Children in the studies who were placed on their stomachs had higher blood oxygen levels and slower breathing rates than those placed on their backs, the review found.

Blood oxygen levels in the stomach-placed infants were about 2 percent higher than in the back-sleeping infants, a small but statistically significant difference. Most of the studies measured changes in blood oxygen levels and other indications of respiratory distress over the course of several hours, making it difficult to say whether stomach positioning has any long-term benefits or drawbacks, says review lead author Deborah Wells, a clinical nurse specialist at The Children's Hospital in Westmead, Australia.

Although the finding seems at first glance to contradict the "back to sleep" recommendation that has been prevalent since 1992, most of the studies in the review involved premature infants breathing with the help of a mechanical ventilator. The findings are not applicable to healthy children, and it is "not clear how generalizable this data is to other infants and children with acute respiratory distress," Wells says.

Wells also notes that even children hospitalized with severe breathing problems should be monitored continuously if they are placed on their stomachs because of the association between sudden infant death syndrome (SIDS) and stomach sleeping positions.

The review appears in the April issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Children and especially infants in respiratory distress risk oxygen poisoning and
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Contact: Deborah Wells
DeboraW2@chw.edu.au
Center for the Advancement of Health
19-Apr-2005