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

Journal of Perinatology volume 39, pages 54–62 (2019) Cite this article

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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.

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Acknowledgements

The authors thank the excellent, dedicated nursing staff and the respiratory therapy staff of the Children’s Hospital of The King’s Daughters Neonatal Intensive Care Unit for their support and assistance.

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Author notes

  1. Michael Kochan

    Present address: Division of Neonatology, University of Maryland School of Medicine, Baltimore, MD, USA

  2. Bianca Leonardi

    Present address: Pediatrix Medical Group of Ohio, Akron, OH, USA

  3. Angela Firestine

    Present address: Central Ohio Newborn Medicine, Columbus, OH, USA

  4. Jacob McPadden

    Present address: Division of Neonatal-Perinatal Medicine, Yale University School of Medicine, New Haven, CT, USA

  5. Danielle Cobb

    Present address: Arnold Palmer Hospital for Children, Orlando, FL, USA

Authors and Affiliations

  1. Department of Pediatrics, Children’s Hospital of The King’s Daughters, Eastern Virginia Medical School, Norfolk, USA

    Michael Kochan, Bianca Leonardi, Angela Firestine, Jacob McPadden & Danielle Cobb

  2. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children’s Hospital of The King’s Daughters, Eastern Virginia Medical School, Norfolk, USA

    Tushar A. Shah

  3. Division of Biostatistics, Department of Pediatrics, Children’s Hospital of The King’s Daughters, Eastern Virginia Medical School, Norfolk, USA

    Turaj Vazifedan & W. Thomas Bass

Authors
  1. Michael Kochan
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  2. Bianca Leonardi
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  3. Angela Firestine
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  8. W. Thomas Bass
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Corresponding author

Correspondence to W. Thomas Bass.

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The authors declare that they have no conflict of interest.

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Kochan, M., Leonardi, B., Firestine, A. 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 39, 54–62 (2019). https://doi.org/10.1038/s41372-018-0261-1

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