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

Kassim, Zainab; Donaldson, Nora; Khetriwal, Babita; Rao, Harish; Sylvester, Karl; Rafferty, Gerrard F.; Hannam, Simon; Greenough, Anne

doi:10.1136/adc.2006.094078

Cited by 36 publications

(27 citation statements)

References 15 publications

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“…Isso corrobora os achados de alguns autores 14,15,18 e difere dos resultados observados em outros estudos, que demonstraram melhora significativa da SpO 2 em recém-nascidos pré-termo na posição prona 7,8,19 . As amostras desses estudos eram constituídas por recém-nascidos em ventilação mecânica ou, em sua maioria, por recém-nascidos em dependência de oxigênio.…”

Section: Peso Nounclassified

“…A literatura aponta para alguns benefícios da posição prona em relação à posição supina: aumento da saturação periférica da hemoglobina em oxigênio (SpO 2 ) 7,8 , aumento do volume corrente (Vc) 9,10 , redução do número de apneias centrais 11 , menor gasto energético 4 , melhora da sincronia toracoabdominal [12][13][14] , menor necessidade de reintubação de recém-nascidos pré-termo em desmame de ventilação mecânica 15 e redução dos episódios de refluxo gastroesofágico 16 . Porém, a posição prona encontra-se fortemente associada à síndrome de morte súbita infantil, não sendo recomendada para recém-nascidos a termo sadios 17 .…”

Section: Introductionunclassified

“…Assim, questiona-se ainda os reais benefícios das posições prona e supina em recém-nascidos a termo e pré-termo 8,15,23 .…”

Section: Introductionunclassified

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Prone position and reduced thoracoabdominal asynchrony in preterm newborns

Oliveira

Rego²,

Pereira³

et al. 2009

J Pediatr (Rio J)

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Objective: To assess the effect of prone and supine positions on breathing pattern variables, thoracoabdominal motion and peripheral oxygen saturation of hemoglobin of premature newborn infants recovering from respiratory distress syndrome, while breathing spontaneously and in rapid eye movement sleep. Methods:This was a quasi-experimental study. Twelve preterms weighing > 1,000 g at enrollment were studied in both positions, in random order. Respiratory inductive plethysmography was used to analyze breathing pattern (tidal volume, respiratory rate, minute ventilation, mean inspiratory flow) and thoracoabdominal motion (labored breathing index, phase relation in inspiration, phase relation in expiration, phase relation in total breath and phase angle). Pulse oximetry was used to evaluate peripheral oxygen saturation. Student's t test for paired samples or the Wilcoxon test were used for statistical analysis. Significance was set at p < 0.05. Results:A total of 9,167 respiratory cycles were analyzed. The prone position was associated with significant reductions in labored breathing index (-0.84±0.69; p = 0.001; 95%CI -1.29 to -0.40), phase relation in inspiration p = 0.000;, phase relation in expiration p = 0.000;) and phase relation in total breath (-30.20±14.76; p = 0.000; 95%CI -39.59 to -20.82). There were no significant differences between the two positions in any of the other variables analyzed. Conclusion:The prone position resulted in a significant reduction in thoracoabdominal asynchrony, without affecting breathing pattern or peripheral oxygen saturation. J Pediatr (Rio J). 2009;85(5):443-448:Prone position, supine position, premature newborn infants, respiratory distress syndrome. ResumoObjetivo: Avaliar a influência das posições prona e supina em recém-nascidos prematuros pós-síndrome do desconforto respiratório, respirando espontaneamente e em estado de sono ativo, sobre variáveis de padrão respiratório, movimento toracoabdominal e saturação periférica da hemoglobina pelo oxigênio.Métodos: Estudo quase experimental. Doze prematuros com peso > 1.000 g no momento do estudo foram estudados nas duas posições, em ordem randomizada. A pletismografia respiratória por indutância foi utilizada para avaliação do padrão respiratório (volume corrente, frequência respiratória, ventilação minuto, fluxo inspiratório médio) e do movimento toracoabdominal (índice de trabalho respiratório, relação de fase inspiratória, relação de fase expiratória, relação de fase respiratória total e ângulo de fase). A oximetria de pulso registrou a saturação periférica de oxigênio. Para a análise estatística foram realizados os testes t de Student para amostras pareadas ou Wilcoxon. Foi considerado significativo p < 0,05.Resultados: Foram analisados 9.167 ciclos respiratórios. Na posição prona, houve redução significativa do índice de trabalho respiratório (-0,84±0,69; p = 0,001; IC95% -1,29 a -0,40), das relações de fase inspiratória (-27,36±17,55; p = 0,000; IC95% -38,51 a -16,20), expiratória (-32,36±16,20; p = 0,000; IC...

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Section: Introductionunclassified

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Prone position and reduced thoracoabdominal asynchrony in preterm newborns

Oliveira

Rego²,

Pereira³

et al. 2009

J Pediatr (Rio J)

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“…The strongest evidence comes from clinical trials in preterm infants, where prone position provides greater physiological regulation than supine, with respect to respiration, cardiac function, metabolism, and state organization. Though some studies report no difference (19), prone sleep is recommended in preterm intensive care (20)(21)(22). The Cochrane review on position in mechanically ventilated infants states prone position will "slightly improve the oxygenation" (23).…”

Section: Re-examination Of Research On Prone and Supine Sleepmentioning

confidence: 99%

Proposal for mechanisms of protection of supine sleep against sudden infant death syndrome: an integrated mechanism review

Bergman

2014

Pediatr Res

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Supine sleep decreases sudden infant death syndrome (SIDS) incidence, however the mechanisms for this are unclear. The triple risk model for SIDS requires that one or more underlying abnormalities of breathing or autonomic control are present; these are rare, but brainstem defects are found in most SIDS cases. Supine sleep increases sympathetic nervous system tone, and level of state organization, and may therefore act as a stressor. This is evidenced by physiological arousal, and by delayed neurodevelopment in supine compared to prone sleepers. It is argued here that prone sleep position is the biological normative standard in healthy infants, supporting autonomic regulation. During rapid eye movement (REM) sleep (and other circumstances), a parasympathetic-mediated adverse autonomic event (AAE) may be spontaneously triggered. In healthy infants, gasping initiates autoresuscitation and recovery. Hypothesis: the underlying vulnerability to SIDS is specific to autoresuscitation from an AAE, the initial serotonin-dependent gasp is commonly compromised. Serotonin metabolism defects also influence sleep architecture, increasing the likelihood of AAE. The mechanism whereby supine sleep decreases SIDS may therefore be a stressor effect, disturbing sleep architecture to decrease REM and AAEs, and increasing sympathetic tone, which may prevent and counteract the purely parasympathetic-mediated AAE, thereby decreasing the risk of SIDS.

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“…Scientific records have shown that postural positions interfere positively in preterm newborns, contributing to improvement in oxygenation, reduction in gastroesophageal reflux episodes, reduction in thoracoabdominal asynchrony, among others [1][2][3] .…”

Section: Introductionmentioning

confidence: 99%

Response of oxygen saturation in preterm infants receiving rib cage stabilization with an elastic band in two body positions: a randomized clinical trial

Brunherotti¹,

Martinez²

2013

Braz. J. Phys. Ther.

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| Background: Preterm newborns have higher thoracic compliance, providing less stability to the different forces of distortion imposed on the rib cage, leading to instability of the chest. Adequate body position may reduce this instability and facilitate respiratory work. Objective: To assess the oxygen saturation response of preterm newborns receiving rib cage stabilization with an elastic band in two body positions. Method: A clinical, prospective, randomized crossover study was conducted, including sixteen newborns with a gestational age of 31 to 35 weeks (mean 32.8 weeks) at a tertiary care facility, who did not receive supplemental oxygen. The infants were placed in a sequence of prone and supine positions with and without chest stabilization with an elastic band. Respiratory rate, heart rate, and oxygen saturation were measured at 10-minute intervals, corresponding to 7 samplings of 60 minutes. Data collection was interrupted when oxygen saturation was less than 90%. Results: The mean gestational age of the infants was 32.8±1.5 weeks and the mean birth weight was 1,789±255g. Better values for the variables studied were observed in the supine position with an elastic chest band compared to the supine position without the band. The positions using an elastic band resulted in lower mean respiratory rate and heart rate and higher oxygen saturation. Conclusion: The use of an elastic chest band improves respiratory indicators such as oxygen saturation.Keywords: respiratory mechanics; preterm newborn; supine position; prone position; movement. Article registered in Registro Brasileiro de Ensaios Clinicos (ReBEC) under number RBR-7wm8mz. HOW TO CITE THIS ARTICLEBrunherotti MAA, Martinez FE. Response of oxygen saturation in preterm infants receiving rib cage stabilization with an elastic band in two body positions: a randomized clinical trial. Braz J Phys Ther.

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

Cited by 36 publications

References 15 publications

Prone position and reduced thoracoabdominal asynchrony in preterm newborns

Prone position and reduced thoracoabdominal asynchrony in preterm newborns

Proposal for mechanisms of protection of supine sleep against sudden infant death syndrome: an integrated mechanism review

Response of oxygen saturation in preterm infants receiving rib cage stabilization with an elastic band in two body positions: a randomized clinical trial

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