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Systematic Review of Safety and Efficacy of Positional Therapy as First-line Management for Robin Sequence

Catherine de Blacam1,2, Aoife Feeley1, Corstiaan Breugem3

  • 1Department of Plastic & Reconstructive Surgery, Children's Health Ireland at Crumlin.

The Journal of Craniofacial Surgery
|March 31, 2025
PubMed

Insights

Positional therapy (PT) may help infants with Robin Sequence (RS) breathe better by managing upper airway obstruction (UAO). However, its safety, particularly regarding sudden infant death syndrome (SIDS) risks, requires further investigation.

Area of Science:

  • Pediatric Otolaryngology
  • Neonatal Care
  • Systematic Review Methodology

Background:

  • Infants with Robin Sequence (RS) often experience breathing and feeding difficulties due to upper airway obstruction (UAO).
  • Positional therapy (PT) is proposed to alleviate UAO in RS by repositioning the tongue.
  • Concerns exist regarding PT safety in RS infants due to potential sudden infant death syndrome (SIDS) risks associated with prone positioning.

Purpose of the Study:

  • To systematically review and evaluate the existing evidence on the safety and efficacy of positional therapy (PT) for managing upper airway obstruction (UAO) in infants with Robin Sequence (RS).

Main Methods:

  • A comprehensive literature search was conducted across major databases (Ebesco Cinahl, EMBASE, OVID Medline, Web of Science, Cochrane library) adhering to PRISMA guidelines.
  • Studies published between 1990 and 2024 using keywords like "robin sequence", "prone position", and "side lying" were included.
  • Data from 23 selected studies, encompassing 875 patients managed with PT, were analyzed.

Main Results:

  • Out of 875 patients, 715 were managed with PT without requiring further interventions for UAO, though objective data for this assessment was often lacking.
  • Six patient deaths occurred during PT management, but none were directly attributed to the sleeping position.
  • Overall mortality appeared lower in more recent studies, suggesting potential improvements in care or reporting.

Conclusions:

  • The current evidence base for the safety and efficacy of PT in infants with RS is limited.
  • Further research is essential to establish definitive safety protocols and optimal monitoring strategies for RS infants undergoing PT.
  • Objective data collection is needed to better assess the effectiveness of PT in managing UAO in this population.

Keywords:
Positional therapyprone positioningrobin sequenceupper airway obstruction

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