Physical Properties of Bedding That May Increase Risk of Sudden Infant Death Syndrome in Prone-Sleeping Infants

Abstract

Soft bedding has been shown in epidemiologic studies to increase the risk for sudden, unexpected death in pronesleeping infants. We compared the physical properties of conventional bedding to bedding from two sources: I ) bedding that covered the airways of victims of sudden infant death syndrome (SIDS) lying prone and face down at the time of death; and, 2) bedding associated with increased risk for SIDS in case-control studies (i.e. bedding filled with ti tree bark). Using simple mechanical models and the head from an infant mannequin, we measured the resistance to airflow, malleability, and capacity to limit CO, dispersal of the bedding. We also describe a technique for quantifying bedding softness. The resistance and malleability were similar for the conventional bedding, the ti tree bedding, and the bedding from SIDS deaths (analysis of variance,^ = 0.85 and 0.16). The ti tree bedding and the other bedding from SIDS cases differed from conventional bedding in two physical properties. Both groups were Many published reports have indicated that the type of bedding an infant sleeps on may increase the risk for SIDS. These reports include 1 ) two epidemiologic casecontrol studies indicating that soft bedding increases SIDS risk (1, 2); 2) case histories of SIDS deaths where bedding covering the victim's airway conceivably produced asphyxia (3-5); and, 3) physiologic reconstructions modeled from the death-scene investigation in cases diagnosed as SIDS, where the relation of the bedding to the victim's airway at the time of death created an asphyxiating environment (6-9). That bedding type and infant sleep position are likely related factors in SIDS is emphasized in a recent report from Australia (2) showing that bedding filled with bark from the ti tree increases the risk of SIDS by 10-fold, but only in prone-sleeping infants. softer ( p I 0.005) and limited CO, dispersal to a greater degree ( p 5 0.009). The finding that increased capacity to limit CO, dispersal is a consistent property of the bedding covering the airways of these SIDS victims and of bedding shown to be an epidemiologic risk factor for SIDS supports rebreathing of expired air as a mechanism underlying the association of certain kinds of bedding with SIDS. (Pediatr Res 36: 7-1 1, 1994) Abbreviations SIDS, sudden infant death syndrome R, resistance to airflow t%, half-time for CO, disappearance ANOVA, analysis of variance group lA, bedding from prone, face-down SIDS cases group lB, bedding filled with bark from the ti tree group 2, conventional bedding Moreover, other studies (1, 10) indicate that approximately 35% of infants who die of SIDS while sleeping prone die with their faces turned down into their bedding, a position recently shown to cause marked rebreathing in healthy sleeping infants. (11, 12) These several reports, and the case-control studies in particular, indicate important associations among SIDS, type of bedding, and sleep position. The mechanism underlying these apparent associations, however, is not well established.A major ...

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