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Patrick L. Carolan1, MD; James S. Kemp2, MD; William B. Wheeler1, MD; James D. Ross, RRT, RCP1

1Pediatrics, Children’s Hospitals and Clinics- Minneapolis, MN; 2Dept. of Pediatrics, Saint Louis University, St. Louis, MO

Background: Less prone sleeping has been accompanied by lower SIDS rates. One explanation may be that non-prone infants are not rebreathing exhaled air from underlying bedding. Despite this risk, many infants still sleep prone. New products claim to reduce rebreathing risk for prone infants.

Methods: 5 commercial sleep products were studied. "Active" systems: Halo Sleep Systems™, Sleep Guardian™; "Passive" systems: Breathe Easy™, Bumpa Bed™, Kid Safe Baby Air™. Products were tested for their ability to hasten CO2 dispersal using a biomechanical model of a mannequin placed face-down on the test surface and "ventilated" with a syringe containing 5% CO2 (J Appl Physiol 78 p 740). The t for CO2 dispersal from the mannequin-bedding ensemble quantitates rebreathing potential of the bedding. Face-down studies were compared to conventional bedding and to a control with the mannequin face-to-side. Each product was tested with the face down and underlying cover 1)taut, 2)wrinkled, and 3)taut but mannequin arm at side of head. Ten repetitions of the CO2 washout were done with each product under each of the three simulations.

Results: t differed among products for all three simulations (ANOVA; all p<0.0001). All sleep systems caused significant increases in t compared to the control system except for the Halo System (sheet taut and sheet wrinkled). In many instances, t exceeded thresholds associated with a rise in PaCO2 ( 21.1 s) or lethality (>24.0 s). All systems exceeded thresholds under one or more simulations except the Halo System.

Conclusions: 1)Standard, firm bedding and most items said to prevent rebreathing, do little to reduce, or may worsen, CO2 trapping. 2)Most cannot be recommended for infants who might turn their face down. 3)No product completely prevented rebreathing, but the Halo Sleep System maintained CO2 dispersal at rates preventing increases in PaCO2. 4)Industry standards for rebreathing based on biomechanical models should be developed.

Control 13.44 0.82
Test Surface Sheet Taut Wrinkled Arm-Up
Kid Safe Baby Air 16.76 1.83* 19.37 2.55* 20.57 3.25*
Breathe Easy 20.63 3.56* 23.01 4.25* 22.75 3.20*
Bumpa Bed 21.81 2.22* 21.38 3.31* 27.51 3.29*
Firm Mattress & flannel sheet 18.45 1.34* 22.37 3.27* 23.67 3.73*
Firm Mattress & poly/cotton sheet 17.87 1.18* 18.94 1.65* 27.24 2.12*
Sleep Guardian 37.89 2.66* NA 23.20 2.35*
Halo Sleep System 14.21 0.69 14.14 0.86 15.46 0.81*

t as seconds (mean + SD)

* denotes statistically significant difference at p<0.0005 when compared to control t (unpaired t test)

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