A sleep position-dependent mechanism for infant death on sheepskins
J. S. Kemp and B. T. Thach
Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110.
OBJECTIVE--To determine whether rebreathing of expired air is a plausible
lethal mechanism of sudden death in infants sleeping face down on
sheepskins. DESIGN--Case reports of infants who died on sheepskins combined
with a controlled study of effects of their respiratory microenvironment at
death. SETTING--Research laboratory. MATERIALS--Rabbits used experimentally
to assist in simulation of an infant's respiratory microenvironment.
Rabbits breathed into sheepskin through the airway of an infant mannequin.
INTERVENTION--None. MEASUREMENTS/MAIN RESULTS--Rebreathing of expired air
was documented by carbon dioxide analysis of airway gas. Arterial blood gas
analysis showed hypoxemia, hypercarbia, and acidosis in all experimental
rabbits but not in controls. Rebreathing expired air was lethal for three
of four experimental rabbits. CONCLUSIONS--Infants sleeping prone on a
sheepskin, with their faces straight down, experience potentially lethal
rebreathing of expired air. Avoidance of the prone position would markedly
reduce the risk of rebreathing expired air. The pronounced decrease in
sudden infant death syndrome in southern New Zealand that followed a
campaign to eliminate prone sleeping may have been attributable to reduced
fatal rebreathing, as deaths of infants sleeping face down on sheepskins
were common before the campaign.
Inspired CO2 and O2 in sleeping infants rebreathing from bedding: relevance for sudden infant death syndrome
Patel et al.
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Rehan et al.
Arch. Dis. Child. 2000;83:234-238.
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Changing Concepts of Sudden Infant Death Syndrome: Implications for Infant Sleeping Environment and Sleep Position
Task Force on Infant Sleep Position and Sudden Inf
Pediatrics 2000;105:650-656.
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Changing Infants' Sleep Position Increases Risk of Sudden Infant Death Syndrome
Mitchell et al.
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Serdarevich and Fewell
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Carleton et al.
Arch. Dis. Child. 1998;78:323-328.
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Skadberg and Markestad
Pediatrics 1997;100:e6-e6.
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Infant Sleep Position and the Sudden Infant Death Syndrome: A Survey of Pediatric Recommendations
Carolan et al.
CLIN PEDIATR 1995;34:402-409.
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The Risk of Sudden Infant Death
Cohle et al.
NEJM 1994;330:63-64.
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