Infant Breathing and Bedding Characteristics: Objective Tests for Evaluating Their Relationship.

Background In infancy, fatal events associated to sleep and bedding may occur. While in industrial countries accidents and suffocation have become rare due to manufacturing regulations for infant beds and bedding materials, the Sudden Infant Death Syndrome (SIDS) is still a relevant ‘cause’ of death in infancy. Although the final pathway of SIDS has not been clarified thus far, soft mattresses and cushions may represent a risk factor. Furthermore, materials compromising thermoregulation may play a major role. The same holds true for environmental conditions like excessive temperature and nicotine exposure. Recently, also bedsharing and sleeping on sofas have been identified as factors potentially contributing to SIDS risk. Recommendations for safe infant sleep Worldwide, paediatric societies and other health professionals have launched campaigns for a ‘safe infant sleep’ by promoting recommendations how to bed babies. These recommendations include (slogans of individual campaigns in brackets): - Same room, but individual beds for baby and parents (avoidance of bedsharing) - Infant beds according to safety regulations - Avoidance of soft underbedding and (soft) cushions - Bedding in supine position for every sleep (‘Back to sleep’) - Avoidance of overheating (‘Keep cool, baby’) - Preferably sleeping bags instead of blankets (‘Bag to sleep’) - Neutral thermal environment (16°C–20°C) - Consideration of pacifier use for every sleep - Avoidance of nicotine exposure - Only small toys if any Consequences of campaigns Recent recommendations have led to a significant reduction of SIDS incidence in many countries. While between 1970 and 1990 SIDS rates were in some countries as high as 2 per 1000 liveborn infants, the introduction of preventive measures have significantly reduced the incidence of this fatal event. In some countries and regions (eg. Netherlands, Styria/Austria) SIDS incidence is now as low as 0,1 per 1000 liveborn infants. Today, SIDS occurs almost exclusively in families not adequately following the recommendations mentioned above. Conclusion Altogether, it remains unsolved in which way the different preventive measures are able to modify the fatal cascade leading to SIDS. Nevertheless, due to the proven effects, as many of these preventive measures as possible should be applied. By doing so, the risk to experience SIDS in an individual infant can be reduced to almost zero and thousands of lives can be saved worldwide in this way every year.

To investigate why sharing the bed with an infant is a not consistent risk factor for the sudden infant death syndrome in ethnic subgroups in New Zealand and to see if the risk of sudden infant death associated with this practice is related to other factors, particularly maternal smoking and alcohol consumption. Nationwide case-control study. Region of New Zealand with 78% of all births during 1987-90. Home interviews were completed with parents of 393 (81.0% of total) infants who died from the sudden infant death syndrome in the postneonatal age group, and 1592 (88.4% of total) controls who were a representative sample of all hospital births in the study region. Maternal smoking interacted with infant bed sharing on the risk of sudden infant death. Compared with infants not exposed to either risk factor, the relative risk for infants of mothers who smoked was 3.94 (95% confidence interval 2.47 to 6.27) for bed sharing in the last two weeks and 4.55 (2.63 to 7.88) for bed sharing in the last sleep, after other confounders were controlled for. The results for infants of non-smoking mothers were inconsistent with the relative risk being significantly increased for usual bed sharing in the last two weeks (1.73; 1.11 to 2.70) but not for bed sharing in the last sleep (0.98; 0.44 to 2.18). Neither maternal alcohol consumption nor the thermal resistance of the infant's clothing and bedding interacted with bed sharing to increase the risk of sudden infant death, and alcohol was not a risk factor by itself. Infant bed sharing is associated with a significantly raised risk of the sudden infant death syndrome, particularly among infants of mothers who smoke. The interaction between maternal smoking and bed sharing suggests that a mechanism involving passive smoking, rather than the previously proposed mechanisms of overlaying and hyperthermia, increases the risk of sudden infant death from bed sharing.

in their study in the Journal of Applied Physiology , Erikson and Sposato ([4][1]) induced anoxic apnea in neonatal Pet -1 knockout (KO) and wild-type mice at postnatal day (P) 4.5 and P9 and examined the subsequent quality of gasping and autoresuscitation while the animals breathed room air. Pet-1

All mutations giving rise to metabolic disorders known to be associated with life-threatening events are possible candidates for genes involved in cases of sudden infant death, either as a cause of death or as a predisposing factor. It is necessary to distinguish between lethal mutations leading to diseases such as MCAD and LQTS, and polymorphisms (for instance, in the IL-10 gene and mtDNA) that are normal gene variants but might be suboptimal in critical situations and thus predispose infants to sudden infant death. It is unlikely that one mutation or polymorphism is the predisposing factor in all SIDS cases. However, it is likely that there are "SIDS genes" operating as a polygenic inheritance predisposing infants to sudden infant death, in combination with environmental risk factors. For genetically predisposed infants, a combination of, for instance, a slight infection, a prone sleeping position, and a warm environment may trigger a vicious circle with a death mechanism, including hyperthermia, irregular breathing, hypoxemia, and defective autoresuscitation, eventually leading to severe hypoxia, coma, and death.

The polygraphic findings from 11 future victims of sudden infant death syndrome (SIDS) are reported and compared with those of matched pairs of control infants. The recordings had been done to alleviate parental anxiety about sleep apnea. Four infants had siblings who were victims of SIDS. Two infants were studied 3.5 to 9.5 weeks before their deaths because of an unexplained apparent life-threatening event that had occurred during sleep. For each victim of SIDS, two control infants were selected from the 2,000 infants who had been tested in the same hospitals. They were matched for sex, gestational age, postnatal age, and weight at birth with the SIDS victims. Their polygraphic recordings had been performed within similar conditions. Each record was allocated a random code number and was analyzed without knowledge of the patient's identity by two independent scorers. Most sleep and cardiorespiratory variables studied did not differentiate SIDS victims from control infants. Only four variables significantly characterized the future SIDS victims: the maximal duration of central apneas, the number of sighs followed by a central apnea, the presence of obstructive apneas, and the presence of mixed apneas. Central apneas were longer during all sleep states in the SIDS victims compared with their matched controls, but none exceeded 14 seconds. Sighs immediately followed by an apnea were significantly less frequent in the future SIDS group. Obstructive and mixed sleep apneas were seen in eight of 11 SIDS victims and in only three of 22 control infants.(ABSTRACT TRUNCATED AT 250 WORDS)

The prevalence and characteristics of periodic breathing in preterm infants were measured by 24-hour impedance pneumograms in 66 preterm infants before discharge from the nursery. Four periodic breathing parameters (percentage of periodic breathing per quiet time, number of episodes of periodic breathing per 100 minutes of quiet time, mean duration of periodic breathing, and longest episode of periodic breathing) were compared to data available from healthy term infants and from term infants who subsequently died of sudden infant death syndrome (SIDS). Periodic breathing was found in all preterm infants studied and mean periodic breathing parameter values (12.0%, 8.6 episodes, 1.2 minutes, and 7.3 minutes, respectively) in our preterm population were substantially higher than values from healthy term infants and SIDS victims. Most periodic breathing parameters decreased significantly in infants studied at 39 to 41 weeks' postconceptional age compared with earlier postconceptional age groups. No relationship was found between central apneas of greater than or equal to 15 seconds' duration and postconceptional age or any periodic breathing parameter. Periodic breathing is a common respiratory pattern in preterm infants that is usually not of pathologic significance. Associations between elevated levels of periodic breathing and respiratory dysfunction or SIDS should be made with caution.

Is baby too warm? The use of infant clothing, bedding and home heating in Victoria, Australia.

An epidemiologic assessment of the relationship between the G985A medium chain acyl-coA dehydrogenase deficiency (MCADD) allelic variant and sudden infant death syndrome (SIDS)

Jerold Francis Lucey, MD (1926-2017)

Robin sequence (RS) is a rare condition associating retrognathia and glossoptosis causing upper airway obstruction. For half of the teams, prone positioning (PP) is the first-line treatment considering the benefit experienced on breathing, sleep, and neurodevelopmental outcome of infants with RS. However, this strategy is debated because of the risk of sudden infant death syndrome (SIDS) associated with PP. This study analyzed the occurrence of SIDS in children < 1 year old with RS during the last 30 years in France to clarify the benefit/risk balance of PP. We gathered data from the French national registry for SIDS. We also collected responses to a survey on SIDS sent to all French national RS reference centers for rare diseases. Finally, we collected data from the national epidemiologic database for causes of deaths (CépiDc). During the last 10 years, the French registry for SIDS documented 1 case of SIDS in a child with RS who died while awake in the back position. Among about 3000 children followed during the last 30 years, the survey to RS centers identified 2 cases of SIDS. Regarding CépiDc data, the proportion of SIDS cases among all causes of death in the RS population was lower than in the general population.Conclusion: In this preliminary work, SIDS was not more common in the RS population than in the general population in France, even if most patients are treated with PP. Taking into account the benefits of this therapy, PP may be proposed in selected patients, with strict cautions. What is Known:• Prone sleeping is a well-known risk factor of SIDS.• In approximately 50% of centers worldwide, prone positioning is used as the first-line treatment of upper airway obstruction in children with Robin sequence.What is New:• No child with Robin sequence died from SIDS while in the prone position in the last 10 years in France (SIDS French registry).• The occurrence of SIDS among all causes of death for children with Robin sequence is not higher than in the general population in France even if prone positioning is the first-line treatment.

Sudden Infant Death Syndrome (SIDS) usually happened for new born. It typically occurs associated with a period of sleep. The cause (or causes) of SIDS is still unknown. Deprived of oxygen, parental alcohol consumption and over-heating are environmental risk factors of SIDS. In this paper, an intelligent method for preventing sudden infant death based on Arduino system is proposed. The proposed method will mainly consist of intelligent software incorporated with hardware components such as sensors to sense and detect important physical signals i.e. infant breath, infant temperature and heart rate and accordingly pass these recording data to Arduino device. In addition, parents will wirelessly receive Multimedia Messaging Service (MMS) via Global System for Mobile communication (GSM) in real time. Such message will carry the recorded data as well as a warning when problems occurred. A prototype is designed and developed which gives a reliable and efficient real time infant monitoring system that can play a vital role in reducing the SIDS occurred and save an infant's life.

Children with achondroplasia (ACH) are at risk for sudden death in infancy due to sleep disordered breathing (SDB) and foramen magnum stenosis (FMS). Sleep studies and neuroimaging are performed in infants with ACH, but interpretation of infant studies is challenging. We sought to describe baseline data on polysomnography (PSG) indices in infants with achondroplasia as well as effects of age and surgery on these parameters. Retrospective data were abstracted from the multisite CLARITY ACH database from years 2008-2017. Both obstructive apnea hypopnea index (OAHI) and central apnea index (CAI) were extracted, and effects of age and surgical intervention (adenoidectomy [AD] or cervicomedullary decompression [CMD]) were analyzed. 172 PSGs from 86 infants were analyzed. In surgically naive children, OAHI decreased over the first year but then increased in the second year, while CAI was mostly stagnant over the first two years. There were no significant differences between age at first PSG or PSG indices for surgically naive infants versus those who underwent AD or CMD. OAHI decreased after AD and CAI decreased after CMD. Similar to average stature infants, our results demonstrate the need to interpret sleep study findings of children with ACH in the context of age, particularly for obstructive indices. Neither OAHI nor CAI differentiated those infants who subsequently underwent surgery, suggesting that there were other important clinical factors in the surgical decision-making process. Independent of age, AD resulted in improvement in OSA and CMD with improvement in central sleep apnea.

The evolution of sleep-disordered breathing and sleeping patterns in a group of high-risk infants was studied throughout the first year of life. Eleven infants with documented sleep apnoea underwent overnight polysomnographic studies at monthly intervals to 6 months, then at 9 and 12 months of age. All infants had central apnoea and obstructive events recorded on their initial sleep studies. The sleep-disordered breathing in these infants was associated with disturbed sleeping patterns. The amount of rapid eye movement (REM) sleep recorded in each study was inversely proportional to the amount of apnoea. The amount of apnoea and sleep disturbances were highest at 2 months of age and then progressively improved and obstructive events resolved by 1 year of age. The respiratory abnormalities and sleep disturbances peaked in severity at the age reported to have the highest incidence of sudden infant death syndrome (SIDS) and may have implications for its aetiology.

To determine whether the risk of the sudden infant death syndrome is increased in bottle fed babies. Population based case-control study matching for age and time. All babies aged 1 week to 1 year dying of sudden infant death syndrome during November 1987 to April 1989 or February 1990 to June 1991 and two live controls. Avon and north Somerset. Breast or bottle feeding, sleeping position, maternal smoking, parental employment, and length of gestation. Compared with being fully breast fed, the crude odds ratio for sudden infant death in fully bottle fed babies was 3.1 and for mixed breast and bottle fed babies 1.5. These odds ratios fell to 1.8 (95% confidence interval 0.7 to 4.8) and 1.2 (0.5 to 2.7) respectively after maternal smoking, parental employment, preterm gestation, and sleeping position had been adjusted for. Sleeping position partly masked the effect of being bottle fed on sudden infant death as breast fed babies were more likely to have slept prone than bottle fed babies. Bottle feeding is not a significant independent risk factor for the sudden infant death syndrome. Patterns of maternal smoking, preterm gestation, and parental employment status account for most of the apparent association with bottle feeding.

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