A62-12 Diaphragmatic Excursion in Preterm Newborns Exposed to the Kangaroo Position: A Case Series

Abstract Introduction Skin-to-skin care in the prone position is a neonatal care strategy within the Kangaroo Method that reduces morbidity and mortality and enhances posterior regional ventilation in preterm newborns (PTNBs). However, evidence regarding diaphragmatic function response during the kangaroo position remains limited. The aim of this study was to evaluate diaphragmatic excursion, assessed by ultrasonography, in preterm neonates exposed to the prone kangaroo position. A description of the actual case report(s): This case series study was conducted in the late rooming-in unit (ward) of the Kangaroo Care Unit at a public hospital in Northeastern Brazil. Diaphragmatic excursion was assessed by ultrasonography in PTNBs before and immediately after exposure to the prone kangaroo position for at least one hour. Inclusion criteria were: corrected gestational age below 37 weeks, clinical stability, and spontaneous breathing in room air. Exclusion criteria included genetic syndromes, malformations, neuromuscular disorders, and grade III/IV peri-intraventricular hemorrhage. The right hemidiaphragm excursion was evaluated using M-mode ultrasonography via a posterior subcostal approach, with a linear transducer, during non-REM sleep, in the prone kangaroo position, after at least one hour of continuous skin-to-skin contact with the mother. Cases consisted of six PTNBs, with a mean gestational age of 33.8 ± 1.8 weeks, mean corrected age of 35.0 ± 1.1 weeks, and mean weight of 1,958 ± 451 g. Among the six infants, one had previously required intubation/CPAP, showing diaphragmatic excursion (DE) of 0.34 cm before and 0.46 cm after the kangaroo position. Three neonates with a history of CPAP use presented a mean DE of 0.28 cm before and 0.30 cm after; and two infants without ventilatory support showed a mean DE of 0.26 cm before and 0.34 cm after exposure. Three newborns had received caffeine therapy and three corticosteroids. A maintenance or slight increase in diaphragmatic excursion was observed in PTNBs. The infant previously submitted to intubation/CPAP showed a 38% increase in diaphragmatic excursion after the intervention. Among those with a CPAP history, a 10% increase was observed, while those without ventilatory support showed an approximate 5% variation.Discussion on the novelty and relevance of the cases: Exposure to the prone kangaroo position for an average duration of 1.3 hours appears to enhance diaphragmatic excursion and optimize respiratory function in PTNBs with a history of ventilatory support. This study is innovative in presenting diaphragmatic ultrasonography as an objective and noninvasive tool to measure respiratory muscle behavior during the kangaroo position. This abstract is funded by: None