Elevated midline head positioning of extremely low birth weight infants: effects on cardiopulmonary function and the incidence of periventricular-intraventricular hemorrhage

Michael Kochan; Bianca Leonardi; Angela Firestine; Jacob McPadden; Danielle Cobb; Tushar A Shah; Turaj Vazifedan; W Thomas Bass

doi:10.1038/s41372-018-0261-1

Elevated midline head positioning of extremely low birth weight infants: effects on cardiopulmonary function and the incidence of periventricular-intraventricular hemorrhage

J Perinatol. 2019 Jan;39(1):54-62. doi: 10.1038/s41372-018-0261-1. Epub 2018 Oct 22.

Authors

Michael Kochan^{1

2}, Bianca Leonardi^{1

3}, Angela Firestine^{1

4}, Jacob McPadden^{1

5}, Danielle Cobb^{1

6}, Tushar A Shah⁷, Turaj Vazifedan⁸, W Thomas Bass⁹

Affiliations

¹ Department of Pediatrics, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk, USA.
² Division of Neonatology, University of Maryland School of Medicine, Baltimore, MD, USA.
³ Pediatrix Medical Group of Ohio, Akron, OH, USA.
⁴ Central Ohio Newborn Medicine, Columbus, OH, USA.
⁵ Division of Neonatal-Perinatal Medicine, Yale University School of Medicine, New Haven, CT, USA.
⁶ Arnold Palmer Hospital for Children, Orlando, FL, USA.
⁷ Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk, USA.
⁸ Division of Biostatistics, Department of Pediatrics, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk, USA.
⁹ Division of Biostatistics, Department of Pediatrics, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk, USA. Thomas.Bass@chkd.org.

PMID: 30348960
DOI: 10.1038/s41372-018-0261-1

Abstract

Objective: Changes in cerebrovascular hemodynamics associated with head position may be important in the pathogenesis of periventricular-intraventricular hemorrhage (PIVH) in premature infants. This study evaluated the effect of elevated midline head positioning on cardiopulmonary function and the incidence of PIVH.

Study design: ELBW infants were randomized to FLAT (flat, supine) or ELEV (supine, bed elevated 30 degrees) for 96 h. Cardiopulmonary function, complications of prematurity, and the occurrence of PIVH were documented.

Results: Infants were randomized into FLAT (n = 90) and ELEV groups (n = 90). No significant differences were seen in the incidence of BPD or other respiratory complications. The ELEV group developed significantly fewer grade 4 hemorrhages (p = 0.036) and survival to discharge was significantly higher in the ELEV group (p = 0.037).

Conclusions: Managing ELBW infants in an elevated midline head position for the first 4 days of life appears safe and may decrease the likelihood of severe PIVH and improve survival.

Publication types

Randomized Controlled Trial

MeSH terms

Cerebral Hemorrhage* / diagnosis
Cerebral Hemorrhage* / epidemiology
Cerebral Hemorrhage* / etiology
Cerebral Hemorrhage* / therapy
Cerebral Ventricles* / blood supply
Cerebral Ventricles* / diagnostic imaging
Cerebrovascular Circulation / physiology*
Female
Gestational Age
Head
Humans
Incidence
Infant, Extremely Low Birth Weight
Infant, Newborn
Infant, Premature, Diseases* / diagnosis
Infant, Premature, Diseases* / epidemiology
Infant, Premature, Diseases* / etiology
Infant, Premature, Diseases* / therapy
Intensive Care, Neonatal / methods
Male
Moving and Lifting Patients* / adverse effects
Moving and Lifting Patients* / methods
Patient Positioning* / adverse effects
Patient Positioning* / methods
Treatment Outcome
Ultrasonography / methods