Cardiorespiratory Assessment of Preterm and Near Term Neonates on Nasal Continuous Positive Airway Pressure (CPAP) in Different Body Positions

Abstract

Abstract Background The use of continuous positive airway pressure (CPAP) is one of the recommended interventions to reduce morbidity and mortality in preterm infants. The effect of body position is directly associated with clinical conditions and factors related to respiratory assistance. Aim and Objectives To evaluate the effect of different body positions on different cardiac, respiratory parameters for preterm and near term neonates with respiratory distress treated with CPAP. Patients and Methods This one arm clinical observational study was conducted on 81 preterm and near term neonates who had respiratory distress, placed on nasal CPAP. They were placed in prone, supine, left lateral and right lateral position, each for 90 minutes. The neonate was kept in each position for 30 minutes (washout period), then was observed clinically and monitored for respiratory rate, heart rate, oxygen saturation. Also, using electrical cardiometry cardiac output, stroke volume and index of contractility (ICON) level were monitored for 60 minutes, recorded at intervals of 10 minutes then the average was taken. Results Respiratory rate was significantly decreased (p-value < 0.001) in prone position 42.65 ±5.03(breath/min), compared to 45.41±7.73(breath/min)in supine position, 45.2±5.39(breath/min) in left lateral position, 45.23±5.32(breath/min) in right lateral position. Oxygen saturation was significantly increased (p-value <0.001) in prone position 97.3%±1.6% compared to 95.8±1.5% in supine position, 94.9%±1.6% in left lateral position, 95±1.5% in right lateral position, while there was no statistically significant difference as regard heart rate (p-value 0.64). As regards cardiometry parameters, cardiac output and stroke volume were highly significantly increased(p- value 0.019, <0.001 respectively) in prone position; that cardiac output was 0.41 ± 0.13 (l/min) in prone position versus0.38± 0.14 (l/min) in supine and right lateral positions, 38± 0.13 (l/min) in left lateral position, stroke volume was 3.02 ± 1.03(ml) in prone position versus 2.67 ± 0.87(ml) in supine position, 2.72 ± 0.94 (ml) in left lateral position, 2.74 ± 1.07(ml) in right lateral position. Conclusion Neonates on nasal CPAP in prone position had the highest oxygen saturation, lowest respiratory rate, highest stroke volume and cardiac output, further researches are needed on a greater scale.