Elevated midline head positioning of extremely low birth weight infants: effects on cardiopulmonary function and the incidence of periventricular-intraventricular hemorrhage

J Perinatol. 2019 Jan;39(1):54-62. doi: 10.1038/s41372-018-0261-1. Epub 2018 Oct 22.


Objective: Changes in cerebrovascular hemodynamics associated with head position may be important in the pathogenesis of periventricular-intraventricular hemorrhage (PIVH) in premature infants. This study evaluated the effect of elevated midline head positioning on cardiopulmonary function and the incidence of PIVH.

Study design: ELBW infants were randomized to FLAT (flat, supine) or ELEV (supine, bed elevated 30 degrees) for 96 h. Cardiopulmonary function, complications of prematurity, and the occurrence of PIVH were documented.

Results: Infants were randomized into FLAT (n = 90) and ELEV groups (n = 90). No significant differences were seen in the incidence of BPD or other respiratory complications. The ELEV group developed significantly fewer grade 4 hemorrhages (p = 0.036) and survival to discharge was significantly higher in the ELEV group (p = 0.037).

Conclusions: Managing ELBW infants in an elevated midline head position for the first 4 days of life appears safe and may decrease the likelihood of severe PIVH and improve survival.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Cerebral Hemorrhage* / diagnosis
  • Cerebral Hemorrhage* / epidemiology
  • Cerebral Hemorrhage* / etiology
  • Cerebral Hemorrhage* / therapy
  • Cerebral Ventricles* / blood supply
  • Cerebral Ventricles* / diagnostic imaging
  • Cerebrovascular Circulation / physiology*
  • Female
  • Gestational Age
  • Head
  • Humans
  • Incidence
  • Infant, Extremely Low Birth Weight
  • Infant, Newborn
  • Infant, Premature, Diseases* / diagnosis
  • Infant, Premature, Diseases* / epidemiology
  • Infant, Premature, Diseases* / etiology
  • Infant, Premature, Diseases* / therapy
  • Intensive Care, Neonatal / methods
  • Male
  • Moving and Lifting Patients* / adverse effects
  • Moving and Lifting Patients* / methods
  • Patient Positioning* / adverse effects
  • Patient Positioning* / methods
  • Treatment Outcome
  • Ultrasonography / methods