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The Effect of Body Position on Oxygenation, Ventilation, and Diaphragmatic Workload in Infants Born Premature on Noninvasive Neurally Adjusted Ventilatory Assist

Year: 2025

Type: article

Abstract: To determine the effect of supine versus prone body position on oxygenation, ventilation, and diaphragmatic workload in infants born ≤32 weeks of gestation on non-invasive NAVA. This study was conducted in two level III-IV NICUs. Infants were randomly assigned into one of two starting positions: supine or prone. Infants alternated between supine and prone positioning every three hours, for a total of twelve hours. Nursing care and feeding were done every three hours with position changes. Infants were allowed a period of one hour following nursing care before data collection resumed. Thirty subjects (22-32 weeks’ gestation at birth) were included in the study. Edi peaks were lower in prone positioning; 8.61±5.57 vs 9.79±6.14 μV (p= 0.02). Edi mins were similarly lower in the prone position; 2.76 vs 3.05 μV (p=0.04). Peak airway pressure, heart rate, respiratory rate, oxygen saturation, transcutaneous carbon dioxide level, and oxygen requirements were not affected by position. When stratified by gestational age, Edi peaks remained lower in prone versus supine positioning; 8.60±5.14 vs 10.14±5.54 μV (p=0.009). The number of clinically significant events were similar between both groups. Prone positioning is associated with lower diaphragmatic workload in premature infants on non-invasive NAVA. Despite this, infants had comparable clinical parameters in both prone and supine positions, suggesting that nivNAVA is able to eliminate differences related to body position to provide consistent proportional and synchronized respiratory support.

Source: The Journal of Pediatrics Clinical Practice

DOI: 10.1016/j.jpedcp.2025.200192