A comparison of prone and supine positioning in the immediate postextubation period of neonates

Lioy, Janet; Manginello, Frank P.

doi:10.1016/s0022-3476(88)80230-0

Cited by 45 publications

(17 citation statements)

References 3 publications

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“…21 In addition, they emphasised that the prone posture increases intra-abdominal pressure, passively distending the diaphragm and stabilising the compliant chest wall. 22 The postulated effect of the prone posture on diaphragmatic function in healthy term neonates 20 is not supported by either our findings of a higher PIMAX in the supine compared with the prone posture or postural differences in diaphragm configuration recently described in healthy term neonates. 10 Using ultrasonographic examination, Relian et al 10 showed that the diaphragm was significantly thicker at end expiratory volume in the prone than in the supine posture.…”

Section: Discussioncontrasting

confidence: 68%

Effect of posture on oxygenation and respiratory muscle strength in convalescent infants

Dimitriou

Greenough²,

Pink

et al. 2002

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Objective: To determine if differences in respiratory muscle strength could explain any posture related effects on oxygenation in convalescent neonates. Methods: Infants were examined in three postures: supine, supine with head up tilt of 45°, and prone. A subsequent study was performed to determine the influence of head position in the supine posture. In each posture/head position, oxygen saturation (SaO 2 ) was determined and respiratory muscle strength assessed by measurement of the maximum inspiratory pressure (PIMAX). Patients: Twenty infants, median gestational age 34.5 weeks (range 25-43), and 10 infants, median gestational age 33 weeks (range 30-36), were entered into the first and second study respectively. Results: Oxygenation was higher in the prone and supine with 45°head up tilt postures than in the supine posture (p<0.001), whereas PIMAX was higher in the supine and supine with head up tilt of 45°p ostures than in the prone posture (p<0.001). Head position did not influence the effect of posture on PIMAX or oxygenation. Conclusion: Superior oxygenation in the prone posture in convalescent infants was not explained by greater respiratory muscle strength, as this was superior in the supine posture.

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Section: Discussioncontrasting

confidence: 68%

Effect of posture on oxygenation and respiratory muscle strength in convalescent infants

Dimitriou

Greenough²,

Pink

et al. 2002

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…Preterm infants recovering from respiratory illness consistently had improved oxygenation and thoracoabdominal synchrony when cared for in the prone position. These findings were attributed to higher lung volumes, 14,15 enhanced ventilation/perfusion ratios, improved chest wall mechanics [15][16][17][18] and respiratory muscle tone, 18 increased time sleeping, 19 and decreased energy expenditure. 20 It is important to note that in convalescing infants, oxygenation and functional residual capacity are improved in oxygen-dependent infants positioned prone; however, these parameters were not improved in infants of similar postmenstrual ages (PMA) who did not need supplemental oxygen.…”

Section: Benefits Of Prone and Side-lying Positioning In Hospitalizedmentioning

confidence: 99%

Nicu Nurses' Knowledge and Discharge Teaching Related to Infant Sleep Position and Risk of Sids

Aris

Stevens

LeMura

et al. 2006

Advances in Neonatal Care

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Nearly 95% of respondents identified a nonsupine sleep position as optimal for hospitalized preterm infants. Further, only 52% of neonatal nurses routinely provide discharge instructions that promote supine sleep positions at home. This study suggests that nursing self-reports of discharge teaching practices are inconsistent, and in some cases in direct conflict with the national "Back to Sleep" recommendations, which emphasize that the supine position is the safest position for healthy full-term and preterm infants after hospital discharge.

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“…When supine, 21 intubated NICU infants on ventilators had evidence of obstructed cerebral venous drainage when their heads were turned to the side, which suggests that acutely ill infants in supine should be positioned with their heads midline [Pellicer et al, 2002]. Several studies have found more effective breathing and oxygenation in preterm infants with lung disease in the prone position (compared to supine and sidelying) [Martin et al, 1979;Lioy and Manginello, 1988;Baird et al, 1991;Mizuno and Aizawa, 1999;Maynard et al, 2000;Chang et al, 2002], but not in healthy preterm infants [Fox et al, 1993]. Repositioning the infant is an effective method for treating apnea of prematurity.…”

Section: Positioning and Handlingmentioning

confidence: 99%

Neurodevelopmental care in the NICU

Aucott

Donohue

Atkins

et al. 2002

Ment. Retard. Dev. Disabil. Res. Rev.

101

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Neurodevelopmental care, which is any NICU intervention undertaken to improve neurodevelopmental outcome, includes NICU design, nursing routines, nursing care plans, management of pain, feeding methods and, most importantly, encouraging parental involvement with their NICU infant. Recognition that sensory stimulation can overwhelm preterm infants and increase physiologic signs of stress led to attempts to reduce sensory input. More recent approaches judiciously add back soothing sensory input (e.g., therapeutic touch, soft music). Circadian light/dark cycles and physical activity improve preterm growth. Attention to infant positioning and handling affects physiologic variables and joint mobility, if not functional motor abilities. A highly organized system of care for NICU infants is Als' NIDCAP (i.e., Neonatal Individualized Developmental Care and Assessment Program). Although NIDCAP may reduce need for respiratory support and hospital length of stay, it does not significantly influence neurodevelopmental outcome at 2-3 years. Pain management includes benign interventions (e.g., nonnutritive sucking, oral glucose), but the prolonged use of narcotics must be balanced against the consequences of sedation and dependency. The foremost challenge for NICUs remains parent disenfranchisement. Kangaroo care, which involves parent/infant skin-to-skin contact, improves preterm growth, decreases nosocomial infections and may shorten hospital length of stay. A great deal of work needs to be done to identify and demonstrate efficacy of specific interventions and changes that humanize the NICU, encourage parental involvement, support infant development and optimize preterm neurodevelopmental outcomes.

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A comparison of prone and supine positioning in the immediate postextubation period of neonates

Cited by 45 publications

References 3 publications

Effect of posture on oxygenation and respiratory muscle strength in convalescent infants

Effect of posture on oxygenation and respiratory muscle strength in convalescent infants

Nicu Nurses' Knowledge and Discharge Teaching Related to Infant Sleep Position and Risk of Sids

Neurodevelopmental care in the NICU

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