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Changes in cardiac output and cerebral oxygenation during prone and supine sleep positioning in healthy term infants
  1. Tai-Wei Wu1,2,
  2. Rey-In Lien3,
  3. Istvan Seri2,
  4. Shahab Noori1,2
  1. 1Division of Neonatology, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
  2. 2Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
  3. 3Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan
  1. Correspondence to Dr Tai-Wei Wu, Division of Neonatology, Fetal and Neonatal Institute, Children's Hospital Los Angeles, 4650 Sunset Blvd; MS #31 Los Angeles, CA 90027, USA; twu{at}


Objective To investigate the changes in systemic and cerebral haemodynamics between supine and prone sleep in healthy term infants during the early postnatal period.

Design/methods Healthy term infants without congenital anomalies, patent ductus arteriosus and/or small for gestational age status were enrolled. Infants were placed in supine (SP1), prone (PP) and back in supine (SP2) position for 15 min each while asleep. Cardiac output (CO) and stroke volume (SV) were assessed by electrical velocimetry (EV) and echocardiography (echo), and cerebral regional oxygen saturation (CrSO2) in the frontal lobes was monitored by near-infrared spectroscopy. Heart rate (HR) and SpO2 were continuously monitored by conventional monitoring.

Results In 34 healthy term infants (mean age 3.7±1.2 days; 16 females), 66 sets of serial CO measurements (34 EV and 32 echo) in three sleep positions were obtained. Mean COEV and COecho were 182±57 (SP1), 170±50 (PP) and 177±54 (SP2), and 193±48 (SP1), 174±40 (PP) and 192±50 (SP2) mL/kg/min, respectively. Mean SVEV and SVecho were 1.46±0.47 (SP1), 1.36±0.38 (PP) and 1.37±0.39 (SP2), and 1.54±40 (SP1), 1.38±0.38 (PP) and 1.51±0.41 (SP2) mL/kg, respectively. Repeated measures analysis of variance revealed a decrease in CO and SV during prone positions by both EV and echo, while HR, SpO2 and CrSO2 did not change. Thirty-eight per cent of the CO measurements decreased ≥10% during prone positioning.

Conclusions In healthy term infants, CO decreases in prone position due to a decrease in SV and not HR. CO recovers when placed back in supine. However, frontal lobe CrSO2 does not change in the different positions.

  • cardiac output
  • echocardiography
  • electrical velocimetry
  • hemodynamics
  • near infrared spectroscopy
  • prone position
  • sudden infant death syndrome

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  • Contributors T-WW made substantial contributions to the conception or design of the work and was responsible for the acquisition, analysis or interpretation of data, and drafted and revised the manuscript. R-IL, IS and SN made substantial contributions to the conception or design of the work.

  • Competing interests None declared.

  • Ethics approval Institution Review Board of Chang Gung Memorial Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Supplementary unpublished data related to the manuscript are available to all upon request by email to

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