Potential to prevent carbon dioxide rebreathing of commercial products marketed to reduce sudden infant death syndrome risk.

OBJECTIVE: Rebreathing of exhaled air is one proposed mechanism for the increased risk for sudden infant death syndrome among prone sleeping infants. We evaluated how carbon dioxide (CO(2)) dispersal was affected by a conventional crib mattress and 5 products recently marketed to prevent prone rebreathing. SETTING: Infant pulmonary laboratory. EQUIPMENT: An infant mannequin with its nares connected via tubing to an 100-mL reservoir filled with 5% CO(2). The sleep surfaces studied included: firm mattress covered by a sheet, Bumpa Bed, Breathe Easy, Kid Safe/Baby Air, Halo Sleep System, and Sleep Guardian. The mannequin was positioned prone face-down or near-face-down. The sleep surfaces were studied with the covering sheet taut, covering sheet wrinkled, and with the mannequin arm positioned up, near the face. MEASUREMENTS: . We measured the fall in percentage end-tidal CO(2) as the reservoir was ventilated with the piston pump. The half-time for CO(2) dispersal (t(1/2)) is an index of the ability to cause or prevent rebreathing. RESULTS: Compared with the face-to-side control, 5 of 6 surfaces allowed a significant increase in t(1/2) in all 3 prone scenarios. The firm mattress and 4 of the 5 surfaces designed to prevent rebreathing consistently allowed t(1/2) above thresholds for the onset of CO(2) retention and lethal rebreathing in an animal model (J Appl Physiol. 1995;78:740). CONCLUSIONS: With very few exceptions, infants should be placed supine for sleep. For infants placed prone or rolling to the prone position, significant rebreathing of exhaled air would be likely on all surfaces studied, except one.

Infant sleep position and the sudden infant death syndrome. A survey of pediatric recommendations.

A questionnaire survey was conducted to assess the impact of the April 1992 American Academy of Pediatrics Task Force Statement, "Infant Positioning and SIDS," on the routine advice provided by pediatricians in Minnesota to families with newborn infants regarding sleep practices, including sleep position. There was a trend toward more discussion between all pediatric practice groups and families regarding infant sleep practices following the AAP Sleep Position Statement (P < 0.001-0.003). Prone sleep recommendations ranged from 9.2% for newborn infants to 21.4% for infants 6 months of age. Recommendations for the supine or lateral sleep positions predominated at all infant ages. Pediatricians in private practice were more likely to identify the AAP Statement as establishing a medicolegal standard (P < 0.05). We conclude that the 1992 AAP Statement has had a significant impact on the routine advice provided to families regarding infant sleep practices, including infant sleep position.

Cerebral abscess formation following ocular trauma: a hazard associated with common wooden toys.

Penetrating orbital trauma is an uncommon pediatric emergency with potentially devastating consequences. We report a five-year-old child who fell on a wooden toy and sustained an orbital roof fracture. He subsequently developed an intracranial abscess. Current information pertaining to penetrating orbitocranial trauma will be reviewed, stressing the importance of early recognition of the intracranial injury in these cases. Both parents and toy manufacturers must remain aware of the potential for injury involving these common toys.

Benign extra-axial collections of infancy.

The clinical histories, physical examinations and results of head computed tomography and head ultrasound scans were reviewed in a group of 15 infants who had macrocrania, excessive extra-axial fluid and normal development. Diagnostic evaluations demonstrated mild ventriculomegaly and extra-axial fluid collections. No treatment was undertaken. All infants continued to exhibit normal development during a period of extended follow-up. In this select group of infants exhibiting these findings, treatment appears to be unnecessary and the prognosis for continued normal development is excellent.