While the difference in rectal temperature between groups at two hours after sleep onset was not significant, the rate of increase in rectal temperature in the bed-share group was slightly higher than that of the cot-sleep group, leading to an increased temperature difference in the latter part of the night.
Tuffnell and colleagues 30 reported a mean overnight rectal temperature difference of 0. In our study, the model predicted a similar rectal temperature difference after approximately eight hours sleep.
Babies are at the greatest risk of SUDI if they sleep on their tummies or sides, or if their faces become covered. If you are buying your cot or bassinet new, there should be a safety sticker attached to the furniture, however with second hand furniture you may need to go through your own safety check list. Protective maternal behaviours Breastfeeding mothers have been observed to adapt sleep environments when sleeping with their baby, including physical orientation facing towards her baby, often in physical contact, positioned so the baby cannot be rolled on to, or baby cannot move up or down the sleeping surface under bedding ,
Sawczenko personal communication and Ball 31 did not find a significant difference in mean overnight rectal temperature between bed-share and cot-sleep groups where infants shared the parental bedroom in the sleep laboratory. Rectal temperature reflects the outcome of thermoregulatory control.
A trend towards a higher rectal temperature found in healthy infants may indicate a potential difficulty for infants with impaired control. In our study, bed-sharing infants exhibited higher shin temperatures than cot infants; these continued to increase overnight, thus maintaining a consistent rectal-shin temperature difference in the bed-share group.
What types of cots are not covered by the regulations? Are babies at risk of being smothered?
Decreasing shin temperatures in the cot group lead to an increase in rectal-shin difference overnight. Shin temperature reflects the peripheral vasodilatory response to the thermal environment, an indicator of thermoregulatory activity of the infant to maintain a constant core temperature. Bed-share infants had more thermal insulation, largely because of greater use of duvets and perhaps a reduced ability to lose heat due to the proximity of their mother, 35 thus requiring more vasodilatation to maintain core temperature.
Ambient temperature appeared not to contribute to the higher shin temperature, as this was significantly higher for cot infants, despite matching for season. Bed-sharing infants were less likely to sleep in the supine position, which is associated with lower overnight rectal temperature than the side or prone position 36 and a lower peripheral foot temperature. However, movements per hour in our study were the same in both groups.
Face covering occurred more often in the bed-share group. Carpenter and colleagues 17 report the risk of SIDS associated with being found head covered as an odds ratio of As face covered infants become increasingly hot, evaporative heat loss 40 and heat loss through bedding become more important.
Mathematical modelling suggests that progressive hyperthermia rapidly becomes lethal in infants entrapped by bedclothes. Identification of the position at death is less reliable during bed-sharing due to possible disruption by co-sleepers.
The risk associated with head covering during sleep is not clear. Although we measured rectal temperature from a small number of infants, some conclusions can be made. Infants were all healthy and despite warmer micro-environments, bed-share infants maintained normal rectal temperatures.
Healthy infants, therefore, do not seem to be at increased risk of overheating when bed-sharing. Wailoo and colleagues 27 reported that cot-sleeping infants, overwrapped for environmental conditions, maintained normal core temperatures overnight. Infants with high risk factors for SIDS, such as maternal smoking during pregnancy, may have poorly developed thermoregulatory control, placing them at an increased risk of SIDS when exposed to warmer micro-environments present in bed-sharing. Tuffnell 45 reported that bottle-fed infants of smoking mothers had higher overnight mean rectal temperatures.
The low number of smokers among the bed-sharers, the high rate of breast feeding and maternal tertiary education, and the active choice to bed-share suggest our sample did not cover the full spectrum of bed-sharers where identified risks associated with bed-sharing are prevalent.
Further to this, an association between bed-sharing and breast feeding that has been reported 1, 46, 47 has not been found among inner city, low income families in the USA. Cot-sleeping infants, on the other hand, were in a heat conservation mode. In this study all infants maintained a normal core temperature.
Future studies targeting infants at high risk of SIDS are needed to identify how risk factors might impact on infant and parental behaviour and on vulnerable infant physiology during bed-sharing. The authors would like to thank: Charissa Makowharemahihi and Amanda Phillips for research assistance, Sheila Williams for statistical advice, Christine Rimene for advice on cultural aspects, Cheryl Wilson for data on thickness and thermal insulation of typical single layer New Zealand bedding and infant clothing, and the families that participated in the study.
Changes in the epidemiological pattern of sudden infant death syndrome in southeast Norway, —
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