Respiratory outcomes after neonatal prone versus supine positioning following scheduled cesarean delivery: a randomized trial

Tomas Havranek, Ellen Shatzkin, Meleen Chuang, Xianhong Xie, Mimi Kim, Orna Rosen

Research output: Contribution to journalArticlepeer-review


Background: Prone positioning is a common practice after vaginal birth promoting skin to skin contact and has been associated with improved oxygenation in mechanically ventilated neonates in the recent analysis. Neonates of women not in labor delivered via C-section are at increased risk of respiratory distress; it is unclear whether vigorous neonates without a need of resuscitation would benefit from prone positioning immediately after birth. Objective: To determine whether prone positioning of vigorous term neonates for the first 5 min after scheduled cesarean delivery will decrease the incidence of respiratory distress and therapeutic interventions, characterized by the frequency and duration of respiratory support (RS). Design/methods: In a single center, randomized parallel clinical trial, vigorous term neonates delivered via scheduled cesarean delivery were positioned prone or supine and their heart rate, oxygen saturation and signs of respiratory distress were recorded at 1-min intervals for the first 5 min. Infants not reaching target oxygen saturations suggested by the neonatal resuscitation guidelines received RS via Neopuff in supine position; respiratory support was discontinued once oxygen saturation targets were met and infant was free of respiratory symptoms. Primary outcomes measured were frequency and duration of RS, secondary outcomes were admission to the NICU for respiratory distress, length of stay, heart rate and oxygen saturation during the initial 5 min of life. Results: Two hundred twenty-five neonates in prone and 231 in supine position completed the study out of 500 randomized subjects. Frequency of RS (31 versus 30%, p =.93), mean RS duration (4.08 versus 4.39 min; p =.71), frequency of admission to the NICU (5% in both groups; p =.95) and mean length of stay (0.14 versus 0.28 days; p =.42) were similar between the prone and supine groups. The supine cohort had higher initial oxygen saturation (p =.02) as well as heart rate (p =.004). Conclusions: Prone or supine positioning of term neonates after scheduled cesarean delivery resulted in comparable respiratory outcomes including the need for resuscitation in the first minutes of life.

Original languageEnglish (US)
Pages (from-to)2938-2944
Number of pages7
JournalJournal of Maternal-Fetal and Neonatal Medicine
Issue number18
StatePublished - 2021


  • Cesarean delivery
  • prone position
  • respiratory distress
  • term newborn

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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