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Reappraising prone positioning for infants with Robin sequence: a cautionary tale
  1. Christian F Poets,
  2. Cornelia Wiechers
  1. Department of Neonatology and Interdisciplinary Centre for Cleft Palate and Craniofacial Malformations, University of Tuebingen, Tuebingen, Germany
  1. Correspondence to Professor Christian F Poets, Dept. of Neonatology, University of Tuebingen, Tuebingen 72076, Germany; christian-f.poets{at}

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(Pierre-)Robin sequence (RS) is characterised by mandibular retrognathia, glossoptosis and upper airway obstruction (UAO). To alleviate the latter, placing such infants prone was already suggested as a first-line treatment by Robin himself, the eponym of this condition. Indeed, it appears intuitively plausible that gravity will help shifting the mandible forward during sleep. Against this background, it was not surprising that the prone position was implemented by about two-thirds of respondents to a recent survey focusing on interventions used in infants with RS.1

In neonatology, however, we have learnt the hard way that what seems plausible is not always effective and, particularly, safe. Thus, we need to scrutinise the evidence for recommending prone positioning to resolve UAO in infants with RS. Objective data on the effectiveness of this intervention, however, are sparse. A retrospective analysis of sleep study data in 18 infants with RS (mean age, 1.5 months) found a higher sleep efficiency in the prone position, but no significant reduction in the severity of obstructive sleep apnoea (OSA).2 A longitudinal prospective study in 14 infants with RS (mean age, 1.8 months) reported a median Obstructive Apnoea–Hypopnoea …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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