title: A randomised trial of placing preterm infants on their back or left side after birth.
abstract: BACKGROUND
  Basic life support guidelines recommend placing spontaneously breathing children and adults on their side. Though the majority of preterm newborns breathe spontaneously, they are routinely placed on their back after birth. We hypothesised that they would breathe more effectively when placed on their side.
  
  
  OBJECTIVE
  To determine whether preterm newborns placed on their left side at birth, compared with those placed on their back, have higher preductal oxygen saturation (SpO2) at 5 min of life.
  
  
  METHODS
  We randomised infants <32 weeks to be placed on their back or on their left side immediately after birth. Respiratory support was given with a T-piece and face mask with initial fraction of inspired oxygen (FiO2) of 0.3. The FiO2 was increased if SpO2 was <70% at 5 min.
  
  
  RESULTS
  We enrolled 87 infants, 41 randomised to back and 46 to left side. The groups were well matched for demographic variables. Fourteen (6 back and 8 left side) infants did not receive respiratory support in the first 5 min. The mean (SD) SpO2 was not different between the groups (back 72 (23) % versus left side 71 (24) %, p=0.956). We observed no adverse effects of placing infants on their side and found no differences in secondary outcomes between the groups.
  
  
  CONCLUSIONS
  Preterm infants on their left side did not have higher SpO2 at 5 min of life. Placing preterm infants on their side at birth is feasible and appears to be a reasonable alternative to placing them on their back.
  
  
  BACKGROUND
  ISRCTN74486341.
authors: Department of Neonatology, National Maternity Hospital, Dublin, Ireland.
authors: Emily
authors: E
authors: Stenke
authors: Department of Neonatology, National Maternity Hospital, Dublin, Ireland National Children's Research Centre, Dublin, Ireland School of Medicine, University College Dublin, Dublin, Ireland.
authors: Emily A
authors: EA
authors: Kieran
authors: Department of Neonatology, National Maternity Hospital, Dublin, Ireland National Children's Research Centre, Dublin, Ireland School of Medicine, University College Dublin, Dublin, Ireland.
authors: Lisa K
authors: LK
authors: McCarthy
authors: Department of Neonatology, Royal Women's Hospital, Melbourne, Australia.
authors: Jennifer A
authors: JA
authors: Dawson
authors: Department of Neonatology, Leiden University Medical Centre, Leiden, Netherlands.
authors: Jeroen J
authors: JJ
authors: Van Vonderen
authors: Department of Neonatology, Royal Women's Hospital, Melbourne, Australia.
authors: C Omar F
authors: CO
authors: Kamlin
authors: Department of Neonatology, Royal Women's Hospital, Melbourne, Australia.
authors: Peter G
authors: PG
authors: Davis
authors: Department of Neonatology, Leiden University Medical Centre, Leiden, Netherlands.
authors: Arjan B
authors: AB
authors: Te Pas
authors: Department of Neonatology, National Maternity Hospital, Dublin, Ireland National Children's Research Centre, Dublin, Ireland School of Medicine, University College Dublin, Dublin, Ireland.
authors: Colm P F
authors: CP
authors: O'Donnell
mesh_terms: D006801:Humans; D007224:Infant Care / Q000379:methods*; D007231:Infant, Newborn; D007234:Infant, Premature; D010100:Oxygen / Q000008:administration & dosage / Q000378:metabolism*; D010102:Oxygen Inhalation Therapy; D011187:Posture
chemical_list: D010100:Oxygen
keywords: Neonatology; Prematurity; Resuscitation