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

Abstract

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.

Effect of time and body position on ventilation in premature infants

“…Repositioning can enhance lung function by improving respiratory rate (RR) (6), oxygenation (7), and respiratory muscle strength (8). Additionally, modifying positions in preterm infants instantaneously alters regional ventilation distribution (9).…”

Effects of Body Position and Time after Feeding on Gastric Residuals in LBW Infants

“…To prevent sudden infant death syndrome (SIDS), the non-prone position was recommended (American Academy of Pediatrics Task Force on Infant Positioning and SIDS, 1996). However, in the prone position the oxygenation was higher than in the supine position (Dimitriou et al, 2001;Mizuno & Aizawa, 1999). In addition, infants sleep more and quietly (Goto et al, 1999;Martin, Herrell, Rubin, & Fanaroff, 1979;Masterson, Zucker, & Schulze, 1987;Myers et al, 1998), cry less, and have more regular respirations, all of which may result in less air actually introduced into the stomach while in the prone position (Chang, Anderson, & Lin, 2002;Yu, 1975).…”

“…It is an important topic not only for its effects on feeding, but also on sleep and respiration for infants (Chang, Anderson, & Lin, 2002;Dimitriou et al, 2001;Goto, Maeda, Miriran, & Ariagno, 1999). Therefore, a well-designed study is needed for the development of more rational feeding strategies and better understanding for neonatal nursing interventions.…”

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

“…In other studies, the indicator that most improved oxygenation and oxygen saturation and reduced hypoxia was the prone position, thus promoting its use in newborns 6,[18][19][20][21] . Our results show that the elastic chest band had a strong influence on oxygen saturation.…”

“…Thus, it has been associated with greater advantages, such as increase in tidal volume, improvement in diaphragm function, reduction in thoracoabdominal asynchrony, increase in oxygenation, and also decrease in carbon dioxide [4][5][6] .…”