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

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.