Nurses often perform interventions that seem, through empiric observation, to be effective and beneficial. One of these is prone positioning of preterm infants afflicted with respiratory distress, with the aim of improving oxygenation. Whether due to comfort, better sleep, more regular breathing, greater lung expansion, or other improvements in lung mechanics, the proof is in the rising oxygen saturation levels often seen while the babies remain in the prone position. Because of widespread awareness of "Back to Sleep" recommendations, nurses are careful to explain to parents the rationale and benefits of using the prone position for monitored, hospitalized infants. However, there are few data offering guidance regarding how much benefit is actually gained with the prone position and when nurses should begin to model supine sleeping in predischarge infants. In 2006, an updated Cochrane Neonatal Review confirmed previous conclusions that no particular body positions produce relevant and sustained improvement in oxygenation in infants receiving assisted ventilation.1 Prone positioning for short periods slightly improves oxygenation and reduces episodes of poor oxygenation. This meta-analysis did not include convalescing preterm infants who were still oxygen dependent. A study published in the September 2007 issue of the Archives of Disease in Childhood: Fetal and Neonatal Edition contributes more information to this important clinical topic. Researchers prospectively evaluated preterm infants, both with and without oxygen dependency, in the prone and supine positions.2 Pulse oxygen saturation (spO₂) and functional residual capacity were measured in each position every 2 weeks until discharge. Overall, lung volumes were higher in the prone position throughout the study. SpO₂ was also higher in the prone position, an effect that was significant only in the oxygen-dependent infants. Prone sleeping did not improve oxygenation in the preterm infants 32 weeks' post menstrual age and older without respiratory problems; therefore, these infants should be maintained in the supine position. However, because the study infants were monitored in each position for only an hour, it is recommended that oxygen saturation should continue to be monitored after 32 weeks' PMA to be certain that longer periods of supine sleeping are not associated with loss of lung volume and hypoxemia.

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