Cerebral Oxygenation and Perfusion When Positioning Preterm Infants: Clinical Implications.

OBJECTIVES To evaluate cerebral oxygenation (cTOI) and cerebral perfusion in preterm infants in supine versus prone positions. STUDY DESIGN Sixty preterm infants, born before 32 weeks gestation, were enrolled; 30 had bronchopulmonary dysplasia (BPD, defined as the need for respiratory support and/or supplemental oxygen at 36 weeks post menstrual age). Cerebral perfusion, cTOI and polysomnography was measured in both the supine and prone position with the initial position being randomized. Infants with a major intra-ventricular hemorrhage or major congenital abnormality were excluded. RESULTS Cerebral perfusion was unaffected by position or BPD status. In the BPD group, the mean cTOI was higher in the prone position as compared with the supine position by a difference of 3.27% (P = .03; 95% CI: 6.28 to 0.25) with no difference seen in the no-BPD group. For the BPD group, the burden of cerebral hypoxemia (cumulative time spent with cTOI < 55%) was significantly lower in the prone position (23%) compared with the supine position (29%) (p < 0.001). In those without BPD, position had no effect on cTOI. CONCLUSIONS In preterm infants with BPD, the prone position improved cerebral oxygenation and reduced cerebral hypoxemia. These findings may have implications for positioning practices. Further research will establish the impact of position on short and long-term developmental outcomes.