Elsevier

The Journal of Pediatrics

Volume 162, Issue 6, June 2013, Pages 1133-1137.e1
The Journal of Pediatrics

Original Article
Positioning Effects on Lung Function and Breathing Pattern in Premature Newborns

https://doi.org/10.1016/j.jpeds.2012.11.036Get rights and content

Objective

To compare breathing patterns and lung function in the supine, lateral, and prone positions in oxygen-dependent preterm infants.

Study design

Respiratory function in preterm infants receiving nasal continous positive airway pressure therapy for mild respiratory failure was evaluated by respiratory inductive plethysmography. Infants were randomized to supine, left lateral, and prone positions for 3 hours. A nest provided a semiflexed posture for the infants placed in the left lateral position, similar to the in utero position. Tidal volume (Vt), phase angle between abdominal and thoracic movements, rib cage contribution to Vt, and dynamic elevation of end-expiratory lung volume were measured.

Results

Fraction of inspired O2 was similar in the 3 positions for 19 infants (mean gestational age, 27 ± 2 weeks; mean birth weight, 950 ± 150 g; mean postnatal age, 17 ± 5 days). However, arterial O2 saturation and Vt were higher in the left lateral and prone positions than in the supine position (P < .05). The phase angle between abdominal and thoracic movements was lower and rib cage contribution to Vt was higher in the left lateral and prone positions than in the supine position (P < .05). Dynamic elevation of end-expiratory lung volume was greater in the supine position than in the left lateral and prone positions (P < .05).

Conclusion

In oxygen-dependent preterm infants, both the left lateral and prone positions improve lung function by optimizing breathing strategy. In the neonatal intensive care unit, the left lateral position can be used as an alternative to the prone position for mild respiratory failure.

Section snippets

Methods

Our study was conducted over a 6-month period in the neonatal intensive care unit at the Regional University Hospital of Lille, France. Inclusion criteria were preterm birth (gestational age 26-30 weeks), spontaneous breathing with nasal continuous positive airway pressure (NCPAP) therapy, and mild respiratory failure, defined as an oxygen requirement of 22%-35% to maintain arterial oxygen saturation (SpO2) between 88% and 95%, pH > 7.24, and PaCO2 <65 mm Hg. Exclusion criteria were circulatory

Results

All 19 preterm infants had received mechanical ventilation at birth for respiratory distress syndrome and received surfactant treatment within the first hour of life. Duration of the mechanical ventilation was less than 24 hours. NCPAP (Infant-Flow; Vyasis, CareFusion, Voisins le Bretonneux, France) was used to wean the infants from mechanical ventilation. At the time of the study, the infants were managed with NCPAP and received caffeine. Mean gestational age was 27 ± 2 weeks, and mean birth

Discussion

We hypothesized that the left lateral position and prone position would improve lung function and breathing strategy in our preterm infants. We found that transcutaneous SpO2 was higher and PaCO2 was lower in the left lateral and prone positions than in the supine position. Furthermore, the left lateral and prone positions were associated with fewer apneic and hypoxic episodes compared with the supine position. Compared with the supine position, the left lateral and prone positions increased

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    The authors declare no conflicts of interest.

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