Prone Positioning Was Associated With Less Hypoxemic Events and Improved Feeding Tolerance in Preterm Infants

Acta Paediatr. 2025 May 26. doi: 10.1111/apa.70153. Online ahead of print.

ABSTRACT

AIM: Cardiorespiratory events such as apnea, bradycardia and hypoxemia are common in preterm infants and may contribute to an impaired neurodevelopmental outcome. We hypothesised a significant reduction in the incidence of hypoxemia, bradycardia and gastric residuals in the prone position.

METHODS: In this monocentric, prospective, randomised, two-arm crossover trial, at a tertiary university hospital, 48 preterm infants with a gestational age of < 32 weeks and a postmenstrual age of < 34 weeks were randomised to either a prone-supine or a supine-prone sequence of cardiorespiratory monitoring over a period of 24 h. The primary outcome parameter was the cumulative frequency of hypoxemias and bradycardias; secondary parameters comprised evaluation of basal parameters, hypoxemias, bradycardias and the amount of gastric residuals.

RESULTS: The cumulative frequency of hypoxemias and bradycardias and the number of severe hypoxemias (peripheral oxygen saturation [SpO₂] < 80%) were halved in the prone position (p = 0.03). Median basal SpO₂ was significantly higher (p = 0.01) and gastric residuals were significantly lower (p = 0.0002) in the prone position. The frequency of apneas (> 10 s) was significantly increased in the prone position (p = 0.01).

CONCLUSION: Prone positioning of preterm infants significantly reduces the cumulative frequency of hypoxemias and bradycardias, severe hypoxemias and gastric residuals while increasing basal SpO₂.

PMID:40418109 | DOI:10.1111/apa.70153