Supine Sleeping Position Does Not Cause Clinical Aspiration in Neonates in Hospital Newborn Nurseries

Abstract

Objectives: To determine the frequency and severity of clinically significant events of spitting up in normal newborns during the first 24 hours of life and to correlate the events with sleeping position.Design: Prospective observational study. Participants: Healthy full-term newborns (n = 3240) (Ն37 weeks estimated gestational age) during the first 24 hours of life.Outcome Measures: Frequency of, and intervention required for, spitting up in supine, side-lying, and prone positions while asleep and awake.Results: Of the 3240 infants, 96.6% did not spit up during sleep. A total of 142 episodes of spitting up were documented in 111 newborns during sleep. While the newborns were supine and asleep, there were 130 episodes of spitting up. Of these episodes, 55% did not require any intervention, 37% only required brief suctioning with a bulb syringe, 6% required gentle stimulation, and 2% required wall suction. Both nurseries had a policy that newborns should sleep supine; therefore, only 6 newborns were noted to have spitting up episodes while lying on the side, with 66.7% requiring no intervention and 33.3% requiring bulb syringe. No episodes of apnea, cyanosis, documented aspirations, neonatal intensive care unit admissions, or deaths from spitting up were noted. Conclusions:We conclude that clinically significant spitting up occurs infrequently in hospital newborn nurseries while the newborns are asleep. Fewer than 4% of newborns spit up while sleeping in the supine position in the first 24 hours of life, and none required significant intervention or experienced serious sequelae.

Reducing the Risk of Sudden Infant Death Syndrome in Child Care and Changing Provider Practices: Lessons Learned From a Demonstration Project

“…19,20,26 There are no data supporting an increased risk of aspiration while supine, and deaths attributable to aspiration have not increased since supine positioning was first recommended. [27][28][29] Additional efforts to understand and to address barriers to changes in attitudes and behaviors are important if continued progress in achieving safe sleep environments in child care settings is to be achieved.…”

Sudden infant death syndrome and advice for safe sleeping

“…Several studies have found that the risk of aspiration is not increased by sleeping in the supine position. [24][25][26] This is also true for infants with gastro-oesophageal reflux.…”

SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment

“…Multiple studies in different countries have not found an increased incidence of aspiration since the change to supine sleeping. [81][82][83] There is often particular concern for aspiration when the infant has been diagnosed with gastroesophageal reflux. The AAP supports the recommendations of the North American Society for Pediatric Gastroenterology and Nutrition, which state that infants with gastroesophageal reflux should be placed for sleep in the supine position, with the rare exception of infants for whom the risk of death from gastroesophageal reflux is greater than the risk of SIDS 84 -specifically, infants with upper airway disorders for whom airway protective mechanisms are impaired, which may include infants with anatomic abnormalities, such as type 3 or 4 laryngeal clefts, who have not undergone antireflux surgery.…”