Effect of Positioning on Work of Breathing and Oxygenation in Premature Infants at Discharge: A Prospective Observational Study

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INTRODUCTION: Premature infants are predisposed to respiratory failure. Body position impacts lung volumes and pulmonary function. Respiratory inductance plethysmography (RIP) measures thoracoabdominal motion and can provide objective, noninvasive diagnostic measurements of work of breathing (WOB) indices. The objective of this study was to compare WOB indices and oxygen saturation in the semi-reclined position to the supine position for preterm infants with and without BPD at discharge. METHODS: A prospective, observational study of premature infants (<32 weeks of gestation) admitted to the neonatal intensive care unit. RIP is a noninvasive way to objectively measure WOB indices. Measurements (phase angle [Փ]) were made with infants in the semi-reclined and supine positions. RESULTS: This study included 28 premature infants with both supine and semi-reclined data. Infants demonstrated decreased phase angle (supine vs. semi-reclined Φ deg (standard error of mean [SEM], 65.2 [10.2] vs. 28.5 [5.9], p = 0.027) and LBI (supine vs. semi-reclined, 1.82 [0.27] vs. 1.13 [0.04], p < 0.01) in the semi-reclined position. Saturations were statistically but not clinically lower in the semi-reclined position (supine vs. semi-reclined %, 96.7 [0.4] vs. 95.3 [0.4]). Infants with BPD demonstrated a greater improvement in WOB in the semi-reclined position compared to premature controls. CONCLUSION: This is the first study to evaluate and compare discharge oxygen saturation and WOB indices in premature infants with and without BPD in the semi-reclined and supine position. Our findings demonstrate improved breathing parameters and a small clinically insignificant decrease in saturations in the semi-reclined position.

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