Prone and Supine Positions in Preterm Infants Receiving Mechanical Ventilation
Condition: Preterm Infant; Ventilator Lung; Newborn; Preterm Birth
MeSH terms: Bronchopulmonary Dysplasia; Premature Birth
Study type: Interventional

Summary: 
      Positioning, which is one of the individualized developmental care methods, is known as the
      important care support process which is applied with the purpose of ensuring the least damage
      from the environmental. Positioning in preterm infants is the basis of neonatal nursing care.
      Positioning in preterm infants receiving mechanical ventilation support is important in terms
      of physiological and neurodevelopment. In infants undergoing respiratory support in NICU, it
      is important to determine the appropriate position, the frequency and duration of position
      change in order to reduce the oxygen need. In this respect, the aim of this study, designed
      as a randomized controlled trial, was to determine the effect of supine and prone positions
      on physiological variables (oxygen saturation and heart rate) of preterm infants receiving
      mechanical ventilation.
    

Detailed description: 
      In infants undergoing respiratory support in NICU, it is important to determine the
      appropriate position, the frequency and duration of position change in order to reduce the
      oxygen need. Therefore, the aim of this randomized controlled study, test the efficacy of two
      different positions (prone-supine) given to preterm newborns receiving mechanical
      ventilation.The study was conducted from February 2015 to June 2016.

      Participants and setting:

      We were interested in establishing the difference between the supine position and the prone
      position, with an error margin of 10%. According to the formula of the calculated sample
      size, for a crossover design with a = 0.05, the sample size required to achieve a 90% power
      is 36 infants. Thirty-eight infants who met the inclusion criteria of the study were selected
      and invited to participate. Of these, parents of 38 infants consented. A convenience sample
      of hospitalized preterm infants (less than 37 weeks gestational age) was selected from a
      tertiary neonatal intensive care unit of a teaching and research hospital in Turkey. Preterm
      infants were divided into two groups by randomization according to position priority (n =
      38). First group was first supine position followed by prone position (n = 19), second group
      was first prone position, then supine position (n = 19). The priority of the positions to be
      given to preterm infants was randomly determined using the closed envelope method. The
      positions of infants were written in envelopes and closed. The clinical nurse, who was not in
      the research, pulled the envelope and identified position group of the infant . Thus, data
      were collected for both the prone and the supine position from a newborn.

      Procedure and data collection:

      The infants involved in the study were cared for in a incubator and wore diapers only. The
      temperature of the incubator was set to maintain a body temperature ranging from 36.5 to 37.2
      °C. After necessary routine procedures such as diapering, body cleaning, weighing and
      suctioning were completed, each subject was randomly assigned to the supine-prone group or
      prone-supine group sequence. All of the positions of preterm infants were given carefully by
      the researcher.

      Data Collection Tools:

      Infant descriptive characteristics form: The form was developed in light of the relevant
      literature to collect data about gender, age, gestational age, body weight at study.

      Infant's clinical variables form. The form was developed by the researchers according to the
      literature to collect data such as infant feeding method, caffeine and surfactant treatment.

      Physiological variable monitoring form: The form was developed to record heart rate (HR)
      (min) and oxygen saturation (% SpO2) values in the literature.

      Pulse Oximeter Device: A pulse oximetry was used to determine HR and SpO2. The physiological
      parameters were measured and recorded every 15 minute for a total of 120 minute. The normal
      vital sign ranges assumed for the study subjects were as follows; heart rate range of 121 to
      179 beats per minute, oxygen saturation range ≥92%. The pulse oximetry was calibrated as
      recommended by the manufacturer prior to use at the beginning of each shift within the study
      period. The pulse oximetry probe was attached to the foot of the leg.All of the measurements
      were performed by researcher who carefully and prudently recorded the infants' response
      throughout the study process.

      Positioning material:

      Rolled sheets were used when infants were given positions.

      Statistical analysis:

      Data were analyzed using SPSS version 22.0 (SPSS Inc., Chicago, IL, USA) statistical program.
      Descriptive statistics were reported using frequencies, percentages, mean values, standard
      deviation, and range. The Kolmogorov-Smirnov test was conducted to assess the distribution of
      the variables in order to use a parametric or non-parametric test. All the variables were
      normally distributed. Therefore, parametric tests such as analysis of variance and t-test
      were used to determine the differences in variables between groups. Variance analysis was
      used for repeated measurements of heart rates and oxygen saturation measured by infants at 15
      min intervals. A value of p <0.05 was considered statistically significant.

      Ethical considerations:

      İn the study, written consent was obtained from the ethics committee, institutions and
      families.
    

Intervention name(s): Group 1:Supine-Prone; Group 2:Prone-Supine
Intervention type(s): Behavioral; Behavioral
Intervention description(s): After the infants were treated and fed, supine position was first given and waited for 60 minutes to stabilise (no data was collected during this time). After 61 minutes, it was allowed to stay in supine position for 2 hours. From the 61st minute, heart rate and oxygen saturation were evaluated in each infant in the supine positions at intervals of 15 min over a period of 120 min. At the end of two hours, the infant was given the prone position after the routine requirements such as diaper replacement were completed. Infants were waiting for 60 minutes to stabilize after the prone position (no data was collected during this time). From the 61st minute, heart rate and oxygen saturation were evaluated in each infant in the prone positions at intervals of 15 min over a period of 120 min.; After the infants were treated and fed, prone position was first given and waited for 60 minutes to stabilise (no data was collected during this time). After 61 minutes, it was allowed to stay in prone position for 2 hours. From the 61st minute, heart rate and oxygen saturation were evaluated in each infant in the prone positions at intervals of 15 min over a period of 120 min. At the end of two hours, the infant was given the supine position after the routine requirements such as diaper replacement were completed. Infants were waiting for 60 minutes to stabilize after the supine position (no data was collected during this time). From the 61st minute, heart rate and oxygen saturation were evaluated in each infant in the prone positions at intervals of 15 min over a period of 120 min.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: The priority of the positions to be given to preterm infants was randomly determined.The positions of preterm infants was identified using the closed envelope method.The positions of infants were written in envelopes and closed.The clinical nurse, who was not in the research, pulled the envelope and identified the infant position.First group was first supine position,then prone position (n = 19), second group was first prone position, then supine position (n = 19).
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Preterm infant; Mechanical ventilation; Position