Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2000 Sep;83(3):234–238. doi: 10.1136/adc.83.3.234

Effects of the supine and prone position on diaphragm thickness in healthy term infants

V Rehan 1, J Nakashima 1, A Gutman 1, L Rubin 1, F McCool 1
PMCID: PMC1718488  PMID: 10952643

Abstract

BACKGROUND—The physiological basis underlying the decline in the incidence of sudden infant death syndrome (SIDS) associated with changing the sleep position from prone to supine remains unknown.
AIMS—To evaluate diaphragm thickness (tdi) and shortening in healthy term infants in the prone and supine positions in order to determine whether changes in body position would affect diaphragm resting length and the degree of diaphragm shortening during inspiration.
METHODS—In 16 healthy term infants, diaphragm thickness at the level of the zone of apposition on the right side was measured using ultrasonography. Heart rate (HR), breathing frequency (f), and transcutaneous oxyhaemoglobin saturation (SaO2) were recorded simultaneously during diaphragm imaging with the infants in the supine and prone positions during quiet sleep.
RESULTS—At end expiratory (EEV) and at end inspiratory lung volumes (EIV), tdi increased significantly in the prone position. The change in tdi during tidal breathing was also greater when the infant was prone. SaO2, HR, and f were not significantly different at EEV and at EIV in both positions.
CONCLUSION—In healthy term infants, placed in the prone position, the diaphragm is significantly thicker and, therefore, shorter, both at EEV and EIV. Diaphragm shortening during tidal breathing is greater when the infant is prone. In the prone position, the decreased diaphragm resting length would impair diaphragm strength, and the additional diaphragm shortening during tidal breathing represents added work performed by the diaphragm. This may compromise an infant's capacity to respond to stressful situations when placed in the prone position and may contribute to the association of SIDS with prone position.



Full Text

The Full Text of this article is available as a PDF (153.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adams J. A., Zabaleta I. A., Sackner M. A. Comparison of supine and prone noninvasive measurements of breathing patterns in fullterm newborns. Pediatr Pulmonol. 1994 Jul;18(1):8–12. doi: 10.1002/ppul.1950180105. [DOI] [PubMed] [Google Scholar]
  2. Bryan A. C. Conference on the scientific basis of respiratory therapy. Pulmonary physiotherapy in the pediatric age group. Comments of a devil's advocate. Am Rev Respir Dis. 1974 Dec;110(6 Pt 2):143–144. doi: 10.1164/arrd.1974.110.6P2.143. [DOI] [PubMed] [Google Scholar]
  3. Chiodini B. A., Thach B. T. Impaired ventilation in infants sleeping facedown: potential significance for sudden infant death syndrome. J Pediatr. 1993 Nov;123(5):686–692. doi: 10.1016/s0022-3476(05)80841-8. [DOI] [PubMed] [Google Scholar]
  4. Cohn D., Benditt J. O., Eveloff S., McCool F. D. Diaphragm thickening during inspiration. J Appl Physiol (1985) 1997 Jul;83(1):291–296. doi: 10.1152/jappl.1997.83.1.291. [DOI] [PubMed] [Google Scholar]
  5. Dwyer T., Ponsonby A. L., Blizzard L., Newman N. M., Cochrane J. A. The contribution of changes in the prevalence of prone sleeping position to the decline in sudden infant death syndrome in Tasmania. JAMA. 1995 Mar 8;273(10):783–789. [PubMed] [Google Scholar]
  6. Engelberts A. C., de Jonge G. A. Choice of sleeping position for infants: possible association with cot death. Arch Dis Child. 1990 Apr;65(4):462–467. doi: 10.1136/adc.65.4.462. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fleming P. J. Understanding and preventing sudden infant death syndrome. Curr Opin Pediatr. 1994 Apr;6(2):158–162. doi: 10.1097/00008480-199404000-00006. [DOI] [PubMed] [Google Scholar]
  8. Franco P., Groswasser J., Sottiaux M., Broadfield E., Kahn A. Decreased cardiac responses to auditory stimulation during prone sleep. Pediatrics. 1996 Feb;97(2):174–178. [PubMed] [Google Scholar]
  9. Guntheroth W. G., Spiers P. S. Sleeping prone and the risk of sudden infant death syndrome. JAMA. 1992 May 6;267(17):2359–2362. [PubMed] [Google Scholar]
  10. Guslits B. G., Gaston S. E., Bryan M. H., England S. J., Bryan A. C. Diaphragmatic work of breathing in premature human infants. J Appl Physiol (1985) 1987 Apr;62(4):1410–1415. doi: 10.1152/jappl.1987.62.4.1410. [DOI] [PubMed] [Google Scholar]
  11. Harding R. Nasal obstruction in infancy. Aust Paediatr J. 1986;22 (Suppl 1):59–61. [PubMed] [Google Scholar]
  12. Heimler R., Langlois J., Hodel D. J., Nelin L. D., Sasidharan P. Effect of positioning on the breathing pattern of preterm infants. Arch Dis Child. 1992 Mar;67(3):312–314. doi: 10.1136/adc.67.3.312. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Heldt G. P., McIlroy M. B. Distortion of chest wall and work of diaphragm in preterm infants. J Appl Physiol (1985) 1987 Jan;62(1):164–169. doi: 10.1152/jappl.1987.62.1.164. [DOI] [PubMed] [Google Scholar]
  14. Hutchison A. A., Ross K. R., Russell G. The effect of posture on ventilation and lung mechanics in preterm and light-for-date infants. Pediatrics. 1979 Oct;64(4):429–432. [PubMed] [Google Scholar]
  15. Hutchison A. A., Ross K. R., Russell G. The effect of posture on ventilation and lung mechanics in preterm and light-for-date infants. Pediatrics. 1979 Oct;64(4):429–432. [PubMed] [Google Scholar]
  16. Kemp J. S., Thach B. T. A sleep position-dependent mechanism for infant death on sheepskins. Am J Dis Child. 1993 Jun;147(6):642–646. [PubMed] [Google Scholar]
  17. Kemp J. S., Thach B. T. Sudden death in infants sleeping on polystyrene-filled cushions. N Engl J Med. 1991 Jun 27;324(26):1858–1864. doi: 10.1056/NEJM199106273242605. [DOI] [PubMed] [Google Scholar]
  18. Margulies S. S., Farkas G. A., Rodarte J. R. Effects of body position and lung volume on in situ operating length of canine diaphragm. J Appl Physiol (1985) 1990 Nov;69(5):1702–1708. doi: 10.1152/jappl.1990.69.5.1702. [DOI] [PubMed] [Google Scholar]
  19. Martin R. J., Herrell N., Rubin D., Fanaroff A. Effect of supine and prone positions on arterial oxygen tension in the preterm infant. Pediatrics. 1979 Apr;63(4):528–531. [PubMed] [Google Scholar]
  20. Masterson J., Zucker C., Schulze K. Prone and supine positioning effects on energy expenditure and behavior of low birth weight neonates. Pediatrics. 1987 Nov;80(5):689–692. [PubMed] [Google Scholar]
  21. McCool F. D., Tzelepis G. E., Leith D. E., Hoppin F. G., Jr Oxygen cost of breathing during fatiguing inspiratory resistive loads. J Appl Physiol (1985) 1989 May;66(5):2045–2055. doi: 10.1152/jappl.1989.66.5.2045. [DOI] [PubMed] [Google Scholar]
  22. Nelson E. A., Taylor B. J., Weatherall I. L. Sleeping position and infant bedding may predispose to hyperthermia and the sudden infant death syndrome. Lancet. 1989 Jan 28;1(8631):199–201. doi: 10.1016/s0140-6736(89)91211-7. [DOI] [PubMed] [Google Scholar]
  23. Numa A. H., Hammer J., Newth C. J. Effect of prone and supine positions on functional residual capacity, oxygenation, and respiratory mechanics in ventilated infants and children. Am J Respir Crit Care Med. 1997 Oct;156(4 Pt 1):1185–1189. doi: 10.1164/ajrccm.156.4.9601042. [DOI] [PubMed] [Google Scholar]
  24. Pelosi P., Croci M., Calappi E., Cerisara M., Mulazzi D., Vicardi P., Gattinoni L. The prone positioning during general anesthesia minimally affects respiratory mechanics while improving functional residual capacity and increasing oxygen tension. Anesth Analg. 1995 May;80(5):955–960. doi: 10.1097/00000539-199505000-00017. [DOI] [PubMed] [Google Scholar]
  25. Prechtl H. F. The behavioural states of the newborn infant (a review). Brain Res. 1974 Aug 16;76(2):185–212. doi: 10.1016/0006-8993(74)90454-5. [DOI] [PubMed] [Google Scholar]
  26. Saternus K. S., Koebke J., von Tamaska L. Neck extension as a cause of SIDS. Forensic Sci Int. 1986 Jul 14;31(3):167–174. doi: 10.1016/0379-0738(86)90184-2. [DOI] [PubMed] [Google Scholar]
  27. Skadberg B. T., Morild I., Markestad T. Abandoning prone sleeping: Effect on the risk of sudden infant death syndrome. J Pediatr. 1998 Feb;132(2):340–343. doi: 10.1016/s0022-3476(98)70456-1. [DOI] [PubMed] [Google Scholar]
  28. Sprung J., Deschamps C., Margulies S. S., Hubmayr R. D., Rodarte J. R. Effect of body position on regional diaphragm function in dogs. J Appl Physiol (1985) 1990 Dec;69(6):2296–2302. doi: 10.1152/jappl.1990.69.6.2296. [DOI] [PubMed] [Google Scholar]
  29. Wagaman M. J., Shutack J. G., Moomjian A. S., Schwartz J. G., Shaffer T. H., Fox W. W. Improved oxygenation and lung compliance with prone positioning of neonates. J Pediatr. 1979 May;94(5):787–791. doi: 10.1016/s0022-3476(79)80157-2. [DOI] [PubMed] [Google Scholar]
  30. Warren R. H., Alderson S. H. Breathing patterns in infants utilizing respiratory inductive plethysmography. Chest. 1986 May;89(5):717–722. doi: 10.1378/chest.89.5.717. [DOI] [PubMed] [Google Scholar]
  31. Willinger M., Hoffman H. J., Hartford R. B. Infant sleep position and risk for sudden infant death syndrome: report of meeting held January 13 and 14, 1994, National Institutes of Health, Bethesda, MD. Pediatrics. 1994 May;93(5):814–819. [PubMed] [Google Scholar]
  32. Wolfson M. R., Greenspan J. S., Deoras K. S., Allen J. L., Shaffer T. H. Effect of position on the mechanical interaction between the rib cage and abdomen in preterm infants. J Appl Physiol (1985) 1992 Mar;72(3):1032–1038. doi: 10.1152/jappl.1992.72.3.1032. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES