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Effectiveness of prone and supine position on respiratory pattern among

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 Research Article

Effectiveness of prone and supine position on respiratory

pattern among neonates
J. Jagadeeswari*, R. Soniya

ABSTRACT

Background: Newborns have irregular breathing patterns that concern new parents. They can breathe fast, take long pauses
between breaths, and make unusual noises. A newborn takes 30–60 breaths per minute. This can slow down to 20 times per
minute while they sleep. At 6 months, babies breathe about 25–40 times per minute. Newborns can also take rapid breaths
and then pause for up to 10 s at a time. Aim: The present study aims are to assess the effectiveness of prone and supine
position on a respiratory pattern among of neonates with respiratory problems. Materials and Methods: The research design
for the study is pre-experimental research design with two group pre-test post-test design. Convenient sampling technique
was used to select samples. Semi-structured interview was used to collect demographic data and bio-physiological method
was to assess the respiratory pattern such as respiratory rate, respiratory depth, retraction, nasal flaring, and chest in drawing,
wheezing, and oxygen saturation. The babies in experimental group were divided into two groups and placed in supine and
prone position. After an hour, the respiratory pattern was re-assessed. Results: The study results show that the respiratory
pattern variable wheezing had shown a statistically significant difference between the prone and supine position with a Chi-
square value of 3.968 which was found to be statistically significant at P < 0.05. This indicates that prone position is more
effective than supine position among neonates. Conclusion: Prone position also helps in maintaining respiratory pattern,
especially oxygen saturation and helps in prompt recovery of the neonates from respiratory diseases.

KEY WORDS: Neonates, Prone position, Respiratory pattern, Supine position

INTRODUCTION care. Newborns have irregular breathing patterns that

An infant whose birth weight <2500 g regardless of
their gestational age is called low birth weight infants.
Reduction in infant and child mortality is a major
goal of strategy to achieve health for all.[1] The major
contribution of infant death is by neonates which are
a serious concern since nearly 5 million neonates
die each year in the world, of which 96% are in the
developing countries, effective reduction of such high
neonatal death rate remains a major global challenge
in 21st century.[2-4]
Birth is a transition from a fluid environment to
one where we breathe air. Breathing difficulties are
common immediately after birth and during the first few
hours of life. However, some babies may experience
more complex breathing problems that require special
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concern new parents. They can breathe fast, take long
pauses between breaths, and make unusual noises. A
newborn takes 30–60 times per minute. This can slow
down to 20 times per minute while they sleep. At 6
months, babies breathe about 25–40 times per minute.
An adult, meanwhile, takes about 12–20 breaths per
minute. Newborns can also take rapid breaths and then
pause for up to 10 s at a time.[5,6]
Breathing difficulties are common immediately after
birth and during the first few hours of a baby’s life. More
complex breathing problems a baby can experience
are asphyxia, transient tachypnea, respiratory distress
syndrome, meconium aspiration, pneumothorax,
pneumonia, and congenital lung malformations.
Neonates have clinical symptoms breathing difficulties
displays classic clinical signs of respiratory distress
regardless of the underlying cause. These consist
of tachypnea (respiratory rate >60 breaths⋅min−1),
tachycardia (heart rate >160 beats⋅min−1), nasal

Department of Obstetrics and Gynecological Nursing, Saveetha College of Nursing, Saveetha Institute of Medical and
Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India

*Corresponding author: J. Jagadeeswari, Department of Obstetrics and Gynecological Nursing, Saveetha College
of Nursing, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India.
Phone: +91-8056474788. E-mail: j.jagadeeswari@gmil.com

Received on: 12-01-2020; Revised on: 10-02-2020; Accepted on: 18-03-2020

Drug Invention Today | Vol 13 • Issue 7 • 2020 983

 J. Jagadeeswari and R. Soniya
flaring, grunting, chest wall recessions (suprasternal,
intercostal, and subcostal), cyanosis, and apnoea.[7]
As nurses it’s our responsibility to maintain good
respiratory and breathing pattern among the neonates.
Hence, the researcher felt the need to contribute
positioning practices in neonates to improve breathing
pattern. This study is to find out the effectiveness of
prone and supine position of newborns.[8]
As newborn infants exhibit physiological and
behavioral signs of pain and stress that can
be recognized by health-care professionals,
pharmacological, and nonpharmacological resources
may be employed in the neonatal intensive care unit
(NICU) to manage such conditions. In this regard,
appropriate positioning is considered an important
nonpharmacological intervention in premature
newborns admitted to NICU, and according to some
studies, the frequency of stress behaviors is lower
when infants are placed in the prone position.[9]
The positioning of infants is a simple and safe
therapeutic maneuver with prompt and demonstrable
benefit. Early hospitalization, the prone position
is best for pre-term infants and result in improved
oxygenation, better-tolerated feedings, and more
organized sleep rest patterns. Infants exhibit less
physical activity and energy expenditure when placed
in a prone position. Concluded that oxygenation was
found to be significantly superior in the prone position
than in the supine position. They justified that prone
ventilation, however, is not yet a standard practice
and it is reasonable to assume that optimized initial
ventilation would lead to improve results in terms
of shortened duration of ventilation and improved
survival.[10]
In 2001, Kornecki et al. concluded that oxygenation
was found to be significantly superior in the prone
position than in the supine position. They justified
that prone ventilation, however, is not yet a standard
practice and it is reasonable to assume that optimized
initial ventilation would lead to improved results
in terms of shortened duration of ventilation and
improved survival.[11]
A study performed by Taccone et al. suggests a
nonsignificant 10% difference in mortality favoring
the prone group and a significantly greater proportion
of infants in the prone group experienced at least one
complication as compared to the supine group. They
concluded that the rate of complications was almost
3 times greater in the prone group than in the supine
group.[12]
A purpose of the study was (1) to assess the
respiratory pattern among of neonates, (2) to assess
the effectiveness of prone and supine position on a
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respiratory pattern among of neonates with respiratory
problems, and (3) to compare the effectiveness of
prone and supine position on a respiratory pattern
among neonates.
MATERIALS AND METHODS
A quantitative approach with a quasi-experimental
research design was used to conduct the study
in the neonatal ICU of Thiruvallur District Head
Quarter Government Hospital. Thirty samples were
selected using a convenience sampling technique.
The criteria for sample selection were low birth
weight infants with a weight between 1200 and
2500, neonates admitted in NICU with spontaneous
breathing with no need of assisting devices,
neonates not treated with sedatives 24 h before the
intervention and neonates whose mothers who are
willing to participate in the study. The exclusion
criteria for the samples were neonates with no
major congenital defects or abnormal neurological
findings, including intraventricular hemorrhage;
neonates should not have any birth complications
such as RDS and neurological problems in low
birth weight babies. The data collection period
was done with prior permission from the HOD of
the Neonatology Department and ethical clearance
was obtained from the institution. The purpose of
the study was explained to the samples with written
informed consent was obtained from them. The
demographic data were collected by using structured
questionnaire. The bio-physiological parameters
were assessed before position among both the
experimental groups. Then, babies in experimental
Group 1 were placed in supine and experimental and
Group 2 in prone position. After an hour, the bio-
physiological parameters were assessed among both
experimental groups. The data were analyzed using
descriptive and inferential statistics. The sample
characteristics were described using frequency and
percentage. Pearson’s correlation coefficient was
used to assess the effectiveness of prone and supine
position in the experimental groups. Chi-square used
to associate the post-test level of posture comfort
with the selected demographic variables.
RESULTS AND DISCUSSION
Section A: Sample Characteristics
Among 15 samples in experimental Group 1 (prone
position), most of them 7 (46.7%) were 11–20 months
old, 8 (53.3%) were baby boy, 10 (66.7%) were
weighing 1500–2001 g, 8 (53.3%) had an APGAR
score of 9–10, 10 (66.77%) were pre-term, 10 (66.7%)
were born by cesarean section, 8 (53.3%) were second
child, and 8 (53.3%) had no history of respiratory
distress at birth.
Drug Invention Today | Vol 13 • Issue 7 • 2020
 J. Jagadeeswari and R. Soniya
Table 1: Comparison of respiratory pattern among neonates in supine and prone position
Respiratory pattern Prone position
(f) (%)
Wheezing
Absent 13 86.7
Minimal audible with stethoscope 2 13.3
Marked audible with stethoscope - -
*P<0.05, S: Significant
Among 15 samples in experimental Group 2 (supine
position), most of them 6 (40%) were 11–20 months
old, 9 (60%) were baby girl, 8 (53.3%) were weighing
2001–2500 g, 12 (80%) had an APGAR score of 9–10,
6 (40%) were term babies, 8 (53.3%) were born by
normal delivery, 8 (53.3%) were a second child, and 8
(53.3%) had a history of respiratory distress at birth.
Section B: Effectiveness of Prone and Supine
Position on Respiratory Pattern among Neonates
The present study results related to prone position
shows that among neonates, most of them 7 (46.7%)
were 11–20 months old, 8 (53.3%) were baby boy, 10
(66.7%) were weighing 1500–2001 g, 8 (53.3%) had
an APGAR score of 9–10, 10 (66.77%) were pre-term,
10 (66.7%) were born by cesarean section, 8 (53.3%)
were second child, and 8 (53.3%) had no history of
respiratory distress at birth.
The present study results related to supine position show
that among neonates, most of them 6 (40%) were 11–20
months old, 9 (60%) were baby girl, 8 (53.3%) were
weighing 2001–2500 g, 12 (80%) had an APGAR score
of 9–10, 6 (40%) were term babies, 8 (53.3%) were born
by normal delivery, 8 (53.3%) were second child, and
8 (53.3%) had a history of respiratory distress at birth.
Section C: Comparing the Effectiveness of Prone
and Supine Position on Respiratory Pattern among
Neonates
The study results show that the respiratory pattern
variable wheezing had shown a statistically significant
difference between the prone and supine position with
a Chi-square value of 3.968 which was found to be
statistically significant at P < 0.05 level [Table 1].
This study is supported by Santos et al. (2017) conducted
a study on “Physiological and behavioral effects of pre-
term infant positioning in a neonatal intensive care
unit.” Twenty-four pre-term newborns with gestational
age ≤32 weeks, who were randomly separated into four
groups: Right side position, supine position, left side
position, and prone position during the intervention,
heart rate decreased in the right side position, supine
position, and prone position. The respiratory rate
reduced in all positions and peripheral oxygen saturation
remained stable in most positions. Behavioral scores
were reduced in supine, left side, and prone positions.
Drug Invention Today | Vol 13 • Issue 7 • 2020
View publication stats
Supine position Chi-square test
(f) (%)
χ2=3.968
8 53.3 d.f=1
7 46.7 P=0.046
- - S*
Positioning according to a standard operating procedure
was able to produce more positive responses in prone
and supine position groups during the intervention.[13]
CONCLUSION
This indicates that prone position is more effective than
supine position among neonates. Prone position also
helps in maintaining respiratory pattern, especially
oxygen saturation, and helps in prompt recovery of
the neonates from respiratory diseases.
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Source of support: Nil; Conflicts of interest: None Declared
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