PEDIATRICS Vol. 80 No. 5 November 1987, pp. 689-692
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Prone and Supine Positioning Effects on Energy Expenditure and Behavior of Low Birth Weight Neonates

Julia Masterson RN, MS1, Christine Zucker MS1, and Karl Schulze MD1

1 From the Human Infant Physiology Laboratory, Department of Pediatrics, Columbia University College of Physicians and Surgeons, and The Babies Hospital, New York

The effect of body position (supine v prone) on energy expenditure and behavior of 42 healthy low birth weight (920 to 1,760 g) infants was evaluated in 66 studies. Each infant was randomly assigned to the supine or prone position for the first three-hour epoch; the position was reversed for the second three-hour epoch. The difference in energy expenditure and the percentage of time in active sleep, quiet sleep, and wakefulness between the two positions was computed. The median difference (supine minus prone) in overall energy expenditure between positions was +3.1 kcal/kg/d (interquartile range 0.6 to 6.5; P < .001). When only periods of active sleep were analyzed, the median difference in energy expenditure remained significant, the supine position being higher than prone by +2.6 kcal/kg/d (interquartile range 0.1 to 4.8; P < .001). In the supine position, the time awake was 5.7% higher (interquartile range 1.8 to 17.4; P < .001) than in the prone position. The percentage of time in active sleep was not significantly different between the positions, hence quiet sleep decreased in the supine position. In summary, when low birth weight infants are changed from the supine to the prone position, energy expenditure decreases, time spent in quiet sleep increases, and time spent awake decreases. These data suggest that prone is the position of choice for the low birth weight infant.

Key Words: low birth weight infant • energy expenditure • sleep state • posture • body position

Submitted on July 7, 1986
Accepted on January 8, 1987




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