Influence of body position on the displacement of nasal prongs in preterm newborns receiving continuous positive airway pressure

OBJECTIVE To evaluate the influence of body position on the displacement of nasal prongs in preterm infants. METHODS This prospective, randomized, crossover study enrolled infants born at a mean gestational age of 29.7±2 weeks, birth weight of 1.353±280g and 2.9±2.2 days of life, submitted to continuous positive airway pressure by nasal prongs. The main outcome was the number of times that the nasal prongs were displaced following infant positioning in the following body positions: prone, right lateral, left lateral, and supine, according to a pre-established random order. Moreover, cardiorespiratory variables (respiratory rate, heart rate, and oxygen saturation) were evaluated for each body position. Data for each position were collected every 10 minutes, over a period of 60minutes. An occurrence was defined when the nasal prongs were displaced from the nostrils after 3 minutes in the desired position, requiring intervention of the examiner. RESULTS Among the 16 studied infants, the occurrence of nasal prong displacement was only observed in the prone position (9 infants-56.2%) and in the left lateral position (2 infants-12.5%). The number of times that the prongs were displaced was 11 in the prone position (seven within the first 10minutes) and two in the left lateral position (one within the first 10minutes). No clinically significant changes were observed in the cardiorespiratory variables. CONCLUSIONS Maintenance of the nasal prongs to provide adequate noninvasive respiratory support was harder in the prone position.