Randomized crossover trial of different postural interventions on bradycardia and intermittent hypoxia in preterm infants

Abstract

Apnoea of prematurity has been shown to respond to changes in posture. We investigated the effect of three postural interventions on the rate of bradycardia and desaturation events. Eighteen infants (<32 weeks gestational age; 11 boys) with apnoea of prematurity underwent recordings of breathing movements, electrocardiogram and instantaneous heart rate, pulse oximeter saturation (SpO2), photoplethysmographic waveforms, and digital video frame while in one out of 3 different prone positions.

The following interventions were applied in random order: horizontal position (HP), 15° head-up tilt position (TP), and 3-level position (3P) according to Kinaesthetics Infant Handling. Primary study variable was the combined event rate of desaturations (SpO2 < 85%) and bradycardias (heart rate < 80/minute). One secondary study variable was the duration of body movements. The median (range) combined event rate was 26.7/hour (0.3-72.7) in HP, 25.2/hour (0.3-70.5) in TP, and 21.2/hour (0-66.3) in 3P (p-value > 0.05). The median (range) duration of body movements was 10.8 seconds/hour (0-48.2) in HP, 7.1 seconds/hour (0-72.4) in TP and 7.0 seconds/hour (0-47.7) in 3P (p-value > 0.05).

We could not confirm a significant advantage of a head-up tilt or a 3-level position over a standard horizontal position.