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In an era of antenatal glucocorticoids and postnatal surfactant therapy
the current inclination towards continuous positive airway pressure (CPAP)
support reflects the desire to avoid/minimise the use of mechanical
ventilation in preterrn neonates as much as possible. The combination of
rising oxygen needs and worsening respiratory distress despite
"adequate" CPAP support is usually taken as an almost undisputable
indication for tracheal intubation and exogenous surfactant therapy in
preterrn neonates, especially in the developed world. We recently faced
a 31 weeks’ gestation female neonate weighing 1330 grams (first of the
twins delivered by cesarean section for failure to progress) with
respiratory distress syndrome (RDS) managed with oxygen and CPAP (6 cm
H2O) from 6 hours after birth. Mother had received two doses of
betamethasone antenatally. By 36 hours of age her intercostal and
subcostal retractions, respiratory rate (increasing from 60/minute to
80/minute), and oxygen requirements (increasing from 30% to 45%) had
pro-gressively worsened. Resisting the tempta-tion to intubate was
difficult to say the least with an anticipated peak of RDS and oncoming
night shift-till the senior registrar took note of the neonate’s
positioning. Within 15 minutes of changing the neonate from supine to
prone position, the respiratory distress improved dramatically
(respiratory rate: 50-60/minute, oxygen: 25% to nil). The improvement
was sustained and by 72 hours of age the neonate was no longer dependent
on CPAP or supplementary oxygen.
A total of 10,471 neonates received assisted
ventilation (72,544 days) in Australia and New Zealand in 1996 and 1997,
estimated to cost in excess of A$ 72 million per year(1). Of those <29
week, about 40% developed chronic lung disease–the
socio-economic/emotional burden of which is extremely significant(1).
The significant impact of simple strategies like prone positioning in
improving oxygenation in neonates with respiratory distress must not be
forgotten(2-4).
S.K. Patole,
L. McGlone,
D. Hares,
Department of Neonatal Pediatrics,
King Edward Memorial Hospital
for Women, Bagot Road,
Subiaco, Western Australia 6008.
E-mail: [email protected]
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References |
1. Donaghue D. Australian and New Zealand
Neonatal Network 1996-1997. (PER 11). Sydney, AIHW National
Perinatal Statistics Unit.
2. Wagaman MJ, Scutack JG, Moomjian AS,
Schwartz JG, Shaffer TH, Fox WW. Improved oxygenation and lung
compliance with prone positioning of neonates. J Pediatr 1979;
94: 787-791.
3. Martin RJ, Herrel N, Rubin D, Fanaroff A
Effect of supine and prone positions on arterial oxygen tension
in the preterm infant. Pediatrics 1979; 63: 528-531.
4. Baird TM, Paton JB, Fisher DE. Improved oxygenation with
prone positioning in neonates: stability of increased
transcutaneous pO2. J Perinatol 1991; 11: 315- 318.
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