Systematic Review of Safety and Efficacy of Positional Therapy as First-line Management for Robin Sequence
Bibliographic record
Abstract
Infants with Robin Sequence (RS) frequently present with breathing difficulties and there may be concomitant feeding issues, most commonly as a result of upper airway obstruction (UAO). Positional therapy (PT) is thought to alleviate UAO in RS by allowing the posteriorly displaced tongue to fall forward. However, an increased risk of sudden infant death syndrome (SIDS) associated with prone positioning is well documented in previously healthy infants, raising concern about the use of PT in infants with RS. Our aim was to collate and evaluate the published evidence regarding the safety and efficacy of PT in RS. A literature search was performed across databases Ebesco Cinahl, EMBASE, OVID Medline, Web of Science and Cochrane library in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 1990 and 2024 were considered for inclusion. Search terms included "robin sequence", "prone position", "side lying" using "AND", "OR" Boolean search strings. After the application of inclusion and exclusion criteria, 23 studies were selected for analysis, which included data on 875 patients managed with PT. Of these, 715 were considered not to require other interventions for the management of UAO, although this decision was often not based on objective data. Six patients died while being managed with PT, though no deaths were directly attributed to the sleeping position; overall mortality seemed lower in more recent studies. Further research is required to establish the safety and efficacy of PT in infants with RS and to determine how these infants should best be monitored.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.042 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.010 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".