The effect of prone posture on nasal temperature in children in relation to induction of staphylococcal toxins implicated in sudden infant death syndrome

Abstract

The incidence of sudden infant death syndrome (SIDS) has declined in response to campaigns discouraging the prone sleeping position. Recent work suggests some SIDS death may be in response to bacterial toxins produced in the upper airway. A minimal temperature of 37 degrees C is required for induction of the pyrogenic toxins of Staphylococcus aureus identified in many SIDS infants. This aim of this study was to test the hypothesis that the prone position raises the temperature of the upper airways in children. A pilot study of 10 children (aged 3-8) and a main study of 30 children were carried out. Nasal septal temperatures were measured with an infra-red thermometer with the subjects in upright and prone positions under controlled conditions of ambient temperature and humidity. In both the pilot study and main study, nasal temperatures in the prone position were significantly higher (P < 0.01) Five subjects' prone readings were 37 degrees C or higher. These findings suggest that lying prone raises the upper airway surface temperature towards that required for toxin production. This could be one means by which the prone sleeping position contributes to the risk of SIDS.

Detection rate of Helicobacter pylori stool antigen in newborn infants and small children

“…Prone sleeping infants with fever are particularly at risk 57 . The prone position raises the upper airway surface temperature and an increased risk for bacterial toxin production has been hypothesized 58 . Prone sleeping has also been shown to increase the total amount of time infants spend asleep and, in particular, the time spent in quiet sleep, a state of reduced arousability 21;59 .…”

“…The prone position raises the upper airway surface temperature, which enhances the growth conditions for pathogenic bacteria such as Staphylococci and Neisseriae 58 . Staphylococci toxins and endotoxins from enteric bacteria such as Clostridium and E. Coli have been suggested as contributory factors to SIDS, inducing shocklike reactions and fever 78 .…”

Synergistic Effect of Influenza A Virus on Endotoxin-Induced Mortality in Rat Pups: A Potential Model for Sudden Infant Death Syndrome

“…During times of viral infection, prone position can increase airway temperature, stimulating bacterial infection and bacterial toxin production (13). The nasal septal temperatures of children who had no evidence of respiratory tract infection were measured in both the prone and erect positions and found to be significantly higher in the prone position (14). Combined with viral infection, prone sleeping would have an even greater effect.…”

Distribution of prenatal and postnatal risk factors for sudden infant death in Budapest

“…The sleeping position has been generally accepted as a characteristic feature in SIDS victims (6)(7)(8)(9). In our study, the rate of sleeping position did not show any signi cant difference, which could be explained by the small number of SIDS cases.…”