Prone and left lateral positioning reduce gastro-oesophageal reflux in preterm infants.
OBJECTIVE
To examine the effect of body position on clinically significant gastro-oesophageal reflux (GOR) in preterm infants.


METHODS
Eighteen preterm infants with clinically significant GOR were studied prospectively using 24 hour lower oesophageal pH monitoring. Infants were nursed in three positions (prone, left, and right lateral) for 8 hours in each position, with the order randomly assigned. Data were analysed using analysis of covariance.


RESULTS
The median (range) reflux index (RI) for the group was 13.8% (5.8-40. 4). There was no significant difference in the mean time spent in each position. RI (mean % (SEM)) was significantly less in prone (6. 3 (1.7)) and left lateral positions (11.0 (2.2)), when compared with the right lateral position (29.4 (3.2)); p<0.001. The mean (SEM) longest episodes (mins) of GOR were reduced by prone and left positions (8.6 (2.2) and 10.0 (2.4), respectively) compared with the right position (26.0 (3.9)); p<0.001. The mean (SE) number of episodes was reduced by prone (15.4 (2.8)) and left (24.6 (3.5)) positions when compared with right (41.6 (4.6)) (p<0.001).


CONCLUSIONS
Prone and left lateral positions significantly reduce the severity of GOR, by reducing the number of episodes and the duration of the longest episodes. Such positioning offers a useful adjunct to the treatment in hospital of preterm infants with gastro-oesophageal reflux.
Ewer
A K
AK
Neonatal Unit, Birmingham Women's Hospital, Edgbaston, Birmingham B15 2TG. a.k.ewer@bham.ac.uk
James
M E
ME
Tobin
J M
JM
D000704:Analysis of Variance; D005260:Female; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011187:Posture / Q000502:physiology*; D016684:Prone Position / Q000502:physiology; D011446:Prospective Studies; D011859:Radiography