Postural effects on pulmonary function and heart rate of preterm infants with lung disease

Mendoza, Julita C.; Roberts, John L.; Cook, Larry N.

doi:10.1016/s0022-3476(05)82166-3

Cited by 46 publications

(32 citation statements)

References 10 publications

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“…Porém, a posição prona encontra-se fortemente associada à síndrome de morte súbita infantil, não sendo recomendada para recém-nascidos a termo sadios 17 . Outros estudos não encontraram diferenças na SpO 2 15,18 e no Vc 19 entre as duas posições.…”

Section: Introductionunclassified

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

Prone position and reduced thoracoabdominal asynchrony in preterm newborns

Oliveira

Rego²,

Pereira³

et al. 2009

J Pediatr (Rio J)

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“…and support of the rib cage with the elastic band. Previous studies only investigated the correlation between postural positioning and thoracoabdominal synchrony, describing enhancements in diaphragm function, oxygen saturation, and oxygen partial pressure, as well as reductions in heart rate and gastroesophageal reflux episodes 3,5,[12][13][14] .…”

Section: Discussionmentioning

confidence: 99%

“…With regard to heart rate, some studies show reduction 14 and others, an increase 1 in the mean value in the prone position. In our study, we found no significant differences between positions or evidence of association between comparisons.…”

Section: Variablesmentioning

confidence: 97%

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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Section: Discussionmentioning

confidence: 99%

“…19 -21 Although the precise physiological mechanism constituting the pronate quieting response has not been elucidated, the phenomenon has been put to good purpose by investigators concerned with preserving the preterm or high-risk infant's often precarious metabolic margin. [22][23][24] Interestingly, the pronate quieting response has not been investigated with infants who are among the most consistently fretful, sleep-fractured of newborns -infants withdrawing from prenatal exposure to narcotics.We hypothesized that newborns undergoing neonatal withdrawal, an acutely stressful, protracted, excitability syndrome, would be positively affected by position; we predicted that withdrawing newborns laid prone (face down) for sleep would be less symptomatic than similar neonates laid supine (face up). Symptomatic status, excitability, was reflected in this study using Neonatal Abstinence Scoring System (NASS) 25 withdrawal severity scores and increased caloric intake.…”

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confidence: 99%

Use of Positioning to Reduce the Severity of Neonatal Narcotic Withdrawal Syndrome

1999

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OBJECTIVE:This study tested the hypothesis that highly fretful, narcotic-withdrawing neonates experience less distress in a prone-lying position than comparable, supine-lying neonates. STUDY DESIGN:Equivalent numbers of randomly assigned, narcotic-withdrawing newborns were assigned to prone-lying (n ϭ 25) or supine-lying (n ϭ 23) conditions. Subjects in the two groups were similar with regard to gestational age, birth weight, and clinical presentation. Peak and mean withdrawal severity, as measured by Neonatal Abstinence Scoring System (NASS) scores and daily caloric intake, were compared between supine and prone groups by Wilcoxon's two-sample test. RESULTS:The prone-lying neonates had lower peak NASS scores (p Ͻ 0.0001), lower mean NASS scores (p Ͻ 0.0001), and lower caloric intake (p Ͻ 0.001) than supine-lying, narcotic-withdrawing newborns. CONCLUSION:The fretfulness associated with neonatal withdrawal and other stressful conditions can be moderated by laying the affected infant prone. The pronate quieting response is a significant, endogenous source of neonatal pacification.Within the first days of life, most infants born to narcotic-dependent women experience a stressful withdrawal syndrome marked by tremor, sleeplessness, hypertonia, irritability, and autonomic and gastrointestinal symptoms. 1,2 Moderate to severe neonatal withdrawal is associated with increased mortality and morbidity 3,4 and is typically treated with low-dose opiates (paregoric, tincture of opium) or barbiturates (phenobarbital) and behavioral interventions such as swaddling, rocking, and increased feeding. 5,6 Even when treated aggressively, neonatal withdrawal can require lengthy intervention and persist for weeks in a subacute form. 7,8 Over the past 25 years, numerous studies have confirmed that infants laid prone enjoy a range of behavioral and physiological advantages. The positive consequences of prone position for sleep include: fewer awakenings and increased time in quiet sleep, 9,10 more sleep with higher arousal thresholds, 11-13 lower levels of activity, 14,15 enhanced respiratory control, 16 -18 and diminished heart rate variability. 11,17 Newborns laid prone cry much less than supine-lying infants 11 and have decreased energy requirements. 19 -21 Although the precise physiological mechanism constituting the pronate quieting response has not been elucidated, the phenomenon has been put to good purpose by investigators concerned with preserving the preterm or high-risk infant's often precarious metabolic margin. [22][23][24] Interestingly, the pronate quieting response has not been investigated with infants who are among the most consistently fretful, sleep-fractured of newborns -infants withdrawing from prenatal exposure to narcotics.We hypothesized that newborns undergoing neonatal withdrawal, an acutely stressful, protracted, excitability syndrome, would be positively affected by position; we predicted that withdrawing newborns laid prone (face down) for sleep would be less symptomatic than similar neonates laid supine...

show abstract

Postural effects on pulmonary function and heart rate of preterm infants with lung disease

Cited by 46 publications

References 10 publications

Prone position and reduced thoracoabdominal asynchrony in preterm newborns

Prone position and reduced thoracoabdominal asynchrony in preterm newborns

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

Use of Positioning to Reduce the Severity of Neonatal Narcotic Withdrawal Syndrome

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