How of ten should preterm infants be repositioned?

Abstract

Background and aims Infants with respiratory dysfunction undergo regular position changes to improve lung function however handling also causes physiological stress. It is not known how often a position change should occur. The aim of this study was to determine the changes in ventilation distribution and gas exchange occurring over time after repositioning in preterm infants. Methods Changes in end-expiratory level (EEL) and ventilation distribution were measured 30 minutes, 2 hours and 4 hours after repositioning into either prone, quarter turn from prone, or supine using Electrical Impedance Tomography (EIT). Physiological measurements were also taken. Results Sixty preterm infants were included in the study. Infants receiving respiratory support (mechanical ventilation or continuous positive airways pressure (CPAP)) had improved regional impedance amplitudes at 4 hours (p<0.05) and improved ventilation homogeneity after 2 hours (p<0.01), maintained at 4 hours. Spontaneously breathing infants had no significant changes in impedance amplitudes, improved homogeneity at 2 hours (p<0.01) and improved global EEL after 4 hours (p<0.01) whereas infants receiving CPAP demonstrated an improved global EEL at 2 hours (p<0.01). There were no significant changes in respiratory rate, inspired oxygen or oxygen saturation/inspired oxygen. Conclusions Regional ventilation distribution is influenced by time independent of changes due to body position. Differences exist between infants on ventilatory support compared to those who are spontaneously breathing. Infants receiving ventilatory support have a physiological peak in lung function after 2 hours which remains above baseline at 4 hours. A change in body position facilitates an improvement in lung function in infants on ventilatory support.L6138859922017-01-02 <br />