Prone position
7/15/2012
-no particular body positions produce relevant and sustained improvement in
oxygenation in infants receiving assisted ventilation. Prone position for short periods
slightly improve oxygenation and reduce episodes of poor oxygenation (saO2 goes up).
(Balaguer A, Escribano J, Rogue M. 2006, infant position in neonates receiving
mechanical ventilation. Cochrane Database Systematic Reviews, CD003668.
Pulse oxygen saturation & functional residual capacity was taken for one hour
every 2 wks until discharge in infants with and without oxygen dependency in prone and
supine position. Lung volumes were higher in the prone position throughout, SpO2 was
higher in prone position only in oxygen dependent infants. Prone sleeping did not
improve oxygenation in preterms 32 weeks and older without respiratory probs, therefore
32 weeks and older infants should be maintained in supine position, but continue to
monitor them because loss of lung volume and hypoxemia may occur. (Kassim Z,
Donaldson N, Khetriwal B. et al., 2007. Sleeping position, oxygen saturation, and lung
volume in convalescent, prematurely born infants. Arch Dis Child Fetal Neonatal Ed 92,
F347-F350.
Bauer K. (2005). Interventions involving positioning and handling in the neonatal intensive care unit:
Early developmental care and skin-to-skin holding. In J. Sizun & JV Browne (Eds.). Research on Early
Developmental Care for Preterm Infants. Montrouge, France; John Libbey Eurotext, pp. 59-65. This is a
review that covers prone positioning, SIDS, prone sleeping helps acquire motor milestones earlier (pg. 60),
supine positioning does not prevent asymmetrical postures which increase functional asymmetries that prone
positioning does not, head up positioning minimizes apnea and bradycardia for 6 hours (Jenni OG et al, in
Pediatr1997, vol 100, 622-625), swaddling, nesting, postural support, sling carrying, minimal handling, and KC
is on page 62-63. They conclude on page 63 that “skin to skin care has several aspects that support the infant’s
neurobehavioral development. It promotes stability of heart and respiratory function, it is a time when infant
is protected from painful interventions, it offers opportunity for maternal proximity and interaction, and
provides stimulation by skin to skin contact, stroking, and by the sound of the mother’s body and voice
Reported short term benefits are an increase in sleep time. Yet, there are few studies of medium-term or longterm effects of skin to skin holding on neurodevelopment. Review, Preterm, development, devel care, HR,
RR, A/B, prone, interaction, swaddling
Chang, Y.J., Anderson, G.C. & Dowling, D., Lin, C.H. (2002). Decreased
activity and oxygen desaturation in prone ventilated preterm infants during the first
postnatal week. Heart and Lung, 31(1), 34-42. Same study as next Chang but desat was
defined as SaO2<90% and > or = to 20 seconds. 28 infants on mechanical ventilation
had higher SaO2, fewer episodes of oxygen desaturation and less motor activity in prone
than supine. No significant differences in duration of SaO2 <90%, 85%, and 80% were
found between the two positions. 74% of desats were associated with vigorous motor
activity and crying. Prone position may stabilize oxygenation for ventilated preterm
infants and conserve energy and decrease hypoxic complications for sick preterms.
Chang, YJ., Anderson, G.C. Lin, C.H. (2002) Effects of prone and supine
positions on sleep state and stress responses in mechanically ventilated preterm infants
during the first postnatal week. Journal of Advanced Nursing, 40(2), 161-169. 25=36
wk GA ≤7 days old and without sedation and anomalies were in cross over study of 2
hours each of prone and supine positioning with data collection starting after 10 minutes
for adaptation. Care procedures were minimal and settings did not change. ABSS
behavioral state was recorded every minute and signs of stress (startle,tremor, twitch)
analyzed by Repeated Measures Analysis of Variance. When prone, there was less
crying, less active sleep, increased quiet sleep and decreased stress responses. Kc
IMPROVED QUALIT OF SLEEP and may assist in conserving energy and adapting to
extrauterine life.
Heinmann, K., Vaessen, P., Peschgens, T., Stanzel, S., Wenzl, T.G. & Orlikowsky T. (2010). Impact
of skin-to-skin care, prone and supine positioning on cardiorespiratory parameters and thermoregulation in
premature infants. Neonatology, 97(4), 311-317. DOI: 10.1159/000255163 Skin-to-skin care and supine
position are standard positions. Influence on cardiorespiratory parameters and thermal regulation are discussed
controversially. Compared KC with prone and supine position and tested H1: KC has no impact on
cardiovascular parameters and thermoregulation. 18 spontaneously breathing PT infants (Median GA= 28
weeks, 24-32; chronologic age 36 days (7-64 days) and weight 1543 gm (R=750-2100 gm). HR, RR, breathing
pattern, desat episodes (<85 &>80; <80), oxygen saturation, rectal temperature in Germany in a 6 hour
measuring cycle of three subsequent series. 120 mins each in SSC and prone position and supine position, then
compared by Wilcoxon. During KC no increase in apnea nor bradycardic episodes and no difference in
respiratory rate, breathing pattern, oxygen saturation episodes and duration of desats compared to supine or
prone. Episodes of desat <85 and >80 and <80 were more frequent in supine than prone. HR increased in KC
and prone compared to supine, and temp ws not sig higher during KC and prone compared to supine except a
rise between the start and end of the 6 hour measuring cycle. No sign that KC mediated changes in quality or
quantity of desats and in body temps compared to prone in preterm infants. Supine was worst position for
preterm infant. PT, HR, RR, SaO2, desats, temperature, prone, supine very low birth weight,
micropreemieNOT on Charts 2/17/2011 GET THIS Costs 26.50 for the article VERY IMPORTANT
ARTICLE for argument that KC position is as safe as supine positioning and being prone does not harm infant.