Body position-dependent changes in cerebral hemodynamics during apnea in preterm infants

The objective of the present study was to evaluate sleeping position-dependent effects on cerebral hemodynamics during apnea in preterm infants. To this end, polygraphic studies were performed on 15 stable preterm infants lying prone and lying supine. Changes in cerebral blood volume (ΔCBV) and in cerebral hemoglobin oxygenation (ΔcHbD) in association with apnea were measured by near infrared spectroscopy. For comparison, apnea in the prone position was matched for duration to apnea in the supine position. A total number of 98 pairs of apnea were compared. The mean duration of apnea was 8.2±3 s. In both positions there was a predominance of decrease in CBV and cHbD in association with apnea. The mean decrease of cHbD (−1.57±1.82 μmol/l) and of CBV (−0.120±0.137 ml/100g brain) in the supine position was significantly pronounced compared to prone position (ΔcHbD: −1.18±1.77 μmol/l, ΔCBV: −0.080±0.095 ml/100 g brain). The degree of ΔCBV and ΔHbD did not correlate with postconceptional or postnatal age (r2<0.01). In both positions there was a similar small decrease of SaO2 in association with apnea. In the supine position heart rate decreased slightly during apnea, whereas in the prone position no change in heart rate could be observed. The present study revealed a position-dependent different impact of apnea on cerebral hemodynamics. With regard to cerebral blood volume and oxygenation in association with apnea no negative effects of prone sleeping position could be observed in preterm infants.