Comparison of the Effects of Prone and Supine Positions on Abdominal Distention in the Premature Infants Receiving Nasal Continuous Positive Airway Pressure (NCPAP)


1 Department of Nursing, School of Nursing, International Campus, Iran University of Medical Sciences, Tehran, Iran

2 Nursing Care Research Centre, Iran University of Medical Sciences, Tehran, Iran

3 Department of Pediatrics, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

4 Department of Public Health, Iran University of Medical Sciences, Tehran, Iran


Background: Premature infants with respiratory distress syndrome (RDS) are in dire need of respiratory support with a ventilator. However, the high tidal volume of mechanical ventilation may cause lung injury, and researchers have been concerned with the use of nasal continuous positive airway pressure (NCPAP). NCPAP has concomitant side effects, such as abdominal distention, which might disrupt the proper nutrition of neonates. The present study aimed to compare the effects of supine and prone positions on the abdominal distension of the newborns with NCPAP.
Methods: This clinical trial was conducted on 37 neonates during six months with a randomized block crossover design selected for the supine and prone positions on the back and abdomen, respectively. Samples were breastfed infants receiving noninvasive ventilation, who were kept in the mentioned positions for two hours. Data analysis was performed in Application SRS version 19 using descriptive and inferential statistics.
Results: In the analysis of variance, comparison of the changes in the abdominal circumference at 15, 30, 60, 90, and 120 minutes in the supine position (P=0.004) and prone position (P=0.001) with repeated sizes indicated a significant difference in at least one of the mentioned timings.
Conclusion: According to the results, prone position while feeding could effectively reduce abdominal distension in the neonates receiving NCPAP.


1. Soon BT. The global action report on preterm birth Switzerland. The Partnership for Maternal, Newborn & Child Health. Available at: URL: birth_report/en/index.html; 2012.
2. Iran (Islamic Republic of) statistics summary (2002- Present). World Health Organization. Available at: URL:; 2013.
3. Bradfield L. Core curriculum for neonatal intensive care nursing. Nurse Educ Pract. 2010; 10(6):e59.
 4. Chen L, Wang L, Li J, Wang N, Shi Y. Noninvasive ventilation for preterm twin neonates with respiratory distress syndrome: a randomized controlled trial. Sci Rep. 2015; 5:14483.
5. Imani M, Derafshi R, Khalili M, Azizollah A. Comparison of nasal continuous positive airway pressure therapy with and without prophylactic surfactant in preterm neonates. Iran J Neonatol. 2013; 4(3):26-34.
6. Bhatia J. Growth curves: how to best measure growth of the preterm infant. J Pediatr. 2013; 162(3):S2-6.
7. Jones L. Oral feeding readiness in the neonatal intensive care unit. 2012; 3(31):148-55.
 8. Velaphi S. Nutritional requirements and parenteral nutrition in preterm infants. South Afr J Clin Nutr. 2011; 24(3):27-31.
 9. Chen SS, Tzeng YL, Gau BS, Kuo PC, Chen JY. Effects of prone and supine positioning on gastric residuals in preterm infants: a time series with cross-over study. Int J Nurs Stud. 2013; 50(11):1459-67.
10. Valizadeh S, Hosseini MB, Asghari Jafarabadi M. Comparison of the effect of nutrition in kangaroo mother care and supine positions on gavage residual volume in preterm infants. Evid Based Care J. 2015; 5(1):17-24.
11. Eghbalian F, Moeinipour AR. Effect of neonatal position on oxygen saturation in Hospitalized premature infants with respiratory distress syndrome. Ann Mil Health Sci Res. 2008; 6(1):9-13. 12. Bredemeyer SL, Foster JP. Body positioning for spontaneously breathing preterm infants with apnoea. Cochrane Database Syst Rev. 2012; 6:CD004951.
13. Meneses J, Bhandari V, Alves JG. Nasal intermittent positive-pressure ventilation vs nasal continuous positive airway pressure for preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch Pediatr Adolesc Med. 2012; 166(4):372-6.
14. Zhao J, Gonzalez F, Mu D. Apnea of prematurity: from cause to treatment. Eur J Pediatr. 2011; 170(9):1097-105.
 15. Ghorbani F, Asadollahi M, Valizadeh S. Comparison the effect of sleep positioning on cardiorespiratory rate in noninvasive ventilated premature infants. Nurs Midwifery Stud. 2013; 2(2):182-7.
 16. Jebreili M, Syeedrasooli A, Headarzadeh M, Gogezadeh M. The effect of body position on gastric residual in preterm infants. Med J Tabriz Univ Med Sci. 2011; 33(2):13-8.