The effect of head position on intracranial pressure in the neonate

Elevation and maintenance of the head in an elevated, midline position reduces cerebral venous and intracranial pressure (ICP) in adult neurosurgical patients. To determine the possible effect of head position on ICP in the neonate, we studied 26 neonates less than 2500 g at birth and less than or equal to 10 days of age. ICP was measured in each of 4 different head positions: head turned to the right and bed horizontal (R-0 degrees); head turned to the right and head of the bed elevated 30 degrees (R-30 degrees); head in the midline and bed horizontal (M-0 degrees); and head in the midline and head of the bed elevated 30 degrees (M-30 degrees). ICP results were as follows: R-0 degrees, 10.0 +/- 1.2 (mean +/- SEM), cm H2O; R-30 degrees, 8.6 +/- 1.3 cm H2O; M-0 degrees, 6.9 +/- 1.2 cm H2O, and M-30 degrees, 5.3 +/- 1.0 cm H2O. ICP was significantly lower in the M-0 degrees and M-30 degrees positions when compared to either R-0 degrees and R-30 degrees. When the effect of elevating the head of the bed 30 degrees was evaluated for infants whose ICP was greater than or equal to 7 cm H2O in the R-0 degrees and M-0 degrees positions, it was noted that there was a significant drop in ICP in the elevated positions. These data suggest that head position influences ICP significantly in the neonate probably due to venous congestion caused when the neck is turned, and hydrostatic pressure changes when the head of the bed is elevated. ICP fluctuations due to changes in head position may be deleterious to the infant at risk for intracranial hemorrhage (ICH) or cerebral edema.