Ballout Rami A, Foster Jann P, Kahale Lara A, Badr Lina
Faculty of Medicine, American University of Beirut, Riad-El-Solh Beirut 1107 2020, P.O. Box: 11-0236, Beirut, Lebanon.
School of Nursing and Midwifery, University of Sydney, Penrith DC, Australia.
Cochrane Database Syst Rev. 2017 Jan 9;1(1):CD004951. doi: 10.1002/14651858.CD004951.pub3.
It has been proposed that body positioning in preterm infants, as compared with other, more invasive measures, may be an effective method of reducing clinically significant apnoea.
To determine effects of body positioning on cardiorespiratory parameters in spontaneously breathing preterm infants with clinically significant apnoea.Subgroup analyses examined effects of body positioning of spontaneously breathing preterm infants with apnoea from the following subgroups.• Gestational age < 28 weeks or birth weight less than 1000 grams.• Apnoea managed with methylxanthines.• Frequent apnoea (> 10 events/d).• Type of apnoea measured (central vs mixed vs obstructive)
We used the standard search strategy of the Cochrane Neonatal Review Group (CNRG) to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 10), MEDLINE via PubMed (1966 to 14 November 2016), Embase (1980 to 14 November 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 2016 November 14). We also searched clinical trials databases and conference proceedings for randomised controlled trials and quasi-randomised trials.
Randomised and quasi-randomised controlled clinical trials with parallel, factorial or cross-over design comparing the impact of different body positions on apnoea in spontaneously breathing preterm infants were eligible for our review.
We assessed trial quality, data extraction and synthesis of data using standard methods of the CNRG. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence.
The search conducted in November 2016 identified no new studies. Five studies (N = 114) were eligible for inclusion. None of the individual studies nor meta-analyses showed a reduction in apnoea, bradycardia, oxygen desaturation or oxygen saturation with body positioning (supine vs prone; prone vs right lateral; prone vs left lateral; right lateral vs left lateral; prone horizontal vs prone head elevated; right lateral horizontal vs right lateral head elevated, left lateral horizontal vs left lateral head elevated).
AUTHORS' CONCLUSIONS: We found insufficient evidence to determine effects of body positioning on apnoea, bradycardia and oxygen saturation in preterm infants. No new studies have been conducted since the original review was published. Large, multi-centre studies are warranted to provide conclusive evidence, but it may be plausible to conclude that positioning of spontaneously breathing preterm infants has no effect on their cardiorespiratory parameters.
有人提出，与其他更具侵入性的措施相比，早产儿的体位摆放可能是减少具有临床意义的呼吸暂停的有效方法。
确定体位摆放对患有具有临床意义的呼吸暂停的自主呼吸早产儿心肺参数的影响。亚组分析研究了以下亚组中自主呼吸的呼吸暂停早产儿体位摆放的影响。
• 胎龄<28周或出生体重低于1000克。
• 使用甲基黄嘌呤治疗的呼吸暂停。
• 频繁呼吸暂停（>10次/天）。
• 所测量的呼吸暂停类型（中枢性vs混合性vs阻塞性）
我们使用Cochrane新生儿综述小组（CNRG）的标准检索策略，检索Cochrane对照试验中心注册库（CENTRAL；2016年第10期）、通过PubMed检索MEDLINE（1966年至2016年11月14日）、Embase（1980年至2016年11月14日）以及护理及相关健康文献累积索引（CINAHL；1982年至2016年11月14日）。我们还检索了临床试验数据库和会议论文集，以查找随机对照试验和半随机试验。
采用平行、析因或交叉设计的随机和半随机对照临床试验，比较不同体位对自主呼吸早产儿呼吸暂停的影响，符合我们的综述要求。
我们使用CNRG的标准方法评估试验质量、数据提取和数据综合。我们采用推荐分级评估、制定和评价（GRADE）方法来评估证据质量。
2016年11月进行的检索未发现新的研究。五项研究（N = 114）符合纳入标准。没有任何一项单独研究或荟萃分析表明体位摆放（仰卧位vs俯卧位；俯卧位vs右侧卧位；俯卧位vs左侧卧位；右侧卧位vs左侧卧位；俯卧位水平位vs俯卧位头部抬高；右侧卧位水平位vs右侧卧位头部抬高，左侧卧位水平位vs左侧卧位头部抬高）能减少呼吸暂停、心动过缓、氧饱和度下降或提高氧饱和度。
我们发现没有足够的证据来确定体位摆放对早产儿呼吸暂停、心动过缓和氧饱和度的影响。自原始综述发表以来，尚未进行新的研究。有必要开展大型多中心研究以提供确凿证据，但可以合理推断自主呼吸早产儿的体位摆放对其心肺参数没有影响。
