Effects of prone and supine positioning on gastric residuals in preterm infants: A time series with cross-over study

Background: Few studies have examined the effect of body position on gastric residuals at different time points in feeding preterm infants. Further, the results of previous studies are inconsistent. Objectives: To describe the changing pattern of gastric residuals over time in the prone and supine position and to examine the effects of position on gastric residuals at different feeding volumes in preterm infants. Design: A randomized, time series with cross-over study. Setting: A neonatal intensive care unit affiliated with a medical center in central Taiwan. Participants: 35 preterm infants who were asymptomatic for gastroesophageal reflux, other gastrointestinal diseases or other significant morbidities of any kind other than prematurity. Methods: Infants were randomly assigned to the following treatments: 3 h in a supine position followed by 3 h in a prone position, or vice versa. Measurements of gastric residual volume were taken by syringe at 30, 60, 90, 120 and 150 min following feeding when the enteral intake was set at 50 or 100 ml/kg/day. Results: The rate of decrease of gastric residuals in the prone and supine positions was fastest during the first half an hour post-feeding according to measurements taken at 30, 60, 90, 120 and 150 min at feeding volumes of 50 and 100 ml/kg/day (p < 001). Gastric residuals were significantly lower in the prone than in the supine position at the five measurement points. Conclusions: Placing preterm infants in the prone position for the first half an hour post-feeding and then changing the position according to the behavior cues of the infants is suggested. This result contributes to a better understanding of the relationships between time, position, and gastric residuals; it could also help health care professionals to provide efficient feeding as well as perform the appropriate positioning of preterm infants. (C) 2013 Elsevier Ltd. All rights reserved.