Body position and apnoea in the preterm infant

Review question: Does body positioning affect cardiorespiratory parameters in spontaneously breathing preterm infants with clinically significant apnoea?

Background: Apnoea is a condition in which an infant stops breathing for a short duration but then resumes normal breathing. Apnoea is rare among infants born at term, but its incidence increases with decreasing gestational age. Apnoea is generally considered a normal occurrence in the healthy preterm infant. However, long-term consequences of recurrent apnoea that lead to lower oxygen levels in sick preterm infants remain unknown. In addition, little agreement has been reached about what degree of apnoea is acceptable. It has been proposed that body positioning is an easy, practical and effective intervention as compared with other, invasive measures for minimising or preventing apnoea. Therefore, this review was conducted to see if different body positions can prevent or alleviate apnoea.

Study characteristics: Review authors searched the medical literature and identified five eligible trials that recruited a total of 114 infants. Our updated search (November 2016) identified no new studies for inclusion in this review. Included studies examined effects on cardiorespiratory parameters of supine versus prone; prone versus right lateral; prone versus left lateral; right lateral versus left lateral; prone horizontal versus prone head elevated; right lateral horizontal versus right lateral head elevated; and left lateral horizontal versus left lateral head elevated positions in spontaneously breathing preterm infants with apnoea.

Key results: None of the individual included studies nor meta-analyses showed differences on cardiorespiratory parameters between different preterm infant body positions.

Quality of evidence: The overall quality of evidence was low to very low because of high or unclear risk of bias and imprecise results yielded by small sample sizes. Thus, this review cannot recommend use of one body position over another for spontaneously breathing preterm infants with apnoea.

Authors' conclusions: 

We found insufficient evidence to determine effects of body positioning on apnoea, bradycardia and oxygen saturation in preterm infants. No new studies have been conducted since the original review was published. Large, multi-centre studies are warranted to provide conclusive evidence, but it may be plausible to conclude that positioning of spontaneously breathing preterm infants has no effect on their cardiorespiratory parameters.

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Background: 

It has been proposed that body positioning in preterm infants, as compared with other, more invasive measures, may be an effective method of reducing clinically significant apnoea.

Objectives: 

To determine effects of body positioning on cardiorespiratory parameters in spontaneously breathing preterm infants with clinically significant apnoea.

Subgroup analyses examined effects of body positioning of spontaneously breathing preterm infants with apnoea from the following subgroups.

• Gestational age < 28 weeks or birth weight less than 1000 grams.

• Apnoea managed with methylxanthines.

• Frequent apnoea (> 10 events/d).

• Type of apnoea measured (central vs mixed vs obstructive)

Search strategy: 

We used the standard search strategy of the Cochrane Neonatal Review Group (CNRG) to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 10), MEDLINE via PubMed (1966 to 14 November 2016), Embase (1980 to 14 November 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 2016 November 14). We also searched clinical trials databases and conference proceedings for randomised controlled trials and quasi-randomised trials.

Selection criteria: 

Randomised and quasi-randomised controlled clinical trials with parallel, factorial or cross-over design comparing the impact of different body positions on apnoea in spontaneously breathing preterm infants were eligible for our review.

Data collection and analysis: 

We assessed trial quality, data extraction and synthesis of data using standard methods of the CNRG. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence.

Main results: 

The search conducted in November 2016 identified no new studies. Five studies (N = 114) were eligible for inclusion. None of the individual studies nor meta-analyses showed a reduction in apnoea, bradycardia, oxygen desaturation or oxygen saturation with body positioning (supine vs prone; prone vs right lateral; prone vs left lateral; right lateral vs left lateral; prone horizontal vs prone head elevated; right lateral horizontal vs right lateral head elevated, left lateral horizontal vs left lateral head elevated).

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