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Effect of position on pulmonary mechanics in healthy preterm newborn infants
R E Fox1, R M Viscardi, V L Taciak
1Department of Pediatrics, University of Maryland School of Medicine, Baltimore.
Insights
Prone positioning does not negatively impact pulmonary function in healthy preterm infants. This suggests prone positioning can support developmental needs without compromising respiratory health.
Area of Science:
- Neonatal Physiology
- Respiratory Mechanics
Background:
- Preterm infants often require supine positioning for care.
- Prone positioning may benefit neurodevelopment but could impact pulmonary function.
Purpose of the Study:
- To investigate the effects of prone versus supine positioning on pulmonary mechanics in healthy preterm infants.
Main Methods:
- Pulmonary mechanics were measured in 11 preterm infants (mean GA 31.7 weeks) using pneumotachography and esophageal balloons.
- Measurements were compared between supine and prone positions.
- Intrasubject variability was assessed in a separate group.
Main Results:
- No significant differences in respiratory rate, oxygen saturation, tidal volume, minute ventilation, pulmonary resistance, or dynamic compliance were observed between positions.
- Heart rate showed a statistically, but not clinically, significant increase in the prone position.
- Intrasubject variability was within acceptable limits.
Conclusions:
- Prone positioning does not adversely affect pulmonary mechanics or oxygen saturation in healthy preterm infants.
- Prone positioning is a viable option to support the developmental needs of preterm infants.
Abstract:
Preterm infants are often placed in the supine position to facilitate care and observation. Prone positioning may positively affect later neurodevelopmental outcome, but it may also affect pulmonary function. Using a computerized system, we examined the effect of positioning on pulmonary mechanics in spontaneously breathing healthy preterm infants. Eleven infants with a mean birth weight (+/- SD) of 1523 +/- 171 gm and a mean gestational age (+/- SD) of 31.7 +/- 1.5 weeks were studied during the first 2 weeks of life. Pulmonary mechanic measurements were obtained in both supine and prone positions by mask pneumotachography and esophageal balloon technique. Respiratory rate and oxygen saturation were unaffected by positioning. There was a statistically, but not clinically, significant increase in heart rate in the prone position. However, there were no significant differences in tidal volume, minute ventilation, pulmonary resistance, or dynamic compliance between positions. The contribution of intrasubject variability of serial measurements was assessed in a separate group of four infants studied three times in the same position. There was no significant difference in respiratory rate, tidal volume, dynamic compliance per kilogram, or total pulmonary resistance in the same infant when studied in the same position over time (p > or = 0.24). The maximum variability (95% confidence limit) was 25.5% for tidal volume, 21% for dynamic compliance, and 44.3% for resistance. Because prone positioning did not adversely affect pulmonary mechanics or oxygen saturation in these healthy preterm infants, we suggest that prone position be used to facilitate the developmental needs of these infants.