Position Effect on Cerebral Oxygenation in Neonates during Transition After Birth

INTRODUCTION: According to delivery room guidelines, optimal position is not specified for stabilisation of baby. This study aimed to defined positions effects on postnatal adaptation parameters and cerebral oxygenation in non-resuscitated neonates.
METHODS: A total of 60 neonates delivered by cesarean section stabilised randomly in the supine, right-side, left-side, or prone positions were enrolled. Apgar scores, the heart rate (HR), arterial oxygen saturation via pulse oximetry (SpO2), and perfusion index (PI) at the 2nd, 5th and 10th minutes were recorded. Cerebral regional oxygen saturation of patients was monitored by using near-infrared spectroscopy.
RESULTS: In the prone position, the 1stminute Apgar score was significantly lower than other groups, but no difference was observed at the 5thminute Apgar scores [1stminApgarprone,p=0.05]. Though there was no statistically significant difference, the prone position had the lowest heart rate in the 2nd minute, while the supine posture had the greatest heart rate in the 5th and 10thminutes. While the groups' SpO2 values were similar, the left-side group's perfusion rates increased at the 5th and 10thminute marks [5th and 10thminPIleft-side,p=0.67,p=0.21,respectively]. Regional cerebral oxygen saturation (rScO2) and cerebral fractional oxygen extraction (cFOE) did not differ significantly between groups when at 5th and 10thminute time intervals. Although right and left rScO2 were found to be high in the first 5 minutes in the prone position, this elevation did not lead to a statistically significant difference, and right and left rScO2 values were found to be similar in all groups at the 10th minute.
DISCUSSION AND CONCLUSION: Adaptation parameters were not affected by position, except for lower 1stminute Apgar 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 affords a higher PI, may be a good alternative. Studies with larger case series may provide further information.