Abstract
Background: Nursing of preterm infants in head elevated prone position (HEPP) has been proposed to reduce apneas without controlled clinical trial up to now. Objective: To investigate the effect of HEPP compared with horizontal prone position on the incidence of apneas. Design: Randomized, controlled, cross-over trial. Patients: 20 spontaneously breathing preterm infants with apneas: 26-31 gestational weeks, birth weight 730-1680 g, postnatal age 2-49 d. 15 infants treated with aminophylline (serum concentration 44-81 nmol/l). Intervention: Each infant was nursed in prone position in an incubator and spent a total of 24 hours in horizontal position and a total of 24 hours in HEPP (15°). Position was changed every 6 hours in random order. Outcome measures: Number of apneas (absence of breathing movements for >10 s by thoracic impedance). Number of severe apneas >20 s and hypoxemia (arterial saturation by pulse oximetry < 85%) or bradycardia (<90 bpm). Results: There were 24% less apneas in HEPP compared with horizontal position (mean difference 16 apneas / 24 h, 95%CI 5-27). Severe apneas were reduced by 21% in HEPP (mean difference 9 apneas / 24 hrs, 95%CI 3-15). Conclusion: Nursing in head up tilt position (15°) reduces central apneas in preterm infants.
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