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  • Original Article
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Prone positioning decreases cardiac output and increases systemic vascular resistance in neonates

Journal of Perinatology volume 35, pages 424–427 (2015)Cite this article

Subjects

Abstract

Objective:

To evaluate the cardiovascular response to short-term prone positioning in neonates.

Study design:

In this prospective study, we continuously monitored heart rate (HR), stroke volume (SV) and cardiac output (CO) by electrical velocimetry in hemodynamically stable neonates in each of the following positions for 10 min: supine, prone and back-to-supine position. Skin blood flow (SBF) was also continuously assessed on the forehead or foot using Laser Doppler technology. Systemic vascular resistance (SVR) index was calculated as mean blood pressure (BP)/CO. Data were analyzed using repeated measures analysis of variance.

Results:

Thirty neonates (gestational age: 35±4 weeks; postmenstrual age: 36±3 weeks) were enrolled. HR did not change in response to positioning. However, in prone position, SV, CO and SBF decreased and SVR index increased from 1.5±0.3 to 1.3±0.3 ml kg−1 (mean ±s.d., P<0.01), 206±44 to 180±41 ml kg−1 min−1 (P<0.01), 0.54±0.30 to 0.44±0.29 perfusion units (P<0.01) and 0.25±0.06 to 0.30±0.07 mm Hg ml−1 kg−1 min−1 (P<0.01), respectively. After placing the infants back-to-supine position, SV, CO, SBF and SVR index returned to baseline. The above pattern of cardiovascular changes was consistent in vast majority of the studied neonates.

Conclusions:

Short-term prone positioning is associated with decreased SV, CO and SBF and increased calculated SVR index.

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Acknowledgements

This study was, in part, supported by grant support from the National Heart, Lung and Blood Institute (1RO1HL103765-01).

Author information

Authors and Affiliations

  1. Division of Neonatology and the Center for Fetal and Neonatal Medicine, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    M Ma, S Noori & I Seri

  2. The LAC+USC Medical Center, Los Angeles, CA, USA

    M Ma, S Noori & I Seri

  3. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,

    M Ma, S Noori & I Seri

  4. Department of Biomedical Engineering, University of Southern California, Los Angeles, CA,USA,

    J-M Maarek & D P Holschneider

  5. Department of Psychiatry and Behavioral Science, University of Southern California, Los Angeles, CA, USA,

    D P Holschneider

  6. Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA,USA,

    E H Rubinstein

  7. Department of Pediatrics, Sidra Neonatology Center of Excellence, Sidra Medical and Research Center, Doha, Qatar,

    I Seri

Authors
  1. M Ma
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  2. S Noori
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  3. J-M Maarek
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Corresponding author

Correspondence to S Noori.

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The authors declare no conflict of interest.

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Ma, M., Noori, S., Maarek, JM. et al. Prone positioning decreases cardiac output and increases systemic vascular resistance in neonates. J Perinatol 35, 424–427 (2015). https://doi.org/10.1038/jp.2014.230

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  • DOI: https://doi.org/10.1038/jp.2014.230

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