Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

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

Journal of Perinatology volume 42, pages 660–666 (2022)Cite this article

Subjects

Abstract

Background

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.

Objective

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

Methods

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.

Results

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.

Conclusion

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°.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

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.

References

  1. Ghazi M, Zare M, Ramezani M, Heidarzadeh M, Bahnam H. The Effect of Home Visit Program Based on the Continued Kangaroo Mother Care on Maternal Resiliency and Development of Premature Infant: A Randomized Clinical Trial. Int J Community Based Nurs Midwifery. 2021;9:64–75.

    PubMed  Google Scholar 

  2. Mardanian F, Shahzamani S Frequency of preterm delivery and premature infants requiring intensive cares at a referral Hospital in Isfahan, Iran. J Isfahan Med School. 2011;28:1–5.

  3. Reihani T, Sekhavatpour Z, Heidarzade M, Mousavi S, Mazloum S. The effect of education on self-care, spiritual distress tolerance mothers of preterm infants admitted to Neonatal Intensive Care Unit. J Obstet Gynecol Infertil (IJOGI). 2014;17:18–28.

    Google Scholar 

  4. Volpe JJ. Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances. Lancet Neurol. 2009;8:110–24.

    Article  Google Scholar 

  5. Volpe JJ Neurology of the Newborn. 6th Ed ed. Philadephia: Elsevier; 2018. p. 325–698.

  6. Khwaja O, Volpe J. Pathogenesis of cerebral white matter injury of prematurity. Arch Dis Child-Fetal Neonatal Ed. 2008;93:F153–F61.

    Article  CAS  Google Scholar 

  7. Sola A, Golombek SG, Montes Bueno MT, Lemus‐Varela L, Zuluaga C, Domínguez F, et al. Safe oxygen saturation targeting and monitoring in preterm infants: can we avoid hypoxia and hyperoxia? Acta Paediatrica. 2014;103:1009–18.

    Article  Google Scholar 

  8. Rhee CJ, Da Costa CS, Austin T, Brady KM, Czosnyka M, Lee JK. Neonatal cerebrovascular autoregulation. Pediatr Res. 2018;84:602–10.

    Article  Google Scholar 

  9. Ramezani M, Emami Zeydi A. Brain-derived neurotrophic factor: a promising biomarker for predicting prematurity-related complications. Int J Prev Med. 2019;12:140.

    Google Scholar 

  10. Humberg A, Härtel C, Paul P, Hanke K, Bossung V, Hartz A, et al. Delivery mode and intraventricular haemorrhage risk in very-low-birth-weight infants: observational data of the German Neonatal Network. Eur J Obstet Gynecol Reprod Biol. 2017;212:144–9.

    Article  Google Scholar 

  11. MacDonald MG, Seshia MM Avery’s neonatology: pathophysiology and management of the newborn: Lippincott williams & wilkins; 2015.

  12. Volpe JJ: Intracranial hemorrhage; in Volpe JJ (ed): Neurology of the Newborn eP, Saunders, 2008, pp 481–588.

  13. Limperopoulos C, Gauvreau KK, O’Leary H, Moore M, Bassan H, Eichenwald EC, et al. Cerebral hemodynamic changes during intensive care of preterm infants. Pediatrics. 2008;122:e1006–e13.

    Article  Google Scholar 

  14. Noori S, McCoy M, Anderson MP, Ramji F, Seri I. Changes in cardiac function and cerebral blood flow in relation to peri/intraventricular hemorrhage in extremely preterm infants. J Pediatrics. 2014;164:264–70. e3.

    Article  Google Scholar 

  15. Dix LML, van Bel F, Lemmers PMA. Monitoring cerebral oxygenation in neonates: an update. Front Pediatrics. 2017;5:46.

    Google Scholar 

  16. Lemmers PM, Benders MJ, D’Ascenzo R, Zethof J, Alderliesten T, Kersbergen KJ, et al. Patent ductus arteriosus and brain volume. Pediatrics. 2016;137:e20153090.

    Article  Google Scholar 

  17. Kenosi M, Naulaers G, Ryan C, Dempsey E. Current research suggests that the future looks brighter for cerebral oxygenation monitoring in preterm infants. Acta Paediatrica. 2015;104:225–31.

    Article  CAS  Google Scholar 

  18. De Bijl-Marcus KA, Brouwer AJ, de Vries LS, van Wezel-Meijler G. The effect of head positioning and head tilting on the incidence of intraventricular hemorrhage in very preterm infants: a systematic review. Neonatology. 2017;111:267–79.

    Article  Google Scholar 

  19. Liao SM, Rao R, Mathur AM. Head position change is not associated with acute changes in bilateral cerebral oxygenation in stable preterm infants during the first 3 days of life. Am J Perinatol. 2015;32:645–52.

    PubMed  Google Scholar 

  20. Ansari M, Shojaeifar M, Mohajerani E. The estimation of recovery time of calf muscle oxygen saturation during exercise by using functional near infrared spectroscopy. Opt Commun. 2014;325:23–7.

    Article  CAS  Google Scholar 

  21. Romantsik O, Calevo MG, Bruschettini M Head midline position for preventing the occurrence or extension of germinal matrix‐intraventricular hemorrhage in preterm infants. Cochrane Database Syst Rev. 2017;7:CD012362.

  22. Fanaroof A, Martin R, Walsh M Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 10thed ed. Philadelphia: Mosby Elsevier Co; 2015.

  23. Alderliesten T, De Vis JB, Lemmers PM, Hendrikse J, Groenendaal F, Van Bel F, et al. Brain oxygen saturation assessment in neonates using T2-prepared blood imaging of oxygen saturation and near-infrared spectroscopy. J Cereb Blood Flow Metab. 2017;37:902–13.

    Article  CAS  Google Scholar 

  24. Naulaers G, Meyns B, Miserez M, Leunens V, Van Huffel S, Casaer P, et al. Use of tissue oxygenation index and fractional tissue oxygen extraction as non-invasive parameters for cerebral oxygenation. Neonatology. 2007;92:120–6.

    Article  CAS  Google Scholar 

  25. Soeding P. Effects of positioning on cerebral oxygenation. Curr Anesthesiol Rep. 2013;3:184–96.

    Article  Google Scholar 

  26. Brady K, Joshi B, Zweifel C, Smielewski P, Czosnyka M, Easley RB, et al. Real-time continuous monitoring of cerebral blood flow autoregulation using near-infrared spectroscopy in patients undergoing cardiopulmonary bypass. Stroke. 2010;41:1951–6.

    Article  Google Scholar 

  27. Jenni OG, von Siebenthal K, Wolf M, Keel M, Duc G, Bucher HU. Effect of nursing in the head elevated tilt position (15) on the incidence of bradycardic and hypoxemic episodes in preterm infants. Pediatrics. 1997;100:622–5.

    Article  CAS  Google Scholar 

  28. Thoresen M, Cowan F, Walløe L. Cardiovascular responses to tilting in healthy newborn babies. Early Hum Dev. 1991;26:213–22.

    Article  CAS  Google Scholar 

  29. Kochan M, Leonardi B, Firestine A, McPadden J, Cobb D, Shah TA, et al. Elevated midline head positioning of extremely low birth weight infants: effects on cardiopulmonary function and the incidence of periventricular-intraventricular hemorrhage. J Perinatol. 2019;39:54–62.

    Article  Google Scholar 

  30. Demirel G, Oguz SS, Celik IH, Erdeve O, Dilmen U. Cerebral and mesenteric tissue oxygenation by positional changes in very low birth weight premature infants. Early Hum Dev. 2012;88:409–11.

    Article  Google Scholar 

  31. Ancora G, Maranella E, Aceti A, Pierantoni L, Grandi S, Corvaglia L, et al. Effect of posture on brain hemodynamics in preterm newborns not mechanically ventilated. Neonatology. 2010;97:212–7.

    Article  Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

  1. Department of Neonatal & Pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

    Zeinab Rabbani Mohamammadie & Monir Ramezani

  2. Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

    Monir Ramezani

  3. Department of Pediatrics, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

    Mohammad Heidarzadeh

  4. Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

    Majid Sezavar

  5. Department of Epidemiology & Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

    Azadeh Saki

Authors
  1. Zeinab Rabbani Mohamammadie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Monir Ramezani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohammad Heidarzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Majid Sezavar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Azadeh Saki
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

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.

Corresponding author

Correspondence to Monir Ramezani.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.1038/s41372-022-01366-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-022-01366-w

Search

Advanced search

Quick links