Influence of prone positioning on premature newborn infant stress assessed by means of salivary cortisol measurement: pilot study

Maria Fernanda Cândia, Erica Fernanda Osaku, Marcela Aparecida Leite, Beatriz Toccolini, Nicolle Lamberti Costa, Sandy Nogueira Teixeira, Claudia Rejane Lima de Macedo Costa, Pitágoras Augusto Piana, Marcos Antonio da Silva Cristovam, Nelson Ossamu Osaku, Maria Fernanda Cândia, Erica Fernanda Osaku, Marcela Aparecida Leite, Beatriz Toccolini, Nicolle Lamberti Costa, Sandy Nogueira Teixeira, Claudia Rejane Lima de Macedo Costa, Pitágoras Augusto Piana, Marcos Antonio da Silva Cristovam, Nelson Ossamu Osaku

Abstract

Objective: This study sought to assess the influence of prone positioning on the stress of newborn premature infants through the measurement of the salivary cortisol concentration and the evaluation of physiological and behavioral responses before and after changes in body positioning.

Methods: Saliva samples were collected from newborn infants at two different times: the first (corresponding to the baseline) after a period of 40 minutes during which the infants were not subjected to any manipulation and were placed in the lateral or supine position, and the second 30 minutes after placement in the prone position. Variables including heart rate, respiratory rate, peripheral oxygen saturation, and the Brazelton sleep score were recorded before, during, and at the end of the period in the prone position.

Results: The sample comprised 16 newborn premature infants (56.3% male) with a gestational age between 26 and 36 weeks, postnatal age between 1 and 33 days, birth weight of 935 to 3,050g, and weight at the time of intervention of 870 to 2,890g. During the intervention, six participants breathed room air, while the remainder received oxygen therapy. The median salivary cortisol concentration was lower in the prone position compared to baseline (0.13 versus 0.20; p=0.003), as was the median Brazelton sleep score (p=0.02). The average respiratory rate was lower after the intervention (54.88±7.15 versus 60±7.59; p=0.0004). The remainder of the investigated variables did not exhibit significant variation.

Conclusion: Prone positioning significantly reduced the salivary cortisol level, respiratory rate, and Brazelton sleep score, suggesting a correlation between prone positioning and reduction of stress in preterm infants.

Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Variation in salivary cortisol concentration before and after prone positioning. * p value=0.003/Wilcoxon test.
Figure 2
Figure 2
Comparison of the variation in respiratory rate before and after prone positioning of infants. p value=0.0004/paired t-test.
Figure 3
Figure 3
Variation in Brazelton sleep score before and after prone positioning. * p value=0.02/Wilcoxon test.

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