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The effect of head positioning on brain tissue oxygenation in preterm infants: a randomized clinical trial study



CNS injury in preterm infants is still one of the leading causes of mortality and morbidity. Routine care events might affect the perfusion and cerebral oxygenation of preterm infants. Although positioning the infant’s head in a particular condition to improve brain oxygenation is included in many institutions, there is no robust clinical evidence to support this intervention’s effectiveness.


The present study aimed to determine the effect of head positioning on brain tissue oxygenation in preterm infants.


This study is a randomized clinical trial. In the first 48 h after birth, 39 infants who met the study inclusion criteria underwent head positioning intervention. In this case, the infants were placed in the supine position, and every 2 h, the head position was changed continuously to one of six randomized modes [using random modes generated by SPSS]. During each head positioning, brain tissue oxygenation was recorded by NIRS.


The findings showed a significant difference in brain tissue oxygen saturation among these positions (P < 0.001). Dunn’s test showed that the brain tissue oxygen saturation in the third position (head rotates 45–60 degrees from the midline to the right and the head of the bed is zero degrees) was significantly lower than the baseline (P = 0.029; Mean difference = 2.3). Also, in the third position, compared to the first position (P = 0.002; Mean difference = 1.9) and compared to the fourth position (P = 0.003; Mean difference = −2.1), and in the second position compared to the first position (P = 0.046; Mean difference = 1.3), the brain tissue oxygen saturation of the infants was lower.


Based on the results of the present study, head positioning was effective on brain tissue oxygenation in preterm infants in the first 48 h after birth; Therefore, it is recommended when possible, not to rotate the infant’s head during the first 48 h after birth while the head of the bed is at 0°.

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Fig. 1: Flowchart of study participants in the study stages.
Fig. 2: Head positioning states under study.
Fig. 3: Brain tissue oxygen saturation in preterm infants in the studied positions.


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This paper is the result of the master’s thesis of neonatal intensive care nursing, which has been approved by the code of ethics of IR.MUMS.NURSE.REC.1398.040 and Grant code 980354 in Mashhad University of Medical Sciences. The authors would like to express their gratitude and appreciation to the Vice Chancellor for Research of Mashhad University of Medical Sciences for their financial support, officials and staff of Om-al-Banin Hospital, and all parents of infants participating in the study.

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Authors and Affiliations



ZR, MR, MH, and MS: Study design and conceptualization. ZR, MR, and MH: Data collection. ZR, MR, MH and AS: Data analysis and interpretation. ZR, MR, MH, MS, and AS: Manuscript writing. MR, MH, and MS: Study supervision.

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Correspondence to Monir Ramezani.

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Mohamammadie, Z.R., Ramezani, M., Heidarzadeh, M. et al. The effect of head positioning on brain tissue oxygenation in preterm infants: a randomized clinical trial study. J Perinatol 42, 660–666 (2022).

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