A comparison between supine and prone positions for better diffusion in neonates

Abstract

Neonates are generally nursed in the supine position however nursing in the prone position seems to aid neonates suffering from respiratory distress. A number of studies have indicated this but to date standards have not been implemented yet. The PICO question investigated in this literature review is: “Does lying down in prone position (I) improve diffusion of gases (O) in neonates and infants up to the age of 35 days (P) and suffering from respiratory distress, when compared to supine position? (C)”. A thorough search was performed to gather relevant literature published from 2005 and 2015. Neonates not suffering from respiratory distress and older than 35 days were excluded, as were studies not published in English. Following, the literature search, five studies were reviewed and included in the review. These included a Systematic Review, 1 Randomised Control Trial, 2 Randomised Cross-Over Trials and 1 Non-Randomised Cross-Over trial, all available in the English language. The studies were critiqued using the CASP tool set or the TREND tool. Results obtained showed that in mechanically ventilated, pre-term neonates suffering from Respiratory Distress, an improvement is observed in various parameters related to diffusion of gases and respiration, when nursed in the prone position. It was hence concluded that the prone position is beneficial in such cases, allowing neonates to rest and recover better when suffering from respiratory distress. It is therefore recommended that in such cases, the neonate’s position is regularly altered from the supine to that of the prone position while observing signs of improvement. Further research on the subject is also recommended, particularly to determine the optimum duration of this intervention and also its effect on term neonates.