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ORIGINAL ARTICLE
Year : 2023  |  Volume : 12  |  Issue : 1  |  Page : 13-15

Impact of a short period of prone versus supine nursing in preterm neonates less than 32 weeks on weight gain: A prospective observational study


Department of Neonatology, Manipal Hospital, Bengaluru, Karnataka, India

Date of Submission14-Sep-2022
Date of Decision18-Sep-2022
Date of Acceptance28-Sep-2022
Date of Web Publication03-Jan-2023

Correspondence Address:
H A Venkatesh
Department of Neonatology, Manipal Hospital, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.jcn_89_22

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  Abstract 


Background: Postnatal growth depends on multiple factors such as gestational age, associated morbidities, and the nutrition and varies from one newborn to another. Preterm babies in neonatal intensive care unit are very much susceptible to growth faltering even after adequate nutrition and supplements. The positioning of preterm infants in neonatal intensive care has an impact on their survival and neurological outcome. Prone positioning is known to improve oxygenation, minute ventilation, and functional residual capacity. Quiet undisturbed sleep in preterms has helped them to conserve energy for growth. Objective: To determine the effect of prone versus supine position on weight gain in infants less than 32 weeks of gestational age. Design: Prospective observational study. Participants: Twenty-two neonates were recruited. Results: On day 1, in the prone position, 63.6% gained weight vs. 59.1% in the supine position (P = 0.425). On day 2, in prone, 72.7% has gained vs. 63.6% in supine (P = 0.359). On day 3, in prone, 68.2% gained weight vs. 63.6% in supine position (P = 0.426). Conclusion: Nursing a baby in a prone position has demonstrated weight gain over nursing in a supine position though not statistically significant.

Keywords: Position, preterm, weight gain


How to cite this article:
Venkatesh H A, Mohanty PK. Impact of a short period of prone versus supine nursing in preterm neonates less than 32 weeks on weight gain: A prospective observational study. J Clin Neonatol 2023;12:13-5

How to cite this URL:
Venkatesh H A, Mohanty PK. Impact of a short period of prone versus supine nursing in preterm neonates less than 32 weeks on weight gain: A prospective observational study. J Clin Neonatol [serial online] 2023 [cited 2023 Jan 30];12:13-5. Available from: https://www.jcnonweb.com/text.asp?2023/12/1/13/366895




  Introduction Top


All sick neonates including preterm infants require aggressive intensive care. Preterm nutrition is a challenge for the treating neonatologist. Even with the best knowledge and the best available nutrition, most of our infants do not gain the required weight. In developing countries, parents expect their baby discharge early as the cost of neonatal intensive care unit (NICU) is unimaginable. One of the criteria looked into in the discharge process is weight. The objective of this study was to evaluate the role of nursing babies prone to weight gain. Preterm babies in NICU are very much susceptible to growth faltering even if nutrition and supplements were provided adequately.[1] Preterm infants can be placed in different positions in the NICU which have an impact on their survival and neurological outcome. Prone positioning improves oxygenation and decreases respiratory distress.[2],[3] Minute ventilation and functional residual capacity is supposed to be higher. They have less severe gastroesophageal reflux with fewer awakening episode.[4] Hence, prone positioning may help for weight gain by decreasing metabolic rate and insensible losses. Preterm infants exhibit more transitions between 6 sleep states,[5] therefore more arousal during sleep. Studies have shown that infants in the prone position have quiet sleep and are less awake.[6] Quiet undisturbed sleep in preterms has helped them to conserve energy for growth. Infants in prone positions develop better self-regulating skills. Many studies have investigated the influence of position on medical outcomes and sleep patterns. Our goal was to evaluate the effect of short-period prone versus supine position on weight gain.


  Methods Top


This prospective observational study was conducted in Manipal Hospital, a tertiary care referral center with a 35-bedded NICU. Participants included were preterm infants <32 weeks of gestation, on full enteral feeds, and with no respiratory support.

The majority of these babies had received total parenteral nutrition for at least 1 week and they required 2 weeks to reach full feeds. Infants were placed in the supine position for 3 days and prone position for the next 3 days except during the feed (supine) and immediately postfeed for 30 min (lateral), and the weights were noted every day.

The descriptive and inferential statistical analysis was carried out. The results on continuous measurements were presented on mean ± standard deviation (SD) (min-max) and the results on categorical measurements were presented in number (%). Significance was assessed at a 5% level of significance paired. Proportion test was used to find the significance.


  Results Top


The total number of infants enrolled was 22 with gestation ranging from 27 to 32 weeks (mean ± SD: 29.68 ± 1.7) and weight ranging from 880 to 1670 g (mean ± SD: 1266.82 ± 240.6) [Figure 1] and [Figure 2]. On day 1, in the prone position, 63.6% gained weight vs. 59.1% in the supine position (P = 0.425). On day 2, in prone, 72.7% gained vs. to 63.6% in supine (P = 0.359). On day 3, in prone, 68.2% have gained weight vs. 63.6% in supine position (P = 0.426) [Figure 3] and [Table 1].
Figure 1: Gestational age distribution in infants in the study

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Figure 2: Depicted birth weight distribution in infants under the study

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Figure 3: Demonstrating weight gain in supine versus prone position

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Table 1: An evaluation of weight changes in prone and supine positioning in infants

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  Discussion Top


In our pilot study, the babies gained weight in the prone position than in supine (63.6% vs. 59.1% on day 1, 72.7% vs. 62.2% on day 2, and 68.2% vs. 63.6% on day 3), although not statistically significant. Several studies have demonstrated that infants nursed in prone position gain more weight than those who are nursed supine. However, babies should be monitored carefully when in the prone position.[1],[2] Symptomatic preterm infants with signs of respiratory distress, very low birth weight, and severe gastroesophageal reflux may benefit from the prone position during sleep. The prone position is preferred over the supine when medically feasible. Preterm infants cry less and move less, thereby conserving energy for optimum growth. Tonic labyrinthine reflex is very strong in infants in the prone position, which can cause more flexor activity preventing the baby to perform "sitting on air" activity.[5],[6] Freedom of movement of head and extremities is very less when baby is nursed prone. In the prone position, more sleep patterns (deep sleep, light sleep, and drowsy) are observed than awake patterns (quiet awake, active awake, and agitated fussy).[7] It is also found that infants in the prone position will have less gastroesophageal reflux. All the parameters mentioned above make the baby move less and conserve more energy. Our study results may not be generalized as the sample size is small. This pilot study underscores the importance of performing a randomized controlled study trial with a good sample size. The early weight gain helps the baby to stay less time in the intensive care unit and get discharged soon which is crucial in resource-limited countries. The continuous monitoring of the baby and vitals is crucial when conducting this study.


  Conclusion Top


Our study showed a novel trend of gaining weight more in prone than supine positions though not statistically significant, which may be due to the small sample size. This study encourages placing the stable babies prone on the monitor, as it regulates behavior, and conserves more energy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pearson A, Wiechula R, Court A, Lockwood C. The JBI model of evidence-based healthcare. Int J Evid Based Healthc 2005;3:207-15.  Back to cited text no. 1
    
2.
Picheansathian W, Woragidpoonpol P, Baosoung C. Positioning of preterm infants for optimal physiological development: A systematic review. JBI Libr Syst Rev 2009;7:224-59.  Back to cited text no. 2
    
3.
Das H, Shaikh S, Kella N. Effect of prone versus supine position on oxygen saturation in patients with respiratory distress. Pak J Med Sci 2011;27:1098-101.  Back to cited text no. 3
    
4.
Susan MP. A Critical Review of the Literature Regarding Positioning for the Treatment of Gastroesophageal Reflux in Neonates. Retrieved from Sophia, the St. Catherine University repository. 2011.  Back to cited text no. 4
    
5.
Ariagno RL, van Liempt S, Mirmiran M. Fewer spontaneous arousals during prone sleep in preterm infants at 1 and 3 months corrected age. J Perinatol 2006;26:306-12.  Back to cited text no. 5
    
6.
Galland BC, Taylor BJ, Bolton DP. Prone versus supine sleep position: A review of the physiological studies in SIDS research. J Paediatr Child Health 2002;38:332-8.  Back to cited text no. 6
    
7.
Bhat RY, Hannam S, Pressler R, Rafferty GF, Peacock JL, Greenough A. Effect of prone and supine position on sleep, apneas, and arousal in preterm infants. Pediatrics 2006;118:101-7.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

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