Neonatal Nurse Practitioner Practice Exam

Which position is optimal for a newborn with Pierre Robin sequence who presents with cyanosis and stridor?

1. Supine

2. Side-lying

3. Prone

4. Sitting upright

The correct answer is: Prone

For a newborn with Pierre Robin sequence presenting with cyanosis and stridor, the optimal positioning is prone. In this condition, anatomical anomalies such as a small jaw (micrognathia) lead to airway obstruction, particularly when the infant is in a supine position. Placing the infant in a prone position helps to alleviate airway obstruction by allowing the tongue to fall forward, thereby improving airflow and reducing the likelihood of upper airway compromise. This position also helps in distributing the weight more evenly across the chest and abdomen, allowing for better respiratory mechanics and less pressure on the airway. Prone positioning has been shown to enhance airway patency in infants who struggle with obstructive breathing patterns, leading to a decrease in stridor and cyanotic episodes. Other positions, such as side-lying or sitting upright, while they may offer some benefits in terms of airway clearance and reducing respiratory distress in certain circumstances, do not provide the same degree of improvement in airway alignment and patency as the prone position does in cases associated with micrognathia and airway obstruction.