PubMed · 9887823
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S Clarke-O'Neill. Dry run.. https://pubmed.ncbi.nlm.nih.gov/9887823/
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AIM: "Reducing the risk" is a public health primary initiative to minimise the incidence of Sudden Infant Death Syndrome (SIDS) in New Zealand. A number of SIDS risks relate to infant sleep practices. We describe current prevalences of these practices. METHODS: A cohort of Canterbury mothers delivering live infants during May 1997 (n = 411) were mailed a questionnaire in July surveying their infant's sleep practices. Survey results were compared to results derived from the Canterbury control infant component of the 1987-90 New Zealand Cot Death Study (NZCDS) (n = 174). Those mothers using either plastic or rubber mattress covers (n = 63) were issued a subsequent questionnaire pertaining to this mattress-wrapping practice. RESULTS: Completed questionnaires were returned by 274 (66.7%) mothers. Room sharing with mother was usual for 133 (48.5%) infants, no different from the 94 (54.0%) recorded in the NZCDS (chi 2 = 5.6, df = 2, p = 0.06). However, of those infants sharing a room with their mother, 101 (75.9%) slept in their own bed compared to 46 (48.9%) in the NZCDS (chi 2 = 57.0, df = 2, p < 0.01). Only 8 (2.9%) infants were regularly placed prone to sleep, considerably fewer than the 69 (39.7%) reported in the NZCDS (chi 2 = 100.1, df = 1, p < 0.01). Mattress-wrapping with plastic (14.6% vs. 4.0%; chi 2 = 12.8, df = 1, p < 0.01) and rubber (8.4% vs. 3.4%; chi 2 = 4.4, df = 1, p = 0.04) has significantly increased since the NZCDS. Results from the subsequent questionnaire, completed by 42 (66.7%) respondents, indicated that most, 25 (59.5%), wrapped their infant's mattress to stop soiling. Less than half, 18 (42.9%), wrapped the mattress for the "safety of their baby". CONCLUSION: The "non-prone sleeping" campaign has been successful in Canterbury. Most infants are now routinely placed non-prone for sleep. Of those infants sharing a room with their mothers, an increased proportion is sleeping in separate beds. The use of "drycot" under-blankets and sheepskins has diminished. While impermeable mattress-wrapping usage has significantly increased, over three-quarters of Canterbury mothers did not use plastic or rubber mattress-covers on their infant's beds.
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OBJECTIVE: Rebreathing of exhaled air is one proposed mechanism for the increased risk for sudden infant death syndrome among prone sleeping infants. We evaluated how carbon dioxide (CO(2)) dispersal was affected by a conventional crib mattress and 5 products recently marketed to prevent prone rebreathing. SETTING: Infant pulmonary laboratory. EQUIPMENT: An infant mannequin with its nares connected via tubing to an 100-mL reservoir filled with 5% CO(2). The sleep surfaces studied included: firm mattress covered by a sheet, Bumpa Bed, Breathe Easy, Kid Safe/Baby Air, Halo Sleep System, and Sleep Guardian. The mannequin was positioned prone face-down or near-face-down. The sleep surfaces were studied with the covering sheet taut, covering sheet wrinkled, and with the mannequin arm positioned up, near the face. MEASUREMENTS: . We measured the fall in percentage end-tidal CO(2) as the reservoir was ventilated with the piston pump. The half-time for CO(2) dispersal (t(1/2)) is an index of the ability to cause or prevent rebreathing. RESULTS: Compared with the face-to-side control, 5 of 6 surfaces allowed a significant increase in t(1/2) in all 3 prone scenarios. The firm mattress and 4 of the 5 surfaces designed to prevent rebreathing consistently allowed t(1/2) above thresholds for the onset of CO(2) retention and lethal rebreathing in an animal model (J Appl Physiol. 1995;78:740). CONCLUSIONS: With very few exceptions, infants should be placed supine for sleep. For infants placed prone or rolling to the prone position, significant rebreathing of exhaled air would be likely on all surfaces studied, except one.