Head position affects intracranial pressure in newborn infants.

We studied the effects of six different head positions on intracranial pressure and cerebral blood flow velocity in six infants with a recent history of asphyxia and eight without. ICP was measured noninvasively using a transfontanel pressure transducer, and CBF was assessed using the continuous-wave Doppler method. We found that ICP was lowest with the head elevated and in the midline (P less than 0.01), and that ICP was higher in all infants in the dependent position (P less than 0.001). This increase was significantly greater in those who had had an episode of asphyxia during the 48 to 72 hours prior to the study (P less than 0.02). Therefore, we recommend a head elevation of 30 degrees in the midline in any infant with increased ICP or at high risk for cerebral injury, and caution against the use of the dependent position in these infants.