Subscribe to RSS
DOI: 10.1055/s-2008-1004610
© Georg Thieme Verlag Stuttgart · New York
Schlafposition für Frühgeborene
Sleeping Position for Preterm InfantsPublication History
2007
2007
Publication Date:
22 February 2008 (online)
![](https://www.thieme-connect.de/media/zgn/200801/lookinside/thumbnails/10.1055-s-2008-1004610-1.jpg)
Zusammenfassung
Zur Prävention des Plötzlichen Säuglingstodes (Sudden Infant Death Syndrome, SIDS) wird ein Schlafen in Rückenlage empfohlen. Kinder mit einem niedrigen Geburtsgewicht haben auch unabhängig von der Schlafposition ein erhöhtes SIDS-Risiko, welches durch Bauch- oder Seitlagerung noch potenziert wird. Allerdings ist auch bekannt, dass die Bauchlage Vorteile bez. der Atemregulation Frühgeborener bietet, wie z. B. eine verminderte Anzahl an Apnoen, eine höhere funktionelle Residualkapazität und einen ruhigeren Schlaf. Kleine Früh- und kranke Neugeborene, die eine unreife oder gestörte Atemregulation haben, sind auf neonatologischen Intensivstationen unter ständiger Beobachtung und Monitorüberwachung. Da unter diesen Umständen ein plötzliches Versterben extrem unwahrscheinlich ist und die Kinder bez. der Atemregulation von der Bauchlage profitieren, sollten sie in dieser Anfangszeit in Bauchlage schlafen. Wir empfehlen jedoch, die Kinder ca. 1 Woche vor Entlassung von der Bauch- in die Rückenlage zu drehen und den Eltern dann zu erklären, dass es ihrem Kind jetzt besser gehe und es daher von nun an so gebettet werde, wie es auch zu Hause schlafen soll: in einem Schlafsack und in Rückenlage. Zur Kindstodprävention verordnen wir keinen Monitor; in seltenen Fällen erhalten Frühgeborene für kurze Zeit zuhause ein Pulsoximeter, wenn sie bei Entlassung noch eine Apnoe-Bradykardie-Symptomatik aufweisen.
Abstract
Supine sleeping is recommended to prevent the sudden infant death syndrome (SIDS). Low birth weight infants are at increased risk for SIDS, which is increased further if they are placed prone. Prone sleeping, however, also has advantages for preterm infants, such as a reduced apnoea rate, an increased lung volume and more quiet sleep. In their first weeks of life, these infants are usually on a monitor and under continuous observation. SIDS is extremely unlikely under these circumstances. Because of the aforementioned advantages, these infants may be placed prone during their first few weeks of life in the hospital. One week before discharge, however, they should be changed to back sleeping and the parents be explained that their baby is now nearing discharge and should thus be placed as it should also sleep at home: on its back and in a sleeping sack. We do not prescribe home monitors for SIDS prevention, but occasionally use pulse oximeters at home for a few weeks if an infant continues to exhibit apnoea of prematurity.
Schlüsselwörter
Plötzlicher Säuglingstod - Bauchlage - Risikofaktoren - Atemregulation
Key words
sudden infant death syndrome - prone position - risk factors - control of breathing
Literatur
- 1 Gilbert R, Salanti G, Harden M, See S. Infant sleeping position and the sudden infant death syndrome: systematic review of observational studies and historical review of recommendations from 1940 to 2002. Int J Epidemiol.. 2005; 34 874-887
- 2 Oyen N, Markestad T, Skjaerven R, Irgens L M, Helweg-Larsen K, Alm B, Norvenius G, Wennergren G. Combined effects of sleeping position and prenatal risk factors in sudden infant death syndrome: the nordic epidemiological SIDS study. Pediatrics. 1997; 100 613-621
- 3 Vennemann M M, Findeisen M, Butterfass-Bahloul T, Jorch G, Brinkmann B, Kopcke W, Bajanowski T, Mitchell E A. The GeSID Group . Modifiable risk factors for SIDS in Germany: results of GeSID. Acta Paediatr. 2005; 94 655-660
- 4 Malloy M H, Freeman Jr D H. Birth weight- and gestational age-specific sudden infant death syndrome mortality: United States, 1991 versus 1995. Pediatrics. 2000; 105 1227-1231
- 5 Sowter B, Doyle L W, Morley C J, Altmann A, Halliday J. Is sudden infant death syndrome still more common in very low birthweight infants in the 1990s?. Med J Aust. 1999; 171 411-413
- 6 Blair P S, Platt M W, Smith I J, Fleming P J. CESDI SUDI Research Group . Sudden infant death syndrome and sleeping position in pre-term and low birth weight infants: an opportunity for targeted intervention. Arch Dis Child. 2006; 91 101-106
- 7 Chiodini B A, Thach B T. Impaired ventilation in infants sleeping facedown: potential significance for sudden infant death syndrome. J Pediatr. 1993; 123 686-692
- 8 Mitchell E A, Thompson J M, Ford R P, Taylor B J. Sheepskin bedding and the sudden infant death syndrome. New Zealand Cot Death Study Group. J Pediatr. 1998; 133 701-704
- 9 Constantin E, Waters K A, Morielli A, Brouillette R T. Head turning and face-down positioning in prone-sleeping premature infants. J Pediatr. 1999; 134 558-562
- 10 Kurlak L O, Ruggins N R, Stephenson T J. Effect of nursing position on incidence, type, and duration of clinically significant apnoea in preterm infants. Arch Dis Child. 1994; 71 F16-F19
- 11 Hashimoto T, Hiura K, Endo S, Fukuda K, Mori A, Tayama M, Miyao M. Postural effects on behavioral state of newborn infants. Brain Dev. 1983; 5 286-291
- 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; 67 312-314
- 13 McEvoy C, Mendoza M E, Bowling S, Hewlett V, Sardesai S, Durand M. Prone positioning decreases episodes of hypoxemia in extremely low birth weight infants (1 000 grams or less) with chronic lung disease. J Pediatr. 1997; 130 305-309
- 14 Kumar P, Leonidas J C, Ashtari M, Napolitano B, Steele A M. Comparison of lung area by chest radiograph, with estimation of lung volume by helium dilution during prone and supine positioning in mechanically ventilated preterm infants: a pilot study. Pediatr Pulmonol. 2005; 40 219-222
- 15 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; 63 528-553
- 16 Baird T M, Paton J B, Fisher D E. Improved oxygenation with prone positioning in neonates: stability of increased transcutaneous PO2. J Perinatol. 1991; 11 315-318
- 17 Kahn A, Groswasser J, Sottiaux M, Rebuffat E, Franco P, Dramaix M. Prone or supine body position and sleep characteristics in infants. Pediatrics. 1993; 91 1112-1115
- 18 Poets C F, Rudolph A, Neuber K, Buch U, Hardt H von der. Arterial oxygen saturation in infants at risk of sudden death: influence of sleep position. Acta Paediatr. 1995; 84 379-382
- 19 Myers M M, Fifer W P, Schaeffer L, Sahni R, Ohira-Kist K, Stark R I, Schulze K F. Effects of sleeping position and time after feeding on the organization of sleep / wake states in prematurely born infants. Sleep. 1998; 21 343-349
- 20 Tobin J M, McCloud P, Cameron D J. Posture and gastro-oesophageal reflux: a case for left lateral positioning. Arch Dis Child. 1997; 76 254-258
- 21 Ewer A K, James M E, Tobin J M. Prone and left lateral positioning reduce gastro-oesophageal reflux in preterm infants. Arch Dis Child Fetal Neonatal Ed. 1999; 81 F 201-F 205
- 22 Keitel H G, Cohn R, Harnish D. Diaper rash, self-inflicted excoriations, and crying in full-term newborn infants kept in the prone or supine position. J Pediatr. 1960; 57 884-886
- 23 Rao H, May C, Hannam S, Rafferty G F, Greenough A. Survey of sleeping position recommendations for prematurely born infants on neonatal intensive care unit discharge. Eur J Pediatr. 2006; 166 809-811
- 24 Ramanathan R, Corwin M J, Hunt C E, Lister G, Tinsley L R, Baird T, Silvestri J M, Crowell D H, Hufford D, Martin R J, Neuman M R, Weese-Mayer D E, Cupples L A, Peucker M, Willinger M, Keens T G. Collaborative Home Infant Monitoring Evaluation (CHIME) Study Group . Cardiorespiratory events recorded on home monitors: Comparison of healthy infants with those at increased risk for SIDS. JAMA. 2001; 285 2199-2207
- 25 Hunt C E, Corwin M J, Baird T, Tinsley L R, Palmer P, Ramanathan R, Crowell D H, Schafer S, Martin R J, Hufford D, Peucker M, Weese-Mayer D E, Silvestri J M, Neuman M R, Cantey-Kiser J. Collaborative Home Infant Monitoring Evaluation study group . Cardiorespiratory events detected by home memory monitoring and one-year neurodevelopmental outcome. J Pediatr. 2004; 145 465-471
Prof. Dr. med. C. F. Poets
Neonatologie · Universitätsklinikum Tübingen
Calwerstr. 7
72076 Tübingen
Phone: 0 70 71 / 2 98 47 15
Fax: 0 70 71 / 29 39 69
Email: christian-f.poets@med.uni-tuebingen.de