Abstract
Background
Prone sleeping is used in preterm infants undergoing intensive care to improve respiratory function, but evidence suggests that this position may compromise autonomic cardiovascular control. To test this hypothesis, this study assessed the effects of the prone sleeping position on cardiovascular control in preterm infants undergoing intensive care treatment during early postnatal life.
Methods
Fifty-six preterm infants, divided into extremely preterm (gestational age (GA) 24–28 weeks, n = 23) and very preterm (GA 29–34 weeks, n = 33) groups, were studied weekly for 3 weeks in prone and supine positions, during quiet and active sleep. Heart rate (HR) and non-invasive blood pressure (BP) were recorded and autonomic measures of HR variability (HRV), BP variability (BPV), and baroreflex sensitivity (BRS) using frequency analysis in low (LF) and high (HF) bands were assessed.
Results
During the first 3 weeks, prone sleeping increased HR, reduced BRS, and increased HF BPV compared to supine. LF and HF HRV were also lower prone compared to supine in very preterm infants. Extremely preterm infants had the lowest HRV and BRS measures, and the highest HF BPV.
Conclusions
Prone sleeping dampens cardiovascular control in early postnatal life in preterm infants, having potential implications for BP regulation in infants undergoing intensive care.
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Acknowledgements
We would like to thank all the parents and their infants who participated in the study, and the nursing staff of Monash Newborn where the studies were carried out. We especially would like to acknowledge Dr. Nadine Brew, Ph.D., Ms. Stacey Willis, Ms. Kristy Elsayed, Dr. Hannah Cooney, Dr. Brenda Thonissen, and Dr. Margy Zuluaga Fernandez for their help with data acquisition and preliminary analysis. This work was supported by the project grant funding from the National Health and Medical Research Council (NHMRC) of Australia (Project No. 1083026), The Scottish Cot Death Trust, Clive and Vera Ramaciotti Foundation, and the Victorian Government’s Operational Infrastructure Support Program; Dr. Kelsee Shepherd is supported by an Australian Government Research Training Program Scholarship; A/Prof Flora Wong is supported by NHMRC Career Development Fellowships 1084254 and 1159120. Dr. Stephanie Yiallourou is supported by the Alice Baker and Eleanor Shaw Gender Equity Fellowship.
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K.S. contributed to acquisition of data, data analysis, interpretation of data, and drafting of the manuscript; S.Y., F.W., and R.S.C.H. made substantial contributions to conception and design, acquisition of data and interpretation of data, and drafting of the manuscript; E.Y. made contributed to acquisition of data and A.O. contributed to the acquisition of data and analysis. All authors contributed to revising the manuscripts critically for important intellectual content, and final approval of the version to be published.
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Written informed parental consent was obtained for all infants studied and approved by the Monash Health and Monash University human research ethics committees.
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Shepherd, K.L., Wong, F.Y., Odoi, A. et al. Prone sleeping affects cardiovascular control in preterm infants in NICU. Pediatr Res 90, 197–204 (2021). https://doi.org/10.1038/s41390-020-01254-z
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DOI: https://doi.org/10.1038/s41390-020-01254-z
