Keen to get a sense of practice across units on this. In a centre I used to work in in Canada, prone positioning with a UVC/UAC in place was common practice after 48h. Curious what others do.

The evidence base is thin either way — the only NICU-specific study I can find (Arnts et al. 2014, Open J Nursing) is a small single-centre pilot with no supine comparator, and no RCT exists.

Would be useful to hear:

• Prone allowed with UC in situ? From what age/dwell time?

• Written into local guidance, or informal practice?

• Anyone audited complication rates by position?

https://www.scirp.org/journal/paperinformation?paperid=51831

Interesting question! I think our unit historically has motivated a non prone position because of easier detection of hemorraghe from the umbilicus when lying on the back but today nurses don’t continously watch the baby so that matters less… The interesting part is - is a prone position more prone (pun intented) to hemorraghe than a supine position?

A very practical topic. UVC is not a contraindication for SSC, but yes, the question always arises: how to do it safely. If the UVC is well secured, there should be no risk during skin-to-skin care. A slightly side-lying position can also be used so that nurses can visualize the UVC insertion site during SSC.

Here is a nice article about safety:

https://pubmed.ncbi.nlm.nih.gov/39111740/

and Swedish approach.

https://www.sciencedirect.com/science/article/pii/S0146000521001567?via%3Dihub

Because of the importance of KMC we do allow SSC after securing the umbilical canula with another tape on the abdominal skin. However we do not allow prone position in the crib routinely

We tend not to move the tiny (<1000 gm) babies around for the first 7 days to prevent IVH (hopefully), so no prone positioning. After that, if catheters are still in, we do allow it. We try to get the UAC out soonest, and try not to leave the UVC in more that ~7-10 days. After that we use PICC lines.

Thanks all, really useful spread of practice here.

A few things stand out:

1. SSC vs prone-in-cot are being conflated in the literature, but practice treats them differently. Most of the actual evidence is about SSC, held against a parent, catheter visible and secured with extra tape, not unsupervised prone positioning in the crib. But so far: SSC yes, routine prone no.

2. The original rationale for avoiding prone (visual monitoring for umbilical bleed) but that just shifts the question to whether prone itself increases bleed/dislodgement risk mechanically, which nobody’s actually tested.

3. Dwell time is emerging as the real safety lever, not position. Hold off any positioning changes in <1000g for the first 7 days (IVH-driven, not catheter-driven), then allow prone with catheters still in, but cap UVC at 7-10 days before converting to PICC, effectively de-risks position by limiting exposure time instead of restricting movement.

4. The IVH-driven caution mostly applies to preterm/ELBW infants, what about term babies with a UC in situ (e.g. post-op, sepsis, PPHN)? IVH logic doesn’t apply there, so does anyone actually practice differently in that group, or does the same blanket “no prone” carry over regardless of gestation?

5. And we shouldn’t lose sight of the other side of the risk-benefit: prone positioning has well-established respiratory benefits (oxygenation, lung mechanics). If the catheter-related risk is largely theoretical, are we potentially withholding a genuinely useful intervention based on precedent rather than evidence?

Net: no unit here is following trial-level evidence, because there isn’t any specific to prone-in-cot with UC in situ. Practice is being driven by extrapolation from SSC safety data, historical convention, and dwell-time ceilings — reasonable pragmatism, but genuinely a gap for someone to fill with a proper cohort study.

Appreciate everyone weighing in, keep them coming if others have local audit data.