Appropriate sleeping position for healthy preterm infants - adapted from Pediatrics 1995;127:609-14

Date: April, 1996

Sudden infant death syndrome (SIDS) has declined in association with the public education campaign to discourage placing infants in the prone position for sleeping. To date, these instructions have been considered to include preterm infants who do not have respiratory distress and are being readied for hospital discharge. This recommendation presents a dilemma because preterm infants have better oxygenation, less chest wall asynchrony and a lower incidence of apnea when they are in the prone position. The cause of apnea is thought to be decreased central respiratory drive, often compounded by upper airway obstruction. Preterm infants with apnea have attenuated ventilatory responses to carbon dioxide. Martin and associates evaluated the respiratory stability of preterm infants shortly before hospital discharge by comparing ventilatory responses to hypercapnia when the infants were placed in the supine versus prone position for sleeping.

Studies were performed during both active and quiet sleep in 19 healthy preterm infants. During supine measurement, the head was in the midline; in the prone position the head was placed to the side. Response to carbon dioxide rebreathing was analyzed.

The supine position was associated with a higher respiratory rate and lower oxygen saturation than the prone position across sleep states and levels of carbon dioxide. Asynchrony of rib cage and abdominal wall motion was significantly greater when the infants were in the supine position, compared with the prone position. The respiratory rate was significantly higher when the infants were in the supine versus the prone position; higher respiratory rate was associated with less efficient oxygenation.

The authors conclude that although the American Academy of Pediatrics Task Force on Infant Sleeping Position and SIDS has stated that the prone sleeping position should not be recommended for premature infants with respiratory disease, no data are available on which to base recommendations for former preterm infants. Respiratory control may be vulnerable in preterm infants who are placed in the supine position at a time when there is no respiratory disease and they are being prepared for discharge. Avoidance of the prone position in these infants might not be appropriate. (Martin RJ, et al. Vulnerability of respiratory control in healthy preterm infants placed supine. J Pediatr 1995;127:609-14.)

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