Prone sleeping position in infancy: Implications for cardiovascular and cerebrovascular function

Advances in neonatal care have improved the survival rates of preterm infants, however, the likelihood of brain injury and neurodevelopmental disability remains a significant problem. Whilst the etiology of preterm brain injury is complex, impairments in the cardio- and cerebro-vascular function have been implicated. During infancy, sleep is vital for brain development. However, instabilities in cardio- and cerebro-vascular function are most marked during sleep. Sleeping position is an important part of a safe sleeping environment. Prone sleeping increases the risk of sudden infant death syndrome and is associated with reduced blood pressure, cerebral oxygenation and impaired autonomic cardiovascular control in infants born at term. Importantly, these effects are amplified by preterm birth. Hospitalized preterm infants are often slept in the prone position to improve respiratory function. However, there is little consensus regarding the sustained benefits of prone sleeping in this population. In light of the impaired cardio- and cerebro-vascular function during prone sleeping in term and preterm infants after hospital discharge, the likely adverse effects of prone sleeping in hospitalized preterm infants are concerning. This review examines the cardiovascular and cerebrovascular effects of prone sleeping in infants born at term, those born preterm after term equivalent age and whilst hospitalized.