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Positioning as a conservative treatment option in infants with micrognathia and/or cleft
1The Children's Hospital at Westmead, Sydney, 2145, NSW, Australia; Department of Child and Adolescent Health, Faculty of Medicine, University of Sydney, NSW, 2050, Australia.
Insights
Prone positioning may help infants with micrognathia or cleft palate manage airway obstruction, but individual responses vary. Polysomnography (PSG) can identify infants who benefit most from this sleep position.
Area of Science:
- Pediatric Sleep Medicine
- Neonatal Airway Management
Background:
- Infants with micrognathia and/or cleft palate often experience airway obstruction.
- Prone positioning is a potential management strategy, but its efficacy requires further investigation.
Purpose of the Study:
- To review studies evaluating airway obstruction management in infants with micrognathia/cleft palate using prone positioning.
- To compare the effectiveness of prone versus other sleep positions.
Main Methods:
- Systematic review of case series and polysomnography (PSG) studies.
- Comparison of prone positioning against other sleep positions in infants.
Main Results:
- Airway obstruction severity is often underestimated by clinical assessment compared to PSG.
- Individual infants respond differently to positioning; some improve when supine.
- Success rates for prone positioning range widely (12-76%) in case series.
Conclusions:
- Prone positioning can be effective for some infants, but individual variability necessitates careful assessment.
- Polysomnography is crucial for differentiating infants who benefit from prone positioning.
- Further research is needed to establish consensus on PSG definitions for airway obstruction severity.
Abstract:
Evaluation and management of airway obstruction in prone position were reviewed from studies in infants with micrognathia and/or cleft palate, using polysomnography (PSG) or similar measures, and comparing prone against other positions. Most studies identified were case series from specialist referral centres. Airway obstruction appears more severe on PSG than clinical assessment, but there is no consensus for PSG definitions of mild, moderate or severe airway obstruction. Infants show individual variability in responses to positioning; sleep quality tends to improve when prone, but 22-25% have better respiratory outcomes when supine. Most centres recommend home monitoring if advising that an infant be placed prone to manage their airway obstruction. In conclusion, in case series, success rates for managing infant airway obstruction by prone positioning vary from 12 to 76%. PSG studies comparing prone with other sleep positions can help differentiate which infants show improved airway obstruction and/or sleep quality when positioned prone.
