Prone position and reduced thoracoabdominal asynchrony in preterm newborns

Abstract

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...

Feasibility and reproducibility of spirometry and inductance plethysmography in healthy Brazilian preschoolers

“…The former assessed between 8 and 15 breaths for each subject, whereas we assessed, on average, 215 cycles per child. Authors examining a large number of respiratory cycles also observed high values of standard deviation of the variables for thoracoabdominal motion 17, 18, 25…”

“…This is a noninvasive method that requires little effort from the individual. The measures are based on changes in the cross‐sectional area of the chest wall and are captured by two bands of inductance,16 one positioned in the axilla and the other placed in the umbilical line, according to established criteria 10, 17, 18. The devices provide breath waveform sampling at 50 points/sec.…”

“…The devices provide breath waveform sampling at 50 points/sec. Calibration was performed using the Qualitative Diagnostic Calibration,17 considering an estimated volume of 6 ml/kg 18…”

Effects of prone and supine positioning on gastric residuals in preterm infants: A time series with cross-over study

“…Table 3 Comparison of the decrease in gastric residuals in the supine and prone positions at feeding volumes of 50 ml/kg/day (stage 1) and 100 ml/kg/day (stage 2). and hypoxia, and better thoracoabdominal synchrony (Oliveira et al, 2009). Infants sleeping in the prone position also have higher surface temperatures and narrower central to peripheral temperature gradients (Ammari et al, 2009), and can sleep for longer, as well as experience fewer awakenings and arousals per hour, with a greater sleep efficiency (Myers et al, 1998).…”

Effect of body position on preterm newborns receiving continuous positive airway pressure

“…The mean rates were very similar, with a variation of less than one breath per minute between the four decubitus positions, and no significant difference was observed between positions. Studies have shown that body position does not interfere with respiratory rate in clinically stable preterm or full-term newborns (3,22). However, body position was found to exert an effect on the respiratory rate of preterm newborns during sleep, in infants receiving supplemental oxygen and during gavage feeding, with lower variability and lower mean values being observed in the prone position (3,6,(10)(11)(12)23).…”