{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T02:41:17Z","timestamp":1792636877556,"version":"4.5.0"},"reference-count":20,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,7,28]]},"abstract":"\n Importance<\/jats:title>\n Prone positioning has been shown to improve respiratory mechanics and oxygenation, but its clinical benefit in infants with acute viral bronchiolitis receiving high-flow nasal cannula (HFNC) support remains unknown.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate whether prone positioning in infants with moderate to severe acute bronchiolitis and HFNC support reduces escalation to noninvasive or invasive ventilation.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Multicenter, randomized, open-label trial conducted in 15 pediatric intermediate or intensive care units in France. Infants aged 6 months or younger admitted for 24 hours or less with a diagnosis of acute bronchiolitis with moderate to severe respiratory distress requiring HFNC support were enrolled between January 2021 and November 2023 and followed up until hospital discharge (last patient discharged on December 11, 2023).<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Participants were randomly assigned to the prone position (n\u2009=\u2009221) or supine position (n\u2009=\u2009230). Infants in the prone position group received prone positioning for 24 hours or longer during the first 48 hours. All participants received standardized HFNC support at 2 L\/kg\/min.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was the need for escalation of care to noninvasive or invasive ventilation within the first 72 hours, according to prespecified criteria. Secondary outcomes included treatment failure, determined by an independent clinical adjudication committee; tolerance of prone positioning; length of hospital stay; duration of respiratory support; infant comfort; and adverse events.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 451 infants randomized, 446 were included in the primary analysis (median age, 41 [IQR, 19-72] days; 54% male). Escalation of care occurred in 80 infants (17.9%), with no significant difference between the prone position (33\/220 [15.0%]) and supine position (47\/226 [20.8%]) groups (adjusted odds ratio, 0.66 [95% CI, 0.40-1.07];\n P<\/jats:italic>\n \u2009=\u2009.09). Secondary outcomes did not differ significantly between the 2 groups. In the safety analysis, serious adverse events occurred in 2 of 180 infants (1.1%) in the prone position group and 2 of 264 (0.8%) in the supine position group.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Prone positioning in infants with moderate to severe bronchiolitis receiving HFNC support did not significantly reduce escalation of care. However, the wide 95% confidence interval around the observed odds ratio suggests that this study was not definitive and further research is warranted.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03976895<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.11078","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T14:30:16Z","timestamp":1781706616000},"page":"315","source":"Crossref","is-referenced-by-count":3,"title":["Prone Positioning in Infants With Acute Bronchiolitis"],"prefix":"10.1001","volume":"336","author":[{"given":"Florent","family":"Baudin","sequence":"first","affiliation":[{"name":"Hospices Civils de Lyon, H\u00f4pital Femme M\u00e8re Enfant, Service d\u2019Urgences et de R\u00e9animation P\u00e9diatriques, Bron, France"},{"name":"Agressions Pulmonaires et Circulatoires Dans le Sepsis (APCSe), VetAgro Sup, Universit\u00e9s de Lyon, Marcy l\u2019Etoile, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Pouyau","sequence":"additional","affiliation":[{"name":"Hospices Civils de Lyon, H\u00f4pital Femme M\u00e8re Enfant, Service d\u2019Urgences et de R\u00e9animation P\u00e9diatriques, Bron, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabien","family":"Subtil","sequence":"additional","affiliation":[{"name":"Department of Bio-Statistics and Bio-Informatics, Hospices Civils de Lyon, Pole de Sant\u00e9 Publique, Lyon, France"},{"name":"Universit\u00e9 Claude Bernard Lyon 1, LBBE, UMR 5558, CNRS, VAS, Villeurbanne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cl\u00e9mence","family":"Jarrasse","sequence":"additional","affiliation":[{"name":"Service de P\u00e9diatrie, Centre Hospitalier Annecy Genevois, Epagny, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Tochon","sequence":"additional","affiliation":[{"name":"Service de P\u00e9diatrie, Centre Hospitalier Nord Ouest, Gleiz\u00e9, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mickael","family":"Afanetti","sequence":"additional","affiliation":[{"name":"Service de Reanimation P\u00e9diatrique, Centre Hopitalo-Universitaire Lenval, Nice, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Mil\u00e9si","sequence":"additional","affiliation":[{"name":"Service de Reanimation P\u00e9diatrique, Centre Hopitalo-Universitaire Arnaud-de-Villeneuve, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Eudes","family":"Piloquet","sequence":"additional","affiliation":[{"name":"Service de Reanimation P\u00e9diatrique, Centre Hopitalo-Universitaire de Nantes, H\u00f4pital Enfant-Adolescent, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillaume","family":"Mortamet","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, University Grenoble-Alps, Grenoble University Hospital, Grenoble\u2013La Tronche, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Nallet Amate","sequence":"additional","affiliation":[{"name":"Service de Reanimation P\u00e9diatrique, Centre Hopitalo-Universitaire de Dijon, H\u00f4pital d\u2019Enfants, Dijon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Val\u00e9rie","family":"Launay","sequence":"additional","affiliation":[{"name":"Hospices Civils de Lyon, H\u00f4pital Femme M\u00e8re Enfant, Service d\u2019Urgences et de R\u00e9animation P\u00e9diatriques, Bron, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fleur","family":"Cour Andlauer","sequence":"additional","affiliation":[{"name":"Hospices Civils de Lyon, H\u00f4pital Femme M\u00e8re Enfant, Service d\u2019Urgences et de R\u00e9animation P\u00e9diatriques, Bron, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvain","family":"Roche","sequence":"additional","affiliation":[{"name":"Department of Bio-Statistics and Bio-Informatics, Hospices Civils de Lyon, Pole de Sant\u00e9 Publique, Lyon, France"},{"name":"Universit\u00e9 Claude Bernard Lyon 1, LBBE, UMR 5558, CNRS, VAS, Villeurbanne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Levy","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Intensive\u2013R\u00e9animation P\u00e9diatrique, Assistance Publique\u2013H\u00f4pitaux de Paris, H\u00f4pital Robert Debr\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9rome","family":"Rambaud","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation P\u00e9diatrique, Assistance Publique\u2013H\u00f4pitaux de Paris, H\u00f4pital Armand-Trousseau, Paris, France"},{"name":"Sorbonne Universit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aur\u00e9lie","family":"Portefaix","sequence":"additional","affiliation":[{"name":"Centre d\u2019Investigation Clinique, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etienne","family":"Javouhey","sequence":"additional","affiliation":[{"name":"Hospices Civils de Lyon, H\u00f4pital Femme M\u00e8re Enfant, Service d\u2019Urgences et de R\u00e9animation P\u00e9diatriques, Bron, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"PROPOSITIS Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"BROSSIER","sequence":"additional","affiliation":[{"name":"for the PROPOSITIS Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"CHANTREUIL","sequence":"additional","affiliation":[{"name":"for the PROPOSITIS Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxence","family":"FERNANDES","sequence":"additional","affiliation":[{"name":"for the PROPOSITIS Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinne","family":"PAGET","sequence":"additional","affiliation":[{"name":"for the PROPOSITIS Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugues","family":"PATURAL","sequence":"additional","affiliation":[{"name":"for the PROPOSITIS Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvain","family":"RENOLLEAU","sequence":"additional","affiliation":[{"name":"for the PROPOSITIS Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaud","family":"WIEDEMANN","sequence":"additional","affiliation":[{"name":"for the PROPOSITIS Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"10349","key":"joi260073r1","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1016\/S0140-6736(22)01016-9","article-title":"Bronchiolitis.","volume":"400","author":"Dalziel","year":"2022","journal-title":"Lancet"},{"issue":"10340","key":"joi260073r2","doi-asserted-by":"publisher","first-page":"2047","DOI":"10.1016\/S0140-6736(22)00478-0","article-title":"Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis.","volume":"399","author":"Li","year":"2022","journal-title":"Lancet"},{"issue":"2","key":"joi260073r3","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1001\/jamapediatrics.2024.5572","article-title":"Respiratory syncytial virus disease burden and nirsevimab effectiveness in young children from 2023-2024.","volume":"179","author":"Moline","year":"2025","journal-title":"JAMA Pediatr"},{"issue":"1","key":"joi260073r4","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/s00134-022-06918-4","article-title":"Clinical practice guidelines: management of severe bronchiolitis in infants under 12 months old admitted to a pediatric critical care unit.","volume":"49","author":"Mil\u00e9si","year":"2023","journal-title":"Intensive Care Med"},{"issue":"6","key":"joi260073r5","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-039115","article-title":"Trends in bronchiolitis ICU admissions and ventilation practices: 2010-2019.","volume":"147","author":"Pelletier","year":"2021","journal-title":"Pediatrics"},{"issue":"10","key":"joi260073r6","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.29920","article-title":"Trends in hospital costs and levels of services provided for children with bronchiolitis treated in children\u2019s hospitals.","volume":"4","author":"Willer","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"5","key":"joi260073r7","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.10746","article-title":"Respiratory support practices for bronchiolitis in the pediatric intensive care unit.","volume":"7","author":"Pelletier","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"5","key":"joi260073r8","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2019-4083","article-title":"High-flow nasal cannula use outside of the ICU setting.","volume":"146","author":"Kalburgi","year":"2020","journal-title":"Pediatrics"},{"issue":"2","key":"joi260073r9","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1007\/s00134-016-4617-8","article-title":"High flow nasal cannula (HFNC) vs nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study).","volume":"43","author":"Mil\u00e9si","year":"2017","journal-title":"Intensive Care Med"},{"key":"joi260073r10","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.prrv.2024.05.004","article-title":"Effectiveness of high flow nasal cannula (HFNC) therapy compared to standard oxygen therapy (SOT) and continuous positive airway pressure (CPAP) in bronchiolitis.","volume":"52","author":"Alexander","year":"2024","journal-title":"Paediatr Respir Rev"},{"issue":"6 pt 2","key":"joi260073r11","first-page":"143","article-title":"Comments of a devil\u2019s advocate.","volume":"110","author":"Bryan","year":"1974","journal-title":"Am Rev Respir Dis"},{"issue":"23","key":"joi260073r12","doi-asserted-by":"publisher","first-page":"2159","DOI":"10.1056\/NEJMoa1214103","article-title":"Prone positioning in severe acute respiratory distress syndrome.","volume":"368","author":"Gu\u00e9rin","year":"2013","journal-title":"N Engl J Med"},{"issue":"22","key":"joi260073r13","doi-asserted-by":"publisher","first-page":"2265","DOI":"10.1001\/jama.2020.8539","article-title":"Is the prone position helpful during spontaneous breathing in patients with COVID-19?","volume":"323","author":"Telias","year":"2020","journal-title":"JAMA"},{"issue":"6","key":"joi260073r14","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.1016\/j.jpeds.2012.11.036","article-title":"Positioning effects on lung function and breathing pattern in premature newborns.","volume":"162","author":"Gouna","year":"2013","journal-title":"J Pediatrics"},{"issue":"3","key":"joi260073r15","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1203\/00006450-199709000-00183","article-title":"Prone vs supine sleep position in bronchiolitis: effects on apnoea and oxygenation.","volume":"42","author":"Poets","year":"1997","journal-title":"Pediatr Res"},{"key":"joi260073r16","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.jpeds.2018.09.066","article-title":"Physiological effect of prone position in children with severe bronchiolitis: a randomized cross-over study (BRONCHIO-DV).","volume":"205","author":"Baudin","year":"2019","journal-title":"J Pediatrics"},{"issue":"5","key":"joi260073r17","doi-asserted-by":"publisher","first-page":"e1474","DOI":"10.1542\/peds.2014-2742","article-title":"Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis.","volume":"134","author":"Ralston","year":"2014","journal-title":"Pediatrics"},{"issue":"11","key":"joi260073r18","doi-asserted-by":"publisher","first-page":"1870","DOI":"10.1007\/s00134-018-5343-1","article-title":"A multicenter randomized controlled trial of a 3-L\/kg\/min vs 2-L\/kg\/min high-flow nasal cannula flow rate in young infants with severe viral bronchiolitis (TRAMONTANE 2).","volume":"44","author":"Mil\u00e9si","year":"2018","journal-title":"Intensive Care Med"},{"issue":"6","key":"joi260073r19","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1097\/WON.0000000000000281","article-title":"Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System.","volume":"43","author":"Edsberg","year":"2016","journal-title":"J Wound Ostomy Continence Nurs"},{"issue":"9","key":"joi260073r20","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1001\/jama.2025.24082","article-title":"Nirsevimab vs RSVpreF vaccine for respiratory syncytial virus-related hospitalization in newborns.","volume":"335","author":"Jabagi","year":"2026","journal-title":"JAMA"}],"container-title":["JAMA"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/articlepdf\/2850558\/jama_baudin_2026_oi_260073_1784646396.2825.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T15:00:29Z","timestamp":1785250829000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2850558"}},"subtitle":["The PROPOSITIS Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":20,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,7,28]]}},"URL":"https:\/\/doi.org\/10.1001\/jama.2026.11078","relation":{},"ISSN":["0098-7484"],"issn-type":[{"value":"0098-7484","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7,28]]}}}