What is the recommended positioning for a sick preterm infant to minimize reflux?

The recommended positioning for a sick preterm infant to minimize reflux is the prone or side-lying position. These positions are effective because they use gravity to help prevent gastric contents from flowing back into the esophagus. In the prone position, the infant is lying on their stomach, which can reduce the pressure on the lower esophageal sphincter and inhibit reflux. Similarly, the side-lying position allows for a more neutral alignment of the gastrointestinal tract, which can also support optimal digestion and minimize the risk of aspiration.

In contrast, the supine or elevated position may not provide as significant a benefit in controlling reflux as the prone or side-lying positions can. While elevating the head in the supine position might help some infants, it does not always effectively prevent reflux because of the anatomical and physiological factors involved in the neonatal digestive system. A seated position is generally not appropriate for sick preterm infants due to their underdeveloped musculature and risk of respiratory compromise. Lastly, having the infant flat on their back lacks any supportive measures against gastroesophageal reflux, which can exacerbate symptoms and lead to complications.