Elsevier

The Journal of Pediatrics

Volume 130, Issue 2, February 1997, Pages 305-309
The Journal of Pediatrics

Prone positioning decreases episodes of hypoxemia in extremely low birth weight infants (1000 grams or less) with chronic lung disease,☆☆,

Presented in part at the Annual Meeting of the Society for Pediatric Research, San Diego, Calif., May 1995.
https://doi.org/10.1016/S0022-3476(97)70360-3Get rights and content

Abstract

Extremely low birth weight infants with chronic lung disease (CLD) have frequent episodes of desaturation (hypoxemia). We quantified oxygenation and episodes of hypoxemia in 55 infants (birth weight ≤1000 gm) with CLD in the supine versus prone position, for 1-hour time intervals. Oxygen saturation was measured with the Nellcor N-200 pulse oximeter and a computer program. Prone positioning increased oxygen saturation from 92.0% to 94.1% ( p <0.001) and significantly decreased episodes of hypoxemia to oxygen saturation levels of less than 90%, 85%, and 80% ( p <0.001). Our findings support prone positioning for the extremely low birth weight infant with CLD in an intensive care setting. (J Pediatr 1997;130:305-9)

Section snippets

METHODS

Fifty-five neonates with CLD were prospectively studied during a 3-year period in the neonatal intensive care unit at Sacred Heart Hospital, Pensacola, Fla., and at Los Angeles County and University of Southern California Medical Center. The study was approved by the institutional review board at both institutions.

RESULTS

Prone positioning resulted in an overall increase in Sa o 2 from 92.0% ± 0.4% to 94.1% ± 0.4% (mean ± SEM; p <0.001). When an infant was prone, there was also a decrease in the percentage of time of desaturation to Sa o 2 of less than 90%, 85%, and 80% ( p <0.001), and a significant decrease in the percentage of time that the infants had Sa o 2 between 76% and 80%, 81% and 85%, and 86% and 90% ( p <0.001; Figure).

Figure. A, Spontaneous hypoxemia (%desaturation) to levels of less than 90%, 85%,

DISCUSSION

Neonates with acute lung disease are traditionally managed in the supine position to facilitate observation, easy access, and umbilical line management. However, as lung disease progresses, preterm infants manifest frequent episodes of hypoxemia. 1, 2 At this point, caretakers often choose the prone position as optimal for the infant from both an oxygenation and a comfort standpoint. Prior studies have demonstrated that prone positioning improves oxygenation in preterm infants with respiratory

Acknowledgements

We thank Dr. Richard J. Martin for critical review of the manuscript and the staff members of the newborn intensive care units for their support and cooperation.

References (14)

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From the Division of Neonatology, Department of Pediatrics, Sacred Heart Hospital, University of Florida, Pensacola, and the Division of Neonatology, Department of Pediatrics, Los Angeles County and University of Southern California Medical Center, Los Angeles.

☆☆

Reprint requests: Cindy McEvoy, MD Division of Neonatology, Sacred Heart Hospital, 5149 North Ninth Ave., Suite 302, Pensacola, FL 32504.

0022-3476/97/$5.00 + 0 9/22/77679

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