not to rotate the infant's head during the first 48 h after birth while the head of the bed is at 0°.
