Related Experiment Video
Updated: Jan 18, 2026
An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
Published on: November 30, 2022
Prone Positioning Was Associated With Less Hypoxemic Events and Improved Feeding Tolerance in Preterm Infants
Bettina Bohnhorst1, Eva Lutz2, Sabine Pirr1
1Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.
Insights
Prone positioning in preterm infants significantly reduces hypoxemia and bradycardia events. This practice also lowers gastric residuals, potentially improving neurodevelopmental outcomes for vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Developmental Pediatrics
Background:
- Cardiorespiratory events like apnea, bradycardia, and hypoxemia are prevalent in preterm infants.
- These events are associated with an increased risk of impaired neurodevelopmental outcomes.
Purpose of the Study:
- To investigate the effect of prone positioning on cardiorespiratory events and gastric residuals in preterm infants.
- To determine if prone positioning can reduce the incidence of hypoxemia, bradycardia, and gastric residuals.
Main Methods:
- A monocentric, prospective, randomized, two-arm crossover trial involving 48 preterm infants (<32 weeks gestational age).
- Infants were monitored in both prone and supine positions for 24 hours.
- Primary outcome: cumulative frequency of hypoxemias and bradycardias; Secondary outcomes: basal SpO2, gastric residuals, and apnea frequency.
Main Results:
- Prone positioning halved the cumulative frequency of hypoxemias and bradycardias (p=0.03).
- Severe hypoxemias (SpO2 <80%) were also reduced by half in the prone position.
- Median basal SpO2 was significantly higher (p=0.01), and gastric residuals were significantly lower (p=0.0002) in the prone position.
- Apnea frequency (duration >10s) increased significantly in the prone position (p=0.01).
Conclusions:
- Prone positioning is effective in reducing hypoxemia, bradycardia, and gastric residuals in preterm infants.
- The increased SpO2 and reduced gastric residuals suggest potential benefits for neurodevelopmental outcomes.
- While prone positioning reduces certain cardiorespiratory events, the increase in apnea requires consideration.
Aim:
Cardiorespiratory events such as apnea, bradycardia and hypoxemia are common in preterm infants and may contribute to an impaired neurodevelopmental outcome. We hypothesised a significant reduction in the incidence of hypoxemia, bradycardia and gastric residuals in the prone position.
Methods:
In this monocentric, prospective, randomised, two-arm crossover trial, at a tertiary university hospital, 48 preterm infants with a gestational age of < 32 weeks and a postmenstrual age of < 34 weeks were randomised to either a prone-supine or a supine-prone sequence of cardiorespiratory monitoring over a period of 24 h. The primary outcome parameter was the cumulative frequency of hypoxemias and bradycardias; secondary parameters comprised evaluation of basal parameters, hypoxemias, bradycardias and the amount of gastric residuals.
Results:
The cumulative frequency of hypoxemias and bradycardias and the number of severe hypoxemias (peripheral oxygen saturation [SpO2] < 80%) were halved in the prone position (p = 0.03). Median basal SpO2 was significantly higher (p = 0.01) and gastric residuals were significantly lower (p = 0.0002) in the prone position. The frequency of apneas (> 10 s) was significantly increased in the prone position (p = 0.01).
Conclusion:
Prone positioning of preterm infants significantly reduces the cumulative frequency of hypoxemias and bradycardias, severe hypoxemias and gastric residuals while increasing basal SpO2.
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