The Effects of Environmental Noise and Infant Position on Cerebral Oxygenation

Abstract

Purpose To assess how different infant positions and peak sound levels effected cerebral oxygen saturation over time. Subjects Twenty-four premature infants who were born less than 32 weeks gestational age without congenital cardiac, neurological, and gastrointestinal anomalies. Design Repeated measures design with the first observation between 2 and 48 hours of life; once again between 49 and 96 hours of life; on Day of Life 7; and every 7 days thereafter until discharge home, transfer to another hospital, or 40 weeks post-menstrual age, whichever came first. Methods Continuous sound levels (decibels) were obtained and two infant positions were performed while measuring cerebral oxygen saturation during 40-minute observation periods. Main outcome measures Effect of peak sound and differences in infant position on cerebral oxygen saturation. Principal results Peak sound levels 5 decibels above the average ambient sound level did not significantly change cerebral oxygen saturation values. Differences in cerebral oxygenation were significantly less when infants were changed from a supine, head midline position to a right lateral, 15° head elevation compared to a left lateral, 0° elevation position. Conclusions Aspects of the current NICU environment do not appear to affect cerebral oxygen saturation.

The Effect of Head Positioning and Head Tilting on the Incidence of Intraventricular Hemorrhage in Very Preterm Infants: A Systematic Review

“…Two studies included infants with a postnatal age ≤72 h [30,33]. Postnatal age in the other three studies varied considerably within, as well as between studies, ranging from 1 h to 3 weeks [31,32,34]. The designs of the included studies were predominantly prospective observational; there was 1 RCT.…”

“…After reading the full-text articles, 24 of these 29 articles did not meet the inclusion criteria and were therefore excluded (12 reports on children/infants with a GA >30 weeks, 7 described no relevant outcome parameters, 1 letter to the editor, 1 case report, and 3 poster abstracts). Finally, 5 studies were included in this systematic review [30,31,32,33,34]. Figure 1 provides a flowchart of the study selection.…”

Positioning of Premature Infants Receiving Mechanical Ventilation in a Neonatal Intensive Care Unit: Review

“…24 Ayrıca, bu bebeklere pozisyon verirken başının orta hatta tutulması venöz dönüşü kolaylaştırarak kafa içi kanama olasılığını azalt-maktadır. 26,27 Bebek, başı orta hatta, gövdesi fleksiyonda olacağı, kendini rahatlatabileceği ve yatış şek-lini değiştirebileceği pozisyonda yatırılmalıdır. Zamanında doğan bebeklerle karşılaştırıldığında prematüre bebekler daha hipotonik olduğundan, fleksiyon postürünü korumaları için desteklenmeleri daha önemlidir.…”

Cerebral Tissue Oxygenation in Postural Changes in Mechanically Ventilated Preterm Newborns Less than 72 Hours after Birth

“…However, there is currently no consensus on which position is suitable for very preterm neonates in the early days of life. For example, some studies evaluating alterations of cerebral oxygenation with head positioning and/or bed tilting on non-mechanically ventilated infants (24)(25)(26), or others assessing the effects of supine or prone positioning on ventilated and spontaneous breathing of premature newborns have reported that cerebral oxygenation was not significantly affected by changes in positioning (24,27).…”