Prone versus supine position for regional cerebral tissue oxygenation in preterm neonates receiving noninvasive ventilation

Abstract

Objective

The prone position was found to improve oxygenation and pulmonary functions in neonates receiving respiratory support. However, how this improvement changes brain tissue oxygenation has not been studied. We aimed to investigate how prone position effects regional cerebral oxygen saturation (rScO₂) and cerebral fractional oxygen extraction (FOE) in preterm neonates during noninvasive ventilation (NIV).

Methods

Preterm neonates < 37 weeks gestational age (GA) stable on NIV were enrolled. NIV was defined as nasal continues positive airway pressure or intermittent positive pressure ventilation via binasal prongs. Near infrared spectroscopy was used to measure rScO₂. Monitoring was started when the infant was lying supine for at least 1 h and continued at the same body position at least for 1 h. Later the infant was changed to prone position and monitored for additional 3 h. Arterial oxygen saturation (SO₂) was also continuously monitored and FOE was calculated from rScO₂ and SO₂.

Results

Mean GA and birth weight of the cohort (n = 32) were 30.63 ± 3.09 weeks and 1459 ± 581 g, respectively. There were 14 females and 18 males. Both SO₂ (95 ± 2.2% versus 96.2 ± 1.9%, p = .001) and rScO₂ (79.2 ± 3.4% versus 82.1 ± 3.2%, p < .001) were higher in prone position compared to supine position. Cerebral FOE (16.6 ± 0.8% versus 14.7 ± 0.8%, p < .001) and respiratory rate (57.3 ± 5.5 versus 55.6 ± 9.2, p = .003) were lower in prone position.

Conclusion

In preterm newborns, receiving nasal NIV for mild to moderate respiratory distress, arterial and cerebral oxygenations were better in prone position.

Keywords:

• Cerebral oxygenation
• near infrared spectroscopy
• noninvasive ventilation
• preterm infants
• prone position

Disclosure statement

No potential conflict of interest was reported by the authors.