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Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 1994 Jul;71(1):F16–F19. doi: 10.1136/fn.71.1.f16

Effect of nursing position on incidence, type, and duration of clinically significant apnoea in preterm infants.

L O Kurlak 1, N R Ruggins 1, T J Stephenson 1
PMCID: PMC1061061  PMID: 8092863

Abstract

AIM--To investigate whether nursing position has any effect on the frequency, type, and duration of apnoeas in preterm infants. METHOD--Thirty five preterm infants were entered into a crossover study and underwent polygraphic monitoring in each of two positions, prone and supine, the initial position being randomly allocated. Four parameters were recorded: nasal airflow, respiratory effort, electrocardiogram (ECG), and oxygen saturation. Each infant was studied in the two positions on the same day and each infant was studied only once. The studies were carried out on the neonatal intensive care unit. RESULTS--The infants were found to have significantly more central and mixed apnoeas in the supine than in the prone position. In addition, the severity of mixed apnoeas in terms of the duration of accompanying bradycardias and desaturations was greater in the supine than in the prone position (median difference 5.1 seconds in both instances). When considering the type of apnoea in relation to the duration, it was found that of those less than 20 seconds in duration there was a greater proportion that were central (25%) compared with the proportion of central (5%) apnoeas that were longer than 20 seconds. Of all the apnoeas that were less than 20 seconds in length, 16% were obstructive and 59% were mixed, whereas of the apnoeas greater than 20 seconds, 13% were obstructive and 82% were mixed. CONCLUSIONS--It appears that in addition to improving measures of lung function, the adoption of the prone nursing position for preterm infants may reduce associated problems of apnoea of prematurity.

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Selected References

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  1. Barrington K., Finer N. The natural history of the appearance of apnea of prematurity. Pediatr Res. 1991 Apr;29(4 Pt 1):372–375. doi: 10.1038/pr.1991.72500. [DOI] [PubMed] [Google Scholar]
  2. Blumenthal I., Lealman G. T. Effect of posture on gastro-oesophageal reflux in the newborn. Arch Dis Child. 1982 Jul;57(7):555–556. doi: 10.1136/adc.57.7.555. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Butcher-Puech M. C., Henderson-Smart D. J., Holley D., Lacey J. L., Edwards D. A. Relation between apnoea duration and type and neurological status of preterm infants. Arch Dis Child. 1985 Oct;60(10):953–958. doi: 10.1136/adc.60.10.953. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dransfield D. A., Spitzer A. R., Fox W. W. Episodic airway obstruction in premature infants. Am J Dis Child. 1983 May;137(5):441–443. doi: 10.1001/archpedi.1983.02140310023005. [DOI] [PubMed] [Google Scholar]
  5. Duffty P., Spriet L., Bryan M. H., Bryan A. C. Respiratory induction plethysmography (Respitrace): an evaluation of its use in the infant. Am Rev Respir Dis. 1981 May;123(5):542–546. doi: 10.1164/arrd.1981.123.5.542. [DOI] [PubMed] [Google Scholar]
  6. Fleming P. J., Gilbert R., Azaz Y., Berry P. J., Rudd P. T., Stewart A., Hall E. Interaction between bedding and sleeping position in the sudden infant death syndrome: a population based case-control study. BMJ. 1990 Jul 14;301(6743):85–89. doi: 10.1136/bmj.301.6743.85. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Girling D. J. Changes in heart rate, blood pressure, and pulse pressure during apnoeic attacks in newborn babies. Arch Dis Child. 1972 Jun;47(253):405–410. doi: 10.1136/adc.47.253.405. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Guilleminault C., Ariagno R. L., Forno L. S., Nagel L., Baldwin R., Owen M. Obstructive sleep apnea and near miss for SIDS: I. Report of an infant with sudden death. Pediatrics. 1979 Jun;63(6):837–843. [PubMed] [Google Scholar]
  9. Heimler R., Langlois J., Hodel D. J., Nelin L. D., Sasidharan P. Effect of positioning on the breathing pattern of preterm infants. Arch Dis Child. 1992 Mar;67(3):312–314. doi: 10.1136/adc.67.3.312. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Herbst J. J., Minton S. D., Book L. S. Gastroesophageal reflux causing respiratory distress and apnea in newborn infants. J Pediatr. 1979 Nov;95(5 Pt 1):763–768. doi: 10.1016/s0022-3476(79)80733-7. [DOI] [PubMed] [Google Scholar]
  11. Hutchison A. A., Ross K. R., Russell G. The effect of posture on ventilation and lung mechanics in preterm and light-for-date infants. Pediatrics. 1979 Oct;64(4):429–432. [PubMed] [Google Scholar]
  12. Martin R. J., Herrell N., Rubin D., Fanaroff A. Effect of supine and prone positions on arterial oxygen tension in the preterm infant. Pediatrics. 1979 Apr;63(4):528–531. [PubMed] [Google Scholar]
  13. Masterson J., Zucker C., Schulze K. Prone and supine positioning effects on energy expenditure and behavior of low birth weight neonates. Pediatrics. 1987 Nov;80(5):689–692. [PubMed] [Google Scholar]
  14. Menon A. P., Schefft G. L., Thach B. T. Apnea associated with regurgitation in infants. J Pediatr. 1985 Apr;106(4):625–629. doi: 10.1016/s0022-3476(85)80091-3. [DOI] [PubMed] [Google Scholar]
  15. Miller M. J., Carlo W. A., Martin R. J. Continuous positive airway pressure selectively reduces obstructive apnea in preterm infants. J Pediatr. 1985 Jan;106(1):91–94. doi: 10.1016/s0022-3476(85)80475-3. [DOI] [PubMed] [Google Scholar]
  16. Newell S. J., Booth I. W., Morgan M. E., Durbin G. M., McNeish A. S. Gastro-oesophageal reflux in preterm infants. Arch Dis Child. 1989 Jun;64(6):780–786. doi: 10.1136/adc.64.6.780. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Orr W. C., Stahl M. L., Duke J., McCaffree M. A., Toubas P., Mattice C., Krous H. F. Effect of sleep state and position on the incidence of obstructive and central apnea in infants. Pediatrics. 1985 May;75(5):832–835. [PubMed] [Google Scholar]
  18. Perlman J. M., Volpe J. J. Episodes of apnea and bradycardia in the preterm newborn: impact on cerebral circulation. Pediatrics. 1985 Sep;76(3):333–338. [PubMed] [Google Scholar]
  19. Stark A. R., Thach B. T. Mechanisms of airway obstruction leading to apnea in newborn infants. J Pediatr. 1976 Dec;89(6):982–985. doi: 10.1016/s0022-3476(76)80615-4. [DOI] [PubMed] [Google Scholar]
  20. Storrs C. N. Cardiovascular effects of apnoea in preterm infants. Arch Dis Child. 1977 Jul;52(7):534–540. doi: 10.1136/adc.52.7.534. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Upton C. J., Milner A. D., Stokes G. M. Combined impedance and inductance for the detection of apnoea of prematurity. Early Hum Dev. 1990 Oct;24(1):55–63. doi: 10.1016/0378-3782(90)90006-5. [DOI] [PubMed] [Google Scholar]
  22. Vandenplas Y., Sacre-Smits L. Seventeen-hour continuous esophageal pH monitoring in the newborn: evaluation of the influence of position in asymptomatic and symptomatic babies. J Pediatr Gastroenterol Nutr. 1985 Jun;4(3):356–361. doi: 10.1097/00005176-198506000-00006. [DOI] [PubMed] [Google Scholar]
  23. Wagaman M. J., Shutack J. G., Moomjian A. S., Schwartz J. G., Shaffer T. H., Fox W. W. Improved oxygenation and lung compliance with prone positioning of neonates. J Pediatr. 1979 May;94(5):787–791. doi: 10.1016/s0022-3476(79)80157-2. [DOI] [PubMed] [Google Scholar]
  24. Walsh J. K., Farrell M. K., Keenan W. J., Lucas M., Kramer M. Gastroesophageal reflux in infants: relation to apnea. J Pediatr. 1981 Aug;99(2):197–201. doi: 10.1016/s0022-3476(81)80449-0. [DOI] [PubMed] [Google Scholar]
  25. Wigfield R. E., Fleming P. J., Berry P. J., Rudd P. T., Golding J. Can the fall in Avon's sudden infant death rate be explained by changes in sleeping position? BMJ. 1992 Feb 1;304(6822):282–283. doi: 10.1136/bmj.304.6822.282. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. de Ajuriaguerra M., Radvanyi-Bouvet M. F., Huon C., Moriette G. Gastroesophageal reflux and apnea in prematurely born infants during wakefulness and sleep. Am J Dis Child. 1991 Oct;145(10):1132–1136. doi: 10.1001/archpedi.1991.02160100064024. [DOI] [PubMed] [Google Scholar]

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