Effect of nursing position on incidence, type, and duration of clinically significant apnoea in preterm infants.

L O Kurlak, N R Ruggins and T J Stephenson

Department of Child Health, University Hospital, Nottingham.

AIM--To investigate whether nursing position has any effect on the frequency, type, and duration of apnoeas in preterm infants. METHOD--Thirty five preterm infants were entered into a crossover study and underwent polygraphic monitoring in each of two positions, prone and supine, the initial position being randomly allocated. Four parameters were recorded: nasal airflow, respiratory effort, electrocardiogram (ECG), and oxygen saturation. Each infant was studied in the two positions on the same day and each infant was studied only once. The studies were carried out on the neonatal intensive care unit. RESULTS--The infants were found to have significantly more central and mixed apnoeas in the supine than in the prone position. In addition, the severity of mixed apnoeas in terms of the duration of accompanying bradycardias and desaturations was greater in the supine than in the prone position (median difference 5.1 seconds in both instances). When considering the type of apnoea in relation to the duration, it was found that of those less than 20 seconds in duration there was a greater proportion that were central (25%) compared with the proportion of central (5%) apnoeas that were longer than 20 seconds. Of all the apnoeas that were less than 20 seconds in length, 16% were obstructive and 59% were mixed, whereas of the apnoeas greater than 20 seconds, 13% were obstructive and 82% were mixed. CONCLUSIONS--It appears that in addition to improving measures of lung function, the adoption of the prone nursing position for preterm infants may reduce associated problems of apnoea of prematurity.

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