Kelsee L Shepherd1, Stephanie R Yiallourou2, Alexsandria Odoi1, Nadine Brew1, Emma Yeomans3, Stacey Willis3, Rosemary S C Horne1, Flora Y Wong4. 1. The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia. 2. The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia. 3. Monash Newborn, Monash Children's Hospital, Melbourne, Australia. 4. The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia; Monash Newborn, Monash Children's Hospital, Melbourne, Australia. Electronic address: flora.wong@monash.edu.
Abstract
OBJECTIVE: To determine the effect of prone sleeping on cerebral oxygenation in preterm infants in the neonatal intensive care unit. STUDY DESIGN: Preterm infants, divided into extremely preterm (gestational age 24-28 weeks; n = 23) and very preterm (gestational age 29-34 weeks; n = 33) groups, were studied weekly until discharge in prone and supine positions during active and quiet sleep. Cerebral tissue oxygenation index (TOI) and arterial oxygen saturation (SaO2) were recorded. Cerebral fractional tissue extraction (CFOE) was calculated as CFOE = (SaO2 - TOI)/SaO2. RESULTS: In extremely preterm infants, CFOE increased modestly in the prone position in both sleep states at age 1 week, in no change in TOI despite higher SaO2. In contrast, the very preterm infants did not have position-related differences in CFOE until the fifth week of life. In the very preterm infants, TOI decreased and CFOE increased with active sleep compared with quiet sleep and with increasing postnatal age. CONCLUSION: At 1 week of age, prone sleeping increased CFOE in extremely preterm infants, suggesting reduced cerebral blood flow. Our findings reveal important physiological insights in clinically stable preterm infants. Further studies are needed to verify our findings in unstable preterm infants regarding the potential risk of cerebral injury in the prone sleeping position in early postnatal life.
OBJECTIVE: To determine the effect of prone sleeping on cerebral oxygenation in preterm infants in the neonatal intensive care unit. STUDY DESIGN: Preterm infants, divided into extremely preterm (gestational age 24-28 weeks; n = 23) and very preterm (gestational age 29-34 weeks; n = 33) groups, were studied weekly until discharge in prone and supine positions during active and quiet sleep. Cerebral tissue oxygenation index (TOI) and arterial oxygen saturation (SaO2) were recorded. Cerebral fractional tissue extraction (CFOE) was calculated as CFOE = (SaO2 - TOI)/SaO2. RESULTS: In extremely preterm infants, CFOE increased modestly in the prone position in both sleep states at age 1 week, in no change in TOI despite higher SaO2. In contrast, the very preterm infants did not have position-related differences in CFOE until the fifth week of life. In the very preterm infants, TOI decreased and CFOE increased with active sleep compared with quiet sleep and with increasing postnatal age. CONCLUSION: At 1 week of age, prone sleeping increased CFOE in extremely preterm infants, suggesting reduced cerebral blood flow. Our findings reveal important physiological insights in clinically stable preterm infants. Further studies are needed to verify our findings in unstable preterm infants regarding the potential risk of cerebral injury in the prone sleeping position in early postnatal life.
Authors: Evelim Leal de Freitas Dantas Gomes; Camilla Malta Dos Santos; Anelise da Costa Souza Santos; Aline Gomes da Silva; Mariza Aparecida Malaquias França; Dyele Souza Romanini; Manoela Cristina Veiga de Mattos; Andrea Fernanda Leal; Dirceu Costa Journal: Rev Bras Ter Intensiva Date: 2019-10-14
Authors: Kelsee L Shepherd; Flora Y Wong; Alexsandria Odoi; Emma Yeomans; Rosemary S C Horne; Stephanie R Yiallourou Journal: Pediatr Res Date: 2020-11-10 Impact factor: 3.756
Authors: Laura M L Dix; Kelsee Shepherd; Graeme R Polglase; Suzanne L Miller; Arvind Sehgal; Flora Y Wong Journal: Front Pediatr Date: 2020-05-27 Impact factor: 3.418