Face-straight-down and face-near-straight-down positions in healthy, prone-sleeping infants

Waters, Karen A.; Gonzalez, Anne V.; Jean, Catherine.; Morielli, Angela; Brouillette, Robert T.

doi:10.1016/s0022-3476(96)80125-9

Cited by 110 publications

(56 citation statements)

References 30 publications

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“…10,13,19 Although most infants in the present study woke up when covered, there was a striking difference in subsequent behavior depending on the infants' body position. Only one prone infant of 5 months managed to remove the duvet from the head compared with 23% of the supine infants at 2 1 ⁄2 months and 60% at 5 months.…”

Section: Discussionmentioning

confidence: 52%

“…Subsequent to a change in body position or movements during sleep, infants may happen to slip under the bedding, 13,14,37,38 and a situation for CO 2 rebreathing and risk of overheating may occur. 10,13,19 Although most infants in the present study woke up when covered, there was a striking difference in subsequent behavior depending on the infants' body position.…”

Section: Discussionmentioning

confidence: 99%

“…Infants' early crawling movements are reciprocal which may tend to bring them under the bedding while prone. It has also been shown that infants sleeping on the side may be able to pull the cover over the head, 13 and that they may roll from the unstable side position to prone. 13,14,37,38 The inability to remove the cover while prone and subsequent awakening and struggling may increase the likelihood of overheating, exhaustion, and a face down position with CO 2 rebreathing, all possible contributors to SIDS.…”

Section: Discussionmentioning

confidence: 99%

“…3,5,6 The possibility of CO 2 rebreathing has mainly been studied in experimental in vitro and animal models, 3,[5][6][7][8][9][10] whereas studies in infants are limited. [11][12][13] We have previously shown that a significant number of SIDS victims are found with their head covered by bedding and usually in the prone position. 14 The purpose of the present investigation was to study the effect of getting the head covered by bedding on CO 2 accumulation around the face, behavior, and physiologic responses in sleeping infants, and to compare outcome measures for the prone and supine sleeping positions.…”

Section: N 1944 Abramsonmentioning

confidence: 99%

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Consequences of Getting the Head Covered During Sleep in Infancy

Skadberg

Markestad

1997

Pediatrics

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ABSTRACT. Objective. To study the consequences of getting the head covered by bedding (fiber quilt) on carbon dioxide (CO 2 ) accumulation around the face, behavior, and physiologic responses during prone and supine sleep in infants to add understanding to why victims of sudden infant death syndrome are often found under the bedding.Methodology. Of 33 healthy term, usually nonprone sleeping infants, behavior and computerized polysomnography were successfully recorded for 30 during prone and supine sleep at 2 1 ⁄2 months and for 23 prone and 25 supine at 5 months.Results. For both ages and body positions, covering the head resulted in significant CO 2 accumulation around the face, fewer apneas (3 to 10 seconds), shorter duration of apneas after sighs, higher heart and respiratory rates, and peripheral skin temperature. Differences were generally greater at 2 1 ⁄2 than at 5 months. While covered, the prone position was associated with higher CO 2 levels close to the face, slightly higher transcutaneous PCO 2 , and higher heart rates and peripheral skin temperatures than the supine position. In the supine position 23% were able to remove the cover from the head at 2 1 ⁄2 and 60% at 5 months, whereas only 1 infant of 5 months managed to remove the cover when prone.Conclusions. The observed responses are consistent with a potential for distress when the head is covered, particularly when placed prone. Probably most important with respect to sudden infant death syndrome is the infants' inability to remove the bedding from the head upon awakening from prone sleep. Pediatrics 1997;100(2). URL: http://www.pediatrics.org/cgi/content/ full/100/2/e6; behavior, CO 2 rebreathing, hyperthermia, SIDS, sleeping position. 3 Although the concentration of carbon dioxide (CO 2 ) in the atmosphere is .03% to .04%, the exhaled air of infants contains 4% to 5% CO 2 , 4 and it has been speculated that under certain conditions, such as sleeping face down on soft bedding, extensive CO 2 accumulation around the infant's face may result in rebreathing, asphyxia, and suffocation. 3,5,6 The possibility of CO 2 rebreathing has mainly been studied in experimental in vitro and animal models, 3,5-10 whereas studies in infants are limited. 11-13We have previously shown that a significant number of SIDS victims are found with their head covered by bedding and usually in the prone position.14 The purpose of the present investigation was to study the effect of getting the head covered by bedding on CO 2 accumulation around the face, behavior, and physiologic responses in sleeping infants, and to compare outcome measures for the prone and supine sleeping positions. SUBJECTS AND METHODS SubjectsThirty-three infants (17 girls and 16 boys) were recruited for an overnight sleep study both at 2 1 ⁄2 (mean, 74 days; range, 71 to 79 days) and 5 (mean, 152 days; range, 147 to 158 days) months of age. The ages were chosen to correspond with the age of highest risk for SIDS (2 1 ⁄2 months) and a period of significantly lower risk (5 months) in Norway. 15 Only t...

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: N 1944 Abramsonmentioning

confidence: 99%

See 2 more Smart Citations

Consequences of Getting the Head Covered During Sleep in Infancy

Skadberg

Markestad

1997

Pediatrics

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“…The most important of these is a sleeping position in ventral decubitus (prone position), 4,5 as extensively demonstrated by the reduction in SIDS incidence that has been achieved by simply switching the sleeping position to dorsal decubitus in all countries in which this procedure has been adopted. [6][7][8][9][10][11] Other risk factors are its higher incidence in winter, peak incidence between two and four months of age, higher incidence among infants living in an environment where people smoke, and more common occurrence among preterm babies. 12 Although SIDS can occur throughout the first year of life, most cases occur between two and four months of life and 95% of these babies are less than six months old when stricken.…”

Section: Introductionmentioning

confidence: 99%

Sudden infant death syndrome in Brazil: fact or fancy?

et al. 2008

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CONTEXT AND OBJECTIVE: The true incidence of sudden infant death syndrome (SIDS) in Brazil is unknown. The aim here was to identify SIDS cases in the city of Ribeirão Preto, State of São Paulo, between 2000 and 2005, in order to estimate its incidence. DESIGN AND SETTING: Retrospective analysis of data on live births and infant deaths in Ribeirão Preto and from autopsies of infants performed at the Death Verification Service of the Interior (SVOI) between 2000 and 2005. RESULTS: There were 47,356 live births and 537 deaths, with infant mortality rates ranging from 12.9‰ to 10.9‰ of live births. Among the 24 infants who died possibly due to SIDS and who were autopsied at the SVOI, six were from families living in the municipality (0.13‰ of live births): three (50%) were diagnosed as SIDS, and one each (16.66%) as indeterminate cause, bronchoaspiration and cerebral edema. Two deaths occurred in the first month of life (33.33%) and one each (16.66%) at two, four, six and eight months. Two deaths each (33.33%) occurred in the months of February and December, one each in August and October (16.66%). Four cases (66.7%) occurred in the summer and one each (16.66%) in winter and spring. There was 5:1 predominance of males over females. CONCLUSIONS: The frequency of SIDS was lower than what has been reported worldwide and in the Brazilian literature, thus suggesting underdiagnosis, indicating the lack of any specific postmortem protocol for SIDS identification and showing the need to implement this.

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Sudden Infant Death With External Airways Covered

Scheers¹,

Dayton²,

Kemp³

1998

Arch Pediatr Adolesc Med

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To study factors associated with sudden infant deaths occurring with the external airways (ie, nose and mouth) covered by bedding. Design: Case-comparison study of infants dying with vs those dying without the external airways covered. Setting: Death-scene investigation and reconstruction at the site of death using an infant mannequin; 18 metropolitan areas. Participants: Caregivers for a consecutive sample of infants who died of sudden infant death syndrome (SIDS). Complete data from 206 of 382 eligible cases. Main Outcome Measures: Among infants dying suddenly and unexpectedly, an analysis of whether sociodemographic risk factors for SIDS, sleep practices, or bedding increased the risk of dying with the external airways covered. Results: Data were analyzed by using univariate and 2 types of multivariate risk analysis, logistic regression and latent class. Of the victims, 59 (29%) were found with Editor's Note: This is one case for soft findings (eg, pillows, comforters) being of great significance.

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Face-straight-down and face-near-straight-down positions in healthy, prone-sleeping infants

Cited by 110 publications

References 30 publications

Consequences of Getting the Head Covered During Sleep in Infancy

Consequences of Getting the Head Covered During Sleep in Infancy

Sudden infant death syndrome in Brazil: fact or fancy?

Sudden Infant Death With External Airways Covered

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