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Oxygen saturation and lung volume-effect of sleeping position and postmenstrual age (PMA) in oxygen and non-oxygen dependent prematurely born infants

Presented at the Neonatal Society 2005 Summer Meeting (programme).

Kassim Z, Khetriwal B, Rao H, Sylvester K, Rafferty GF, Hannam S, Greenough A

Division of Asthma, Allergy and Lung Biology, Guy’s, King’s and St Thomas’ School of Medicine, King’s College London, Denmark Hill, London SE5 9RS, UK

Background: Supine sleeping is frequently only started close to NICU discharge in prematurely born infants (1). Yet, we have shown that at 36 weeks PMA, sleeping position only affects the respiratory status of oxygen dependent infants (2). Demonstration that the supine position is safe in younger non-oxygen dependent infants might further reassure staff and parents to promote supine sleeping and reduce prone sleeping following discharge.

Aim: To test the hypothesis that prone versus supine positioning is associated with superior oxygenation and lung volumes from 32 weeks PMA only in oxygen dependent and not in nonoxygen dependent infants.

Patients: Infants born prior to 32 weeks of gestational age.

Methods: Infants were studied both supine and prone: each posture maintained for at least one hour. Oxygen saturation (SaO2) was monitored continuously and at the end of each period lung volume was assessed by measurement of functional residual capacity (FRC). This study was approved by the Research Ethics Committee of the King’s Healthcare NHS Trust.

Results: Overall, the median SaO2 and FRC were significantly higher in the prone position at 32 (n=15) and 34 weeks PMA (n=20). Analysis of the data according to oxygen dependency status, however, demonstrated that the higher lung volumes in the prone position only reached statistical significance at 38 weeks PMA and only in the oxygen dependent group. The median SaO2 levels in the non oxygen dependent group were similar at 32 and 34 weeks PMA, but tended to be higher in the prone position at 34, 36 and 38 weeks PMA in the oxygen dependent group.

Conclusion: These results suggest supine sleeping could be safely instituted at 32 weeks PMA in non-oxygen dependent infants.

1 Bhat RY, Leipala JA, Rafferty GF, Hannam S, Greenough A. Eur J Pediatr 2003; 162(6):426-7.
2 Bhat RY, Leipala JA, Singh NR, Rafferty GF, Hannam S, Greenough A. Pediatrics 2003;112: 29-32.

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