title: Influence of prone positioning on premature newborn infant stress assessed by means of salivary cortisol measurement: pilot study.
abstract: OBJECTIVE
  This study sought to assess the influence of prone positioning on the stress of newborn premature infants through the measurement of the salivary cortisol concentration and the evaluation of physiological and behavioral responses before and after changes in body positioning.
  
  
  METHODS
  Saliva samples were collected from newborn infants at two different times: the first (corresponding to the baseline) after a period of 40 minutes during which the infants were not subjected to any manipulation and were placed in the lateral or supine position, and the second 30 minutes after placement in the prone position. Variables including heart rate, respiratory rate, peripheral oxygen saturation, and the Brazelton sleep score were recorded before, during, and at the end of the period in the prone position.
  
  
  RESULTS
  The sample comprised 16 newborn premature infants (56.3% male) with a gestational age between 26 and 36 weeks, postnatal age between 1 and 33 days, birth weight of 935 to 3,050g, and weight at the time of intervention of 870 to 2,890g. During the intervention, six participants breathed room air, while the remainder received oxygen therapy. The median salivary cortisol concentration was lower in the prone position compared to baseline (0.13 versus 0.20; p=0.003), as was the median Brazelton sleep score (p=0.02). The average respiratory rate was lower after the intervention (54.88±7.15 versus 60±7.59; p=0.0004). The remainder of the investigated variables did not exhibit significant variation.
  
  
  CONCLUSIONS
  Prone positioning significantly reduced the salivary cortisol level, respiratory rate, and Brazelton sleep score, suggesting a correlation between prone positioning and reduction of stress in preterm infants.
authors.affiliation: Programa de Residência em Fisioterapia em Terapia Intensiva, Hospital Universitário do Oeste do Paraná, Cascavel, PR, Brasil.
authors.forename: Maria Fernanda
authors.initials: MF
authors.lastname: Cândia
authors.affiliation: Programa de Residência em Fisioterapia em Terapia Intensiva, Hospital Universitário do Oeste do Paraná, Cascavel, PR, Brasil.
authors.forename: Erica Fernanda
authors.initials: EF
authors.lastname: Osaku
authors.affiliation: Programa de Residência em Fisioterapia em Terapia Intensiva, Hospital Universitário do Oeste do Paraná, Cascavel, PR, Brasil.
authors.forename: Marcela Aparecida
authors.initials: MA
authors.lastname: Leite
authors.affiliation: Programa de Residência em Fisioterapia em Terapia Intensiva, Hospital Universitário do Oeste do Paraná, Cascavel, PR, Brasil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Toccolini
authors.affiliation: Programa de Residência em Fisioterapia em Terapia Intensiva, Hospital Universitário do Oeste do Paraná, Cascavel, PR, Brasil.
authors.forename: Nicolle Lamberti
authors.initials: NL
authors.lastname: Costa
authors.affiliation: Programa de Residência em Fisioterapia em Terapia Intensiva, Hospital Universitário do Oeste do Paraná, Cascavel, PR, Brasil.
authors.forename: Sandy Nogueira
authors.initials: SN
authors.lastname: Teixeira
authors.affiliation: Programa de Residência em Fisioterapia em Terapia Intensiva, Hospital Universitário do Oeste do Paraná, Cascavel, PR, Brasil.
authors.forename: Claudia Rejane Lima de Macedo
authors.initials: CR
authors.lastname: Costa
authors.affiliation: Universidade Estadual do Oeste do Paraná, PR, Brasil.
authors.forename: Pitágoras Augusto
authors.initials: PA
authors.lastname: Piana
authors.affiliation: Curso de Medicina, Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brasil.
authors.forename: Marcos Antonio da Silva
authors.initials: MA
authors.lastname: Cristovam
authors.affiliation: Programa de Residência em Fisioterapia em Terapia Intensiva, Hospital Universitário do Oeste do Paraná, Cascavel, PR, Brasil.
authors.forename: Nelson Ossamu
authors.initials: NO
authors.lastname: Osaku
mesh_terms: D005260:Female; D005865:Gestational Age; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010100:Oxygen / Q000378:metabolism; D056888:Patient Positioning; D010865:Pilot Projects; D016684:Prone Position / Q000502:physiology; D056152:Respiratory Rate / Q000502:physiology*; D012463:Saliva / Q000378:metabolism*; D012890:Sleep / Q000502:physiology; D013312:Stress, Physiological / Q000502:physiology*
chemical_list: D010100:Oxygen; D006854:Hydrocortisone