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Prone and supine positioning effects on energy expenditure and behavior of low birth weight neonates
J Masterson1, C Zucker, K Schulze
1Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY 10032.
Insights
Prone positioning in infants with low birth weight (LBW) reduces energy expenditure and wakefulness while increasing quiet sleep. These findings suggest the prone position is optimal for LBW infant care.
Area of Science:
- Neonatal Physiology
- Infant Sleep Studies
- Energy Metabolism Research
Background:
- Understanding optimal positioning for low birth weight (LBW) infants is crucial for their development and well-being.
- Previous research has explored various infant care practices, but the specific impact of body position on LBW infants requires further elucidation.
Purpose of the Study:
- To evaluate the effect of body position, specifically supine versus prone, on energy expenditure and behavioral states in healthy LBW infants.
- To determine if a preferred position exists that optimizes energy conservation and sleep patterns for LBW infants.
Main Methods:
- A study involving 42 healthy LBW infants (920–1,760 g) across 66 observations.
- Infants were randomly assigned to either supine or prone positions for sequential three-hour epochs, with position reversal.
- Measurements included overall energy expenditure, time spent in active sleep, quiet sleep, and wakefulness for each position.
Main Results:
- Overall energy expenditure was significantly lower in the prone position compared to the supine position (median difference: +3.1 kcal/kg/d).
- During active sleep, energy expenditure remained higher in the supine position (median difference: +2.6 kcal/kg/d).
- Infants spent significantly more time awake in the supine position (5.7% higher) and less time in quiet sleep compared to the prone position.
Conclusions:
- Transitioning LBW infants from supine to prone positioning leads to decreased energy expenditure and reduced wakefulness.
- The prone position is associated with increased time spent in quiet sleep.
- These findings strongly suggest that the prone position is the preferred choice for LBW infants to promote energy conservation and optimize sleep.
Abstract:
The effect of body position (supine v prone) on energy expenditure and behavior of 42 healthy low birth weight (920 to 1,760 g) infants was evaluated in 66 studies. Each infant was randomly assigned to the supine or prone position for the first three-hour epoch; the position was reversed for the second three-hour epoch. The difference in energy expenditure and the percentage of time in active sleep, quiet sleep, and wakefulness between the two positions was computed. The median difference (supine minus prone) in overall energy expenditure between positions was +3.1 kcal/kg/d (interquartile range 0.6 to 6.5; P less than .001). When only periods of active sleep were analyzed, the median difference in energy expenditure remained significant, the supine position being higher than prone by +2.6 kcal/kg/d (interquartile range 0.1 to 4.8; P less than .001). In the supine position, the time awake was 5.7% higher (interquartile range 1.8 to 17.4; P less than .001) than in the prone position. The percentage of time in active sleep was not significantly different between the positions, hence quiet sleep decreased in the supine position. In summary, when low birth weight infants are changed from the supine to the prone position, energy expenditure decreases, time spent in quiet sleep increases, and time spent awake decreases. These data suggest that prone is the position of choice for the low birth weight infant.