Aim: The aim of this study was to determine the effectiveness of quarter turn from prone compared with supine and prone positioning in maintaining respiratory function in premature infants managed in a neonatal intensive care unit. Methods: The study was a prospective, randomised, cross-over trial with concealed allocation and intention to treat analysis. Fifty-four infants ≤32 weeks gestation were randomly allocated to the order of the positions supine, prone and quarter turn from prone. Distribution of ventilation was assessed by measurement of regional impedance amplitude, global inhomogeneity index and phase angle analysis using electrical impedance tomography 30 min after each position change. Physiological characteristics of heart rate, respiratory rate (RR), oxygen saturation and inspired oxygen were also measured. Results: There was a significant difference between positions for RR with the RR in quarter turn from prone significantly lower than for supine (mean difference 6.53 breaths/min; 2.04–11.02), but not compared with the prone position. No significant differences between positions were found for any of the other outcomes measured. Conclusion: This study demonstrated that quarter turn fromprone had an immediate positive positional effect on the RR of premature infants. The position of quarter turn from prone was comparable with prone in the maintenance of lung function and had a superior effect over supine on RR. These findings support the view that a quarter turn from prone can be confidently used in neonatal nurseries to manage premature infants.
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