Effect of Different Body Positions on Cardiorespiratory Parameters of Preterm Neonates Undergoing Mechanical Ventilation

Atyat Mohammed Hassan^{1, 2,} , Fathia Zaky Mohamed² and Nahed Thabet Mohamed²

¹Department of Nursing Science, College of Applied Medical Science- Wadi Addawasir, Prince Sattam Bin Abdulaziz University, Kingdom of Saudi Arabia

²Department of Pediatric Nursing, Faculty of Nursing, Assiut University, Egypt

Cite this paper:
Atyat Mohammed Hassan, Fathia Zaky Mohamed and Nahed Thabet Mohamed. Effect of Different Body Positions on Cardiorespiratory Parameters of Preterm Neonates Undergoing Mechanical Ventilation. American Journal of Nursing Research. 2020; 8(4):463-470. doi: 10.12691/ajnr-8-4-6

Abstract

High prevalence of preterm infants' birth is considered a serious problem in health system in recent decades. Positions of the body in preterm neonates who receive respiratory support are accounted an important factor for ventilation and tissue oxygenation. Therefore, this study aimed to determine the effects of different body positions on cardiorespiratory parameters of preterm neonates undergoing mechanical ventilation. Crossover non-randomized clinical trial study design was used. Setting: The study was conducted at neonatal intensive care unit (NICU) in Assiut University Children Hospital. The study subjects included 40 preterm neonates undergoing mechanical ventilation and met the inclusion criteria. A structured questionnaire was designed especially to collect the required data for this study; it included three parts: preterm neonates' personal and clinical data, and assessment of cardiorespiratory parameters including: Heart Rate (HR), Respiratory Rate (RR), and oxygen saturation (SpO2) in each position. Each preterm neonate was placed in three different positions (supine, right lateral and semi-prone). Results of the current study revealed a significant improvement in heart rate, respiratory rate and increase in oxygen saturation in neonates placed in semi-prone position with statistically significant differences were found between them during the three different body positions (p=0.02*, p=0.012*&p<0.001)respectively. The study concluded that positioning of preterm neonates can be considered as an effective way of modifying the cardiorespiratory parameters and improving oxygenation in neonates undergoing mechanical ventilation. Likewise, semi-prone position was a safe, simple, noninvasive method which can be helpful in stabilizing preterm neonates’ cardiorespiratory status. Also, the right lateral position was slightly effective while, the supine position was the least effective. Recommendation: Use of semi-prone position in the routine pediatric care of ventilated neonates as it is a safe, simple, non-invasive method that can help in improving oxygenation of preterm neonates’.

Keywords:
Body positions cardiorespiratory parameters mechanical ventilation preterm neonates

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	El-Nagger N. and BayoumiO. (2016). Effect of Applying Nesting Technique as a Developmental Care on Physiological Functioning and Neurobehavioral Organization of Premature Infants. Life Sci J; 13(1s): 79-92.
[2]	World Health Organization. (2015). Preterm Birth. (November 2015): Retrieved at: http://www.who.int/mediacentre/factsheets/fs363/e n/.
[3]	Abdelhady A. and Abdelwahid A. (2015). Rate and Risk Factors of Preterm Births in a Secondary Health Care Facility in Cairo. World Journal of Medical Sciences; 12 (1): 09-16.
[4]	Elsagh A., Lotfi R., Amiri S. and Gooya H. (2019). Comparison of Massage and Prone Position on Heart Rate and Blood Oxygen Saturation Level in Preterm Neonates Hospitalized in Neonatal Intensive Care Unit: A Randomized Controlled Trial. Iran J Nurs Midwifery Res; 24(5): 343-7.
[5]	Abdeyazdan Z., Nematollahi M. and Mohamadizadeh M. (2010). The Effects of Supine and Prone Positions on Oxygenation in Premature Infants Undergoing Mechanical Ventilation; Open-Access Article ; Iran J Nurs Midwifery Res.; 15(4): 229-33.
[6]	Rivas-Fernandez M., Roqué I., Figuls M., Diez-Izquierdo A., Escribano J. and Balaguer A. (2016). Infant position in Neonates Receiving Mechanical Ventilation. Cochrane Database of Systematic Reviews, Issue 11: CD003668.
[7]	Hough J., Trojman A. and Schibler A. (2016). Effect of Time and Body Position on Ventilation in PrematureInfants. Pediatric Research; 80(4): 498-504.
[8]	Ballout R., Foster J., Kahale L. and Badr L. (2017). Body Positioning for Spontaneously Breathing Preterm Infants with Apnea: Cochrane Database Syst Rev. Jan; (1): CD004951.
[9]	Warren I. (2015). The Nursery Environment. In: Warren, I. and Bond, C. Guide to Infant Development in the .Newborn Nursery, (7th Ed.) Winnacot Baby Unit, London.
[10]	Diwate A., Khatri S. and Mhaske S. (2018). The Effectiveness of Cardiopulmonary Physiotherapy Versus Prone Positioning on Respiratory Functions in Ventilated Neonates: A Randomized Controlled Pilot Study. International Journal ofPhysiotherapy; 5(1): 18-22.
[11]	Rocha G., Soares P., Gonçalves A., Silva A., Almeida D., Figueiredo S., Pissarra S., Costa S., Soares H., Florde-Lima F. and Guimarães H. (2018). Respiratory Care for the Ventilated Neonate Review Article .Canadian Respiratory Journal, Article ID 7472964, 12 pages.
[12]	Joseph R. (2015). Prolonged Mechanical Ventilation: Challenges to Nurses and Outcome in Extremely Preterm Babies, Critical Care Nurse, vol. 35, pp. 58-66.
[13]	Kassim Z., Donaldson N., KhetriwalB., Rao H., Sylvester K., RaffertyG. and GreenoughA. (2007). Sleeping Position, Oxygen Saturation and Lung Volume in Convalescent, Prematurely Born Infants. Archives of Disease in Childhood. Fetal and Neonatal Edition, 92, 347-50.
[14]	BabuyehT., Farhadi R., Zahed Pasha Y. and Mojaveri M. (2018). The Impacts of Prone Position on The Blood Oxygen Saturations and Heart Rates of Preterm Infants Under Mechanical Ventilation. Caspian J Pediatr .Sep; 4(2): 301-5.
[15]	Brunherotti M., Martinez E. and MartinezF. (2013). Effect of Body Position on Preterm Newborns Receiving Continuous Positive Airway Pressure; Acta Paediatric; 103 (3).
[16]	Ghorbani F., Asadollahi M. and Valizadeh S. (2013). Comparison the Effect of Sleep Positioning on Cardiorespiratory Ratein Noninvasive Ventilated Premature Infants; Nurs Midwifery Stud; 2(2): 182-7.
[17]	Santos A., Viera C., Bertolini G., Osaku E., Costa C. and Grebinski A. (2017). Physiological and Behavioral Effects of Preterm Infant Positioning in A neonatal Intensive Care Unit. British Journal of Midwifery; 25 (10).
[18]	Ma M., Noori S., Maarek J., Holschneider D., Rubinstein E. and Seri I. (2015). Prone Positioning Decreases Cardiac Output and Increases Systemic Vascular Resistance in Neonates. J Perinatol; 35: 424.
[19]	Alinejad-Naine M. (2014). Neonatal Positioning During Care in Neonatal Intensive Care Unit; Iran J Cardiovascnurs. 3: 60-5.31.
[20]	Malagoli R., Fagundes F., Santos A., Oliveira E., Cândida M. and Bouzada F. (2012). Influence of Prone Position on Oxygenation, Respiratory Rate and Muscle Strength in Preterm Infants Being Weaned from Mechanical Ventilation; Rev Paul Pediatr; 30(2): 251-6.
[21]	Babaei H., Pirkashani L. and Soleimani B. (2019). Comparison of the Effect of Supine and Prone Positions on Physiological Parameters of Preterm Infants Under Nasal Continuous Positive Airway Pressure (N-CPAP): A Cross over Clinical Trial. Cukurova Med J; 44(4): 1250-55.
[22]	Heimler R., Langlois J., Hodelm J., Nelin D. and Sasidharan P. (2016). Effect of Positioning on the Breathing Pattern of Preterm Infants; Archives of Disease in Childhood; 67: 312-14.
[23]	Gouna G., RakzaT., Kuissi E., Pennaforte T., Mur S. and Storme L. (2013). Positioning Effects on Lung Function and Breathing Pattern in Premature Newborns. J Pediatr. 162: 1133-7.
[24]	Vafaienejad T., Fakhr-MovahediA., Salimi T. and Nooripur S. (2015). Comparing the Effect of Prone and Supine Positions on Respiratory Status of Acute Respiratory Distress Syndrome Newborns Treated by Insure Protocol. Journal of Urmia Nursing and Midwifery Faculty. 13: 116-23.
[25]	BalaguerA., Escribano J., Roque I., Figuls M. and Rivaz‐Fernandez M. (2013). Infant Position in Neonates Receiving Mechanical Ventilation. Cochrane Database of Systematic Reviews, Issue 3.
[26]	Balali F., Jafari Z., Dabirian A., Heidarzadeh M. and Nasiri M. (2017). The Effect of Posture in Premature Infants on the Arterial Oxygen Saturation, Fraction of Inspired Oxygen and Abdominal Distension. Feyz Journal of Kashan University of Medical Sciences. 21: 470-6.
[27]	Bredemeyer SL. and Foster JP. (2012). Body positioning for Spontaneously Breathing Preterm Infants with Apnea. Cochrane Database of Systematic Reviews, Issue 6.
[28]	Brunherotti M., Martinez Z. and Martinez F. (2014). Effect of Body Position on Preterm Newborns Receiving Continuous Positive Airway Pressure.; Acta Paediatrica ;103(3): 101-5.
[29]	Burg P., Jongh F., Miedema M., Frerichs I. and Kaam A. (2016). The Effect of Prolonged Lateral Positioning During Routine Care on Regional Lung Volume Changes in Preterm Infants. Pediatric Pulmonology; 51(3): 280-5.
[30]	Gardner S., Carter B., Enzman-Hines M., Hernandez J.and Merenste N. (2015). Handbook of Neonatal Intensive Care. E-Book: Elsevier Health Sciences; 8thed; 125-7.