Position Effect on Cerebral Oxygenation in Neonates During Transition After Birth

• Published in: The journal of pediatric research 2024-06, Vol.11 (2), p.80-87
• Main Authors: Ergon, Ezgi Yangin, Colak, Ruya, Terek, Demet, Koroglu, Ozge Altun, Calkavur, Sebnem, Yalaz, Mehmet, Kultursay, Nilgun
• Format: Article
• Language: English
• Subjects: apgar; Cerebral circulation; cerebral oxygenation; delivery room; Health aspects; Infants (Newborn); neonate; Patients; Pediatric research; position; Positioning
• ISSN: 2147-9445; 2147-9445; 2587-2478
• DOI: 10.4274/jpr.galenos.2024.79735

Aim: According to delivery room guidelines, an optimal position is not specified for the stabilization of the baby. This study aimed to define the positions effects on postnatal adaptation parameters and cerebral oxygenation in non-resuscitated neonates. Materials and Methods: A total of 60 neonates delivered by cesarean section stabilized randomly in the supine, right-side, left-side, or prone positions were enrolled. Apgar scores, heart rates (HR), arterial oxygen saturations via pulse oximetry, and perfusion indexes (PI) at the 2nd, 5th and 10th minutes were recorded. Cerebral regional oxygen saturation (Sp[O.sub.2]) of the patients was monitored by near-infrared spectroscopy. Results: In the prone position, the 1st minute Apgar score was significantly lower than other groups, but no difference was observed at the 5th minute Apgar scores (1st min Apgarprone, p=0.05). Although there was no statistically significant difference, the prone position had the lowest HR at the 2nd minute, while the supine posture had the greatest HR at the 5th and 10th minutes. While the groups' Sp[O.sub.2] values were similar, the left-side group's perfusion rates increased at the 5th and 10th minute marks (5th and 10th min PIleft-side, p=0.67, p=0.21, respectively). Regional cerebral oxygen saturation (rSc[O.sub.2]) and cerebral fractional oxygen extraction did not differ significantly between groups at the 5th and 10th minute time intervals. Although right and left rSc[O.sub.2] were found to be higher in the first 5 minutes in the prone position, this elevation did not lead to a statistically significant difference, and right and left rSc[O.sub.2] values were found to be similar in all groups at the 10th minute. Conclusion: Adaptation parameters were not affected by position, except for lower 1st minute Apgar scores in the prone group and higher perfusion indices in the left lateral position. Cerebral perfusion was similar in all groups. The left-side position, which results in a higher PI, may be a good alternative. Studies with larger case series may provide further information. Keywords: Apgar, cerebral oxygenation, delivery room, neonate, position