[Show abstract][Hide abstract] ABSTRACT: The prone sleeping position, particularly in prematurely born infants, is associated with an increased risk of sudden infant death syndrome. A possible mechanism is an impaired ability to respond to respiratory compromise. The hypothesis that the ventilatory response to a carbon dioxide (CO(2)) challenge in convalescent, prematurely born infants would be lower in the prone compared with the supine position was therefore tested.
In each position, ventilatory responses to increasing levels of inspired CO(2) were assessed. The airway pressure change after the first 100 ms of an occluded inspiration (P(0.1)) and the maximum inspiratory pressure with an occluded airway during crying (P(imax)) were measured; the ratio of the P(0.1) to the P(imax) at each inspired CO(2) level and the slope of the P(0.1)/P(imax) response were calculated. Chest and abdominal wall asynchrony was assessed using inductance plethysmography and functional residual capacity (FRC) measured using a helium gas dilution technique.
Eighteen infants with a median postmenstrual age of 35 (range 35-37) weeks were studied. In the prone versus the supine position, the mean P(0.1) (p=0.002), the mean P(imax) (p=0.006), the increase in P(0.1) with increasing CO(2) (p=0.007) and the P(0.1)/P(imax) response slope (p=0.007) were smaller. Thoracoabdominal asynchrony was not significantly influenced by position or inspired CO(2). FRC was higher in the prone position (p=0.019).
Convalescent, prematurely born infants have a reduced ventilatory response to CO(2) challenge in the prone position, suggesting they may have an impaired ability to respond to respiratory compromise in that position.
[Show abstract][Hide abstract] ABSTRACT: Objective:
To compare breathing patterns and lung function in the supine, lateral, and prone positions in oxygen-dependent preterm infants.
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.
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).
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.
The Journal of pediatrics 01/2013; 162(6). DOI:10.1016/j.jpeds.2012.11.036 · 3.79 Impact Factor
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