Effect of Positioning on Work of Breathing and Oxygenation in Premature Infants at Discharge. A prospective observational study

Objective To compare work of breathing (WOB) indices and oxygen saturation in the semi-reclined position to the supine position for preterm infants with and without BPD at discharge. Study Design A prospective, observational study of premature infants (<32 weeks gestation) admitted to the Neonatal Intensive Care Unit (NICU). Respiratory Inductance Plethysmography (RIP) is a noninvasive way to objectively measure WOB indices. Measurements (phase angle (Փ)) were made with infants in the semi-reclined and supine positions. Results This study included 28 premature infants with both supine and semi-reclined data. Infants demonstrated decreased phase angle (supine vs semi-reclined Φ deg (Standard Error of Mean, (SEM), 65.2 (10.2) vs 28.5 (5.9), p=0.027) and LBI (supine vs semi-reclined,1.82 (0.27) vs 1.13(0.04), p<0.01) in the semi-reclined position. Saturations were statistically but not clinically lower in the semi-reclined position (supine vs semi-reclined %, 96.7 (0.4) vs 95.3 (0.4) Infants with BPD demonstrated a greater improvement in WOB while in the semi-reclined position compared to premature controls. Conclusion This is the first study to evaluate and compare discharge oxygen saturation and WOB indices in premature infants with and without BPD in the semi-reclined and supine position. Our findings demonstrate improved breathing parameters and a small clinically insignificant decrease in saturations while in the semi-reclined position.