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a Monash Medical Centre, Clayton, Victoria, Australia:
Monash University Department of Paediatrics, b Monash University Department of Mathematics, c Paediatric Gastroenterology Unit
Correspondence to: Dr Jacinta Tobin, Institute of Child Health, Francis Road, Birmingham B16 8ET.
Accepted 4 November 1996
AIM
Prone posture is often recommended for
symptomatic gastro-oesophageal reflux in young infants, but prone
positioning has been associated with sudden infant death. The aim of
this study was thus to establish the optimal alternative posture for
reducing reflux.
METHODS24 infants (< 5 months) with symptomatic
gastro-oesophageal reflux were studied prospectively with 48 h pH
monitoring. They were randomly assigned to one of the 24 permutations
of the four positions (supine, prone, right, left). During the first 24 hours the infant was held horizontally, and then the permutation was repeated at 30 degrees head elevation, giving a total of eight study
segments for each infant. Data were edited to remove all time when the
infants were not in the prescribed positions. Results were evaluated
using analysis of covariance.
RESULTSGastro-oesophageal reflux expressed as
reflux index (mean % (SEM)) was significantly less in the prone and
left lateral positions (6.72 (1.06) and 7.69 (1.03) respectively) than
in the supine and right lateral positions (15.33 (2.33) and 12.02 (1.38); p < 0.001). Head elevation did not affect any
variables significantly.
CONCLUSIONSHead elevation may not always be of
clinical value. The left lateral position is a suitable alternative to
prone for the postural management of infants with symptomatic
gastro-oesophageal reflux.
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