The effect of prolonged lateral positioning during routine care on regional lung volume changes in preterm infants.
BACKGROUND
During routine nursing care, preterm infants are often placed in lateral position for several hours, but the effect of this procedure on regional lung volume and ventilation is unknown. In our study we examined this effect during 3 hrs of lateral positioning in stable preterm infants.


METHODS
Preterm infants on non-invasive respiratory support were eligible for the study. Infants were placed in supine position and subsequently transferred to right or left lateral position, according to their individual routine nursing schedule. Changes in end-expiratory lung volume (EELV), tidal volume (VT ) and ventilation distribution were recorded using electrical impedance tomography (EIT), starting 10 min before and up to 180 min after the positional change. Additionally, oxygen requirement, transcutaneous oxygen saturation and respiratory rate were recorded.


RESULTS
15 infants were included (GA 28.9 ± 2.0 wk, BW 1167 ± 290 g). EELV increased significantly after changing to lateral position, stabilizing at a median value of 40.8 (IQR 29.0-99.3) AU/kg at 30 min. This increase could almost be exclusively attributed to the non-dependent lung regions. Tidal volume, oxygenation, and respiratory rate remained stable. Changing to the right, but not the left, lateral position resulted in a rapid but transient shift in ventilation to the dependent lung regions. After 180 min there were no differences in ventilation distribution between lateral and supine positioning.


CONCLUSIONS
This study shows that lateral position up to 3 hours, as part of normal nursing care of preterm infants, has no adverse effects on lung volumes and its regional distribution.
Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Pauline S
PS
van der Burg
Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Frans H
FH
de Jongh
Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Martijn
M
Miedema
Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Germany.
Inez
I
Frerichs
Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Anton H
AH
van Kaam
D017097:Electric Impedance; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008168:Lung / Q000502:physiology*; D009929:Organ Size; D010100:Oxygen; D056888:Patient Positioning; D012119:Respiration; D012121:Respiration, Artificial / Q000379:methods; D013990:Tidal Volume / Q000502:physiology*
D010100:Oxygen
continuous positive airway pressure; electrical impedance tomography; imaging; nasal cannula; neonatal pulmonary medicine; non-invasive ventilation; positioning