The effect of position given to preterms after feeding on gastric residual volume, abdominal oxygenation and fractional oxygen extraction

Objective: The aim of this study was to evaluate the effect of three different positions on gastric residual volume, fractional oxygen extraction, and abdominal oxygenation in clinically stable breastfed preterm neonates. Method: The study was conducted in Kartal Dr. Lutfi Kirdar City Hospital in Istanbul between September 2023 and June 2024 in a randomized crossover design. The sample consisted of 48 preterm newborns aged 30+0-33+6 gestational weeks, divided into three intervention groups (Group 1=16-prone, right lateral, and semi-raised supine), (Group 2=16-semi-raised supine, prone, and right lateral), (Group 3=16-right lateral, semi-raised supine, and prone) according to the position order determined by lottery. Preterms were followed in three positions determined according to the group for two hours after feeding. In all three intervention groups, gastric residue control was performed just before feeding, and SPO2, abdominal NIRS, and FOE values were recorded just before, during, and after feeding. The data were analyzed by using the SPSS 27 program with percentage, arithmetic mean, Repeated Measures, Bonferroni, Friedman, Dunn Benferroni, Cochran's Q and Pearson's Chi-Square tests. The results were evaluated at a 95% confidence interval, and significance was evaluated at the p<0.05 level. Results: In preterm neonates, the presence of gastric residual volume before feeding was found to be higher in the semi-elevated supine position than in the prone and right lateral positions (p=0.001), while the 2nd hour NIRS measurements of preterm neonates in the prone and right lateral positions were higher than those of preterm neonates in the semi-elevated supine position (p=0.028; p=0.023). There was no statistically significant difference between the 1st hour and 2nd hour SPO2 and FOE measurements before, during, and after feeding according to the positions (p>0.05). Conclusion: Prone and right lateral positions were found to be effective in providing less gastric residual and higher abdominal oxygenation in preterm neonates treated in neonatal intensive care units. It is recommended to increase the number of studies evaluating the efficacy of nonpharmacologic methods in preterms using NIRS. Keywords: Preterm, Position, Gastric residual volume, Abdominal oxygenation, Fractional oxygen extraction, Oxygen level