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

Infants with Robin Sequence (RS) frequently present with breathing difficulties and there may be concomitant feeding issues, most commonly as a result of upper airway obstruction (UAO). Positional therapy (PT) is thought to alleviate UAO in RS by allowing the posteriorly displaced tongue to fall forward. However, an increased risk of sudden infant death syndrome (SIDS) associated with prone positioning is well documented in previously healthy infants, raising concern about the use of PT in infants with RS. Our aim was to collate and evaluate the published evidence regarding the safety and efficacy of PT in RS. A literature search was performed across databases Ebesco Cinahl, EMBASE, OVID Medline, Web of Science and Cochrane library in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 1990 and 2024 were considered for inclusion. Search terms included "robin sequence", "prone position", "side lying" using "AND", "OR" Boolean search strings. After the application of inclusion and exclusion criteria, 23 studies were selected for analysis, which included data on 875 patients managed with PT. Of these, 715 were considered not to require other interventions for the management of UAO, although this decision was often not based on objective data. Six patients died while being managed with PT, though no deaths were directly attributed to the sleeping position; overall mortality seemed lower in more recent studies. Further research is required to establish the safety and efficacy of PT in infants with RS and to determine how these infants should best be monitored.