Sleeping position, oxygen saturation and lung volume in convalescent, prematurely born infants

Zainab Kassim ¹, Nora Donaldson ¹, Babita Khetriwal ¹, Harish Rao ¹, Karl Sylvester ¹, Gerrard F Rafferty ¹, Simon Hannam ¹ and Anne Greenough ^1*

¹ King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, United Kingdom

^* To whom correspondence should be addressed. E-mail: anne.greenough{at}kcl.ac.uk.

Accepted 21 September 2006

Abstract

Objective: To determine if the effects of sleeping position on lung volume and oxygenation were influenced by postmenstrual age and oxygen dependency status in convalescent prematurely born infants.

Design: Prospective study.

Setting: Tertiary neonatal unit.

Patients: Forty one infants (21 oxygen dependent), median gestational age 28 (range 24-31) weeks and birthweight 1120 (range 556-1780) gms were studied.

Interventions: Infants were studied both supine and prone at two weekly intervals from 32 weeks PMA until neonatal unit discharge. Each posture was maintained for one hour.

Main outcome measures: Oxygen saturation (SpO2) was monitored continuously and at the end of each one hour period, functional residual capacity (FRC) was measured.

Results: Overall, lung volumes were higher in the prone position throughout the study period; there was no significant effect of PMA on lung volumes. Overall, SpO2 was higher in the prone position (p=0.02), the effect was significant in the oxygen dependent (p=0.03) (mean difference in SpO2 levels between the prone and supine positions was 1.09, 95% CI 0.11 to 1.92), but not in the non oxygen dependent infants. There was no significant influence of PMA on oxygen saturation.

Conclusion: Prone sleeping did not improve the oxygenation of prematurely born infants without ongoing respiratory problems who are 32 weeks PMA or older. The infants, however, were only monitored in each position for one hour, thus we would recommend continuing monitoring oxygen saturation after 32 weeks PMA to be sure longer periods of supine sleeping were not associated with loss of lung volume and hypoxaemia.

Keywords: bronchopulmonary dysplasia, lung volume, oxygen saturation, preterm

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