prone positioning improves oxygenation in neonates with respiratory distress and improves signs of respiratory distress thereby leading to easier management and reduced requisite of oxygen particularly in resource limitation environment of most public sector hospitals. Moreover, it is simple to use, low-cost and doesn't need any special training.

1. Dr. Syed Kamrul Hasan
Medical Officer
NICU , SWMCH

2. Impact of Positioning on Neonate
with Respiratory Distress:
Prone Vs Supine Position.

3. Authors:
Shahenda A. Salih
Ayat M. Omar
Shereen A. Elwasefy
Doaa A. Said
Abozer Y. Elderdery.
Source:
Sylwan Journal. March 2020, Vol-
163(12), 54-69

4. Respiratory distress is highly prevalent in
neonates. A study in united states in 2010
reported that 29% of preterm newborns and
15% of term newborns have been found with a
significant respiratory disease, particularly
those ones who were admitted to the neonatal
ICU. There are several risk factors may involve
in having neonatal respiratory disorder such

5. as caesarian section delivery, immaturity,
maternal chorioamnionitis, meconium-stained
amniotic fluid and gestational diabetes
mellitus. These collectively indicate a standard
neonatal clinical problem. Body position
enhances oxygen transport by the operational
effect of gravity on cardiopulmonary and
cardiovascular function. Body positioning is an
important part of respiratory care.

6. Positioning improves gas exchange and reduces
pathology. Once useful positions are adopted,
gravitational, hydrostatic and compressional
forces engaged on the heart, chest wall, lungs,
vascular system, and blood volume, as well as
the diaphragm, eventually combine to improve
oxygen transport.

7. The physiological advantages of the prone
position are represented with improved
ventilation-perfusion mismatching, the
achievement of dependent lung regions and
increased drain of secretions from the trachea
and bronchus. Improving nursing intervention
for neonates with respiratory distress is very
important because of the costly medical care,
high morbidity and mortality rates associated
with the disease.

8. It also reduces length of hospital stay,
especially in settings with limited facilities for
intensive care, including the availability of
mechanical ventilation and cost of oxygen
therapy. Neonates with acute lung disease are
traditionally managed in the supine position to
facilitate observation, easy access, and
umbilical line management. The given results
will guide for the proper position to be
adopted for the newborns who suffer from
respiratory distress.

9. To compare the effect of the prone and supine
position on respiratory rate, pulse rate and
oxygen saturation on newborns with acute
respiratory distress syndrome.

10. Place of the study :-
Mansoura University Children’s Hospital
(MUCHs), Mansoura City, Egypt.
Design of Study:
Cohort study
Sample size:
60

11. Inclusion Criteria:
All neonates delivered after 32 weeks of
gestational age, and diagnosed as having
respiratory distress.

12. Exclusion Criteria :-
 Neonates with congenital heart disease,
 Major congenital malformations,
 Cephalhaematoma,
 Under ventilator and unable to tolerate
the position
 Neonates whose parents refused to
participate in this research.

14. 60 newborns with
respiratory distress admitted to neonatal ICU were
recruited according to the inclusion and exclusion criteria.
Kept on supine position for
2 hours.
Kept on prone position for
2 hours
Oxygen saturation, pulse
rate and respiratory rate
was measured every hour
Oxygen saturation, pulse
rate and respiratory rate
was measured every hour
Data processing,
analysis and results
Data processing,
analysis and results

15. Neonates clinical data Number
(n=60)
Percentage
Age in days <7days
<14 days
<21 days
≥21 days
52
08
00
00
86.7%
13.3%
00
00
Gender Male
Female
46
14
76.7%
23.3%
Neonate
gestational age
/ weeks
32-<37weeks
37-<42 weeks
≥42 weeks
30
28
02
50%
46.7%
3.3%
Weight
according to
Gestational age
SGA
AGA
LGA
20
34
06
33.3%
56.7%
10%
Mode of delivery vaginal delivery
Caesarian section
Instrumental delivery
12
48
00
20%
80%
00

16. Method of oxygen
administration
Number (percentage)
Nasal cannula 40 (66.7)
Oxygen mask 6(10)
Oxygen hood 2 (3.3)
oxygen tent 12 (20)

17. Items supine
position
after 1hr
(SD)
Prone
position
after 1hr
(SD)
Level of
significan
ce (p
value)
Supine
position
after
2hrs (SD)
Prone
position
after
2hrs (SD)
Level of
significan
ce (p
value)
Respiratory
rate (br/m)
59.6
(9.6)
56.4
(8.5)
0.000 59.6
(11.7)
53.6
(6.4)
0.000
Pulse rate
(b/m)
149.1
(29.7)
146
(24.5)
0.44 146.9
(28.2)
118.8
(21.1)
0.000
O2
Saturation
(%)
93.8
(5.1)
96
(3.45)
0.004 95.8
(3.7)
97.7
(2.2)
0.000

18. Positions After 1hour
(SD)
After 2 hours
(SD)
P value
Respiratory
rate(br/m)
Supine position 59.6(9.64) 59.6(11.73) 1.000
Prone position 56.36(8.45) 53.6(6.43) 0.001
Pulse rate
(b/m)
Supine position 149(29.6) 146.9(28.18) 0.571
Prone position 146(24.46) 118.76(21.13) 0.000
Oxygen
saturation
(%)
Supine position 93.83(5.14) 95.76(3.56) 0.010
Prone position 96(3.45) 97.56(2.20) 0.000

20. In conclusion, prone positioning improves
oxygenation in neonates with respiratory
distress and improves signs of respiratory
distress thereby leading to easier management
and reduced requisite of oxygen particularly in
resource limitation environment of most public
sector hospitals. Moreover, it is simple to use,
low-cost and doesn't need any special training.

21. Some parents refused to participate in the
study.

22. Title: -Effect of prone versus supine position on
oxygen saturation in patients with respiratory
distress in neonates.
Authors : Heman Das et al
Source : Pak J Med Sci October- December 2011
Vol. 27 No. 5 1098-1101
Results : One hundred patients were enrolled in the
study with age range 3 hours-28 days, out of them
87 (87%) term, 9 (9%) preterm and 4 (4%) were post
term respectively, male to female ratio was 1.2:1.

23. The oxygen saturation in supine position was
84.84±4.20. After 2 hour in prone position
saturation was 91.05±3.29, after 4 hour 91.62
±3.89 and after 6 hours it was 92.63±3.02
respectively with P value of < 0.001 which is
statistically highly significant. It shows that
Oxygen saturation is increased by about 7%,
and maximum oxygen saturation increases in
first 2 hours. Similar trend was seen in
respiratory rate with reduction of respiratory
rate by 6 breaths / min in first two hours.

24. Title : Effects of Position on Oxygen Saturation in
Acute Respiratory Distress in Neonates.
Authors : Shankar lal et al.
Source : Journal of Surgery Pakistan (International)
18 (4) October-December 2013
Result : One hundred neonates were included in
this study by non-probability sampling. Age
ranged from 1 hour-25 days. There were 77
(77%) term, 19 (19%) preterm and 4 (4%) post
term babies with male to female ratio of 1.3:1.

25. All the patients with respiratory distress (RD)
were kept in supine position for three hours
and oxygen saturation and respiratory rate
were recorded. After that they were kept in
prone position for six hours. Oxygen
saturation and respiratory rate were measured
every two hours interval for six hours. After 6
hour in prone position the PaO2 of all patients
increased by about 7%. In supine position it
was 86.4 ± 5.7 and in prone 93.5±4.1 with p
value of < 0.001 which is statistically highly
significant.