Premature infants (infants born \<37 weeks' gestational age) are discharged from the hospital and transported home in car seats designed for term babies. The safe transport of these premature infants is an important concern. Sub-optimal positioning in car seats can lead to breathing problems in premature infants. With the help of electrical impedance tomography, the investigators want to assess the changes in lung volume during the transition from a supine to a semi-upright position in the car seat.
Hypothesis The investigators hypothesise that there is a decrease in the end-expiratory lung volume (EELV) of preterm infants transferred from supine to car seat position. They expect that the curved, semi-upright built of a standard car seat negatively impacts lung aeration and ventilation of preterm infants, which may result in cardiorespiratory events. They also hypothesise that EELV will normalise following the repositioning of the infant back to the supine position. Primary objective The primary objective of this study is to assess lung volume changes during the transition from a supine to a semi-upright position in a car seat in preterm infants. Study procedures As soon as all inclusion criteria are met, the study intervention is initiated. For the baseline measurement, the child is placed in supine position on a flat surface. The EIT belt is attached at nipple level around the infant's thorax during the last nursing care before the start of the intervention. Continuous measurement is conducted for 30 minutes. Subsequently, the child, with the EIT belt securely in place, is repositioned from a supine to a semi-upright position in a car seat, where another 30-minute measurement is taken. A third measurement will be conducted after the infant is returned to the standard supine position in his/her cot. Manipulations during the measurement periods will be kept to a minimum to avoid disruptions or artefacts in the data recordings. EIT data will be obtained for a total of 90 minutes (plus a maximum of 10 minutes for repositioning). Subgroup analyses will be performed for the primary outcome: * Preterm infants ≥ 32 versus \< 32 weeks at birth * Infants with a weight ≥ 2 kg versus \< 2 kg at the time of the study * Car seat positioning: nursing staff versus parents
Study Type
OBSERVATIONAL
Enrollment
51
Electrical Impedance Tomography data and the physiological and clinical parameters will be recorded continuously in three different positions (supine 1, car seat, supine 2) to assess alterations in lung volume and cardiorespiratory events.
University Hospital Zurich
Zurich, Canton of Zurich, Switzerland
Global end-expiratory lung impedance
Changes in global end-expiratory lung impedance (EELZ) between a baseline measurement in supine position, measurement in a semi-upright car seat position, and a follow-up measurement back in a supine position, as a measure of lung aeration and a proxy for end-expiratory lung volume (∆EELZ = EELZCarSeat - EELZBaseline).
Time frame: Continuous measurement is conducted for 30 minutes in a supine position, 30 minutes in a semi-upright car seat position and an additional 30 minutes in a supine position. Total measurement of 90 minutes.
Heart rate
Changes of heart rate between baseline, a semi-upright car seat position, and a follow-up supine position.
Time frame: Continuous measurement is conducted for 30 minutes in a supine position, 30 minutes in a semi-upright car seat position and an additional 30 minutes in a supine position. Total measurement of 90 minutes.
Number of bradycardia
Changes in the number of bradycardia (heart rate \< 80 bpm) between a baseline measurement in supine position, measurement in a semi-upright car seat position, and a follow-up measurement back in a supine position.
Time frame: Continuous measurement is conducted for 30 minutes in a supine position, 30 minutes in a semi-upright car seat position and an additional 30 minutes in a supine position. Total measurement of 90 minutes.
Respiratory rate
Changes in respiratory rate between baseline, a semi-upright car seat position, and a follow-up supine position based on EIT data.
Time frame: Continuous measurement is conducted for 30 minutes in a supine position, 30 minutes in a semi-upright car seat position and an additional 30 minutes in a supine position. Total measurement of 90 minutes.
Oxygen Saturation
Changes in oxygen saturation between baseline, a semi-upright car seat position, and a follow-up supine position.
Time frame: Continuous measurement is conducted for 30 minutes in a supine position, 30 minutes in a semi-upright car seat position and an additional 30 minutes in a supine position. Total measurement of 90 minutes.
Number of desaturations
Changes in the number of desaturations (SpO2 \< 80%) between a baseline measurement in supine position, measurement in a semi-upright car seat position, and a follow-up measurement back in a supine position.
Time frame: Continuous measurement is conducted for 30 minutes in a supine position, 30 minutes in a semi-upright car seat position and an additional 30 minutes in a supine position. Total measurement of 90 minutes.
Regional end-expiratory lung impedance
Changes in regional end-expiratory lung impedance between baseline, a semi-upright car seat position, and a follow-up supine position.
Time frame: Continuous measurement is conducted for 30 minutes in a supine position, 30 minutes in a semi-upright car seat position and an additional 30 minutes in a supine position. Total measurement of 90 minutes.
Tidal Volume
Changes in tidal volume using EIT between baseline, a semi-upright car seat position, and a follow-up supine position.
Time frame: Continuous measurement is conducted for 30 minutes in a supine position, 30 minutes in a semi-upright car seat position and an additional 30 minutes in a supine position. Total measurement of 90 minutes.
Respiratory minute volume
Changes in respiratory minute volume using EIT between baseline, a semi-upright car seat position, and a follow-up supine position.
Time frame: Continuous measurement is conducted for 30 minutes in a supine position, 30 minutes in a semi-upright car seat position and an additional 30 minutes in a supine position. Total measurement of 90 minutes.
Regional tidal volume distribution
Changes in regional tidal distribution using EIT between baseline, a semi-upright car seat position, and a follow-up supine position.
Time frame: Continuous measurement is conducted for 30 minutes in a supine position, 30 minutes in a semi-upright car seat position and an additional 30 minutes in a supine position. Total measurement of 90 minutes.
Silent spaces, depenent
Changes in dependent silent spaces using EIT between baseline, a semi-upright car seat position, and a follow-up supine position.
Time frame: Continuous measurement is conducted for 30 minutes in a supine position, 30 minutes in a semi-upright car seat position and an additional 30 minutes in a supine position. Total measurement of 90 minutes.
Silent spaces, nondependent
Changes in nondependent silent spaces using EIT between baseline, a semi-upright car seat position, and a follow-up supine position.
Time frame: Continuous measurement is conducted for 30 minutes in a supine position, 30 minutes in a semi-upright car seat position and an additional 30 minutes in a supine position. Total measurement of 90 minutes.
Center of ventilation, ventral to dorsal
Changes in center of ventilation (ventral to dorsal) using EIT between baseline, a semi-upright car seat position, and a follow-up supine position.
Time frame: Continuous measurement is conducted for 30 minutes in a supine position, 30 minutes in a semi-upright car seat position and an additional 30 minutes in a supine position. Total measurement of 90 minutes.
Center of ventilation, left to right
Changes in center of ventilation (left to right) using EIT between baseline, a semi-upright car seat position, and a follow-up supine position.
Time frame: Continuous measurement is conducted for 30 minutes in a supine position, 30 minutes in a semi-upright car seat position and an additional 30 minutes in a supine position. Total measurement of 90 minutes.
Global inhomogeneity index
Changes in global inhomogeneity index using EIT between baseline, a semi-upright car seat position, and a follow-up supine position.
Time frame: Continuous measurement is conducted for 30 minutes in a supine position, 30 minutes in a semi-upright car seat position and an additional 30 minutes in a supine position. Total measurement of 90 minutes.
Coefficient of variation
Changes in coefficient of variation using EIT between baseline, a semi-upright car seat position, and a follow-up supine position.
Time frame: Continuous measurement is conducted for 30 minutes in a supine position, 30 minutes in a semi-upright car seat position and an additional 30 minutes in a supine position. Total measurement of 90 minutes.
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