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An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
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'Propped and prone' positioning reduces respiratory events in spontaneously breathing preterm infants: A randomised

Christopher M Richmond1,2,3, Fabian Ring1, Lacey Richmond1,4

  • 1Newborn Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia.

Journal of Paediatrics and Child Health
|October 31, 2022
PubMed

Insights

Propped/prone infant positioning significantly reduced respiratory events and improved oxygen saturation in preterm infants. Continuous pump feeds did not show significant benefits over standard bolus feeding methods.

Area of Science:

  • Neonatal Medicine
  • Pediatric Respiratory Care
  • Infant Physiology

Background:

  • Preterm infants (<32 weeks gestation) are susceptible to respiratory events and hypoxemia.
  • Current management in neonatal units includes positioning and feeding strategies.
  • Optimizing these interventions is crucial for improving outcomes.

Purpose of the Study:

  • To compare the effects of infant positioning and feed-rate interventions on respiratory events and oximetry in preterm infants.
  • To evaluate the impact of propped/prone positioning versus supine positioning.
  • To assess the efficacy of continuous pump feeds versus gravity bolus feeds.

Main Methods:

  • Randomized triple crossover design with 68 preterm infants.
  • Three conditions: control (supine/flat, gravity bolus feeds), position intervention (propped/prone), and feed-rate intervention (continuous pump feeds).
  • Primary outcomes: number of respiratory events (apnea, bradycardia, desaturation) and time with SpO2 <80% over 24 hours. Secondary outcome: time with SpO2 ≥88%.

Main Results:

  • Propped/prone positioning significantly reduced respiratory events compared to control and continuous pump feeds (P < 0.001).
  • Improved percentage of time with SpO2 <80% and ≥88% in the propped/prone position (P < 0.001).
  • No significant difference in outcomes between continuous pump feeds and gravity bolus feeds.

Conclusions:

  • Alternative infant positioning, specifically propped/prone, is recommended for preterm infants in neonatal units.
  • Positioning interventions offer a significant benefit for respiratory and oxygenation parameters.
  • Feed-rate interventions did not demonstrate a significant advantage over standard methods in this study.
Abstract

Keywords:
apnoeabradycardiaenteral feedingneonatal healthpreterm infantsprone position

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