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Supine Positioning
Does Supine Positioning Increase Apnea, Bradycardia and Desaturation in Preterm Infants? Keene DJ, Wimmer JE, and Mathew OP. J Perinatol 2000; 1:17-20. This study was done to evaluate the effects of prone and supine positioning on cardiorespiratory stability of 22 preterm infants with symptomatic apnea and bradycardia. Each infant was studied for 6-hour blocks alternating between prone and supine position over a 24 hour period. The incidence of apnea was not statistically different between prone and supine positions, but mild apneas (10-15 sec) were more common when positioned prone (p<.05). No positional difference was noted in the incidence or severity of bradycardia episodes. The total incidence of oxygen desaturation episodes and the incidence of mild desaturation (sat 80-89%) episodes were increased with supine positioning. There was no significant increase in "clinically significant" desaturation (<80%) episodes with supine positioning.
Comment. Since 1992, the AAP has recommended supine positioning for healthy term babies to decrease the incidence of SIDS. In 1996, they added that "healthy" premature infants should also be positioned supine, but they continue to recommend that premature babies with significant GE reflux or cardiorespiratory instability may do better when positioned prone. Several studies have now demonstrated that premature babies oxygenate better when positioned prone. It is now apparent that this improvement in oxygenation is unrelated to apnea or bradycardia events. It is probably related to improvements in pulmonary function with prone positioning. It makes sense that premature infants routinely be positioned supine once their pulmonary insufficiency has resolved, unless they have clinically significant GE reflux. Furthermore, it would be prudent to require that premature infants demonstrate their ability to tolerate supine positioning prior to discharge home without supplemental oxygen.
Andrew B. Kairalla MD