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Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing. SCH Journal Club Elspeth Ferguson ST5 Paediatrics. Aim. To determine if there is any difference in physiological parameters of bed-sharing and non-bed sharing infants during sleep. Objectives.

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hypoxic and hypercapnic events in young infants during bed sharing

Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing

SCH Journal Club

Elspeth Ferguson

ST5 Paediatrics

slide2
Aim

To determine if there is any difference in physiological parameters of bed-sharing and non-bed sharing infants during sleep

objectives
Objectives

To search the literature for relevant articles

Select a relevant paper to discuss

Determine validity and reliability of paper in answering clinical question

Discuss how this information may affect our clinical practice

what we know about sids
What we know about SIDS
  • 300 deaths/year
  • Risk factors
    • Prematurity
    • LBW
    • Smoking
    • Sleep environment
what is the mechanism of sids
What is the mechanism of SIDS

Not well understood

Presumed particular vulnerability

?Upper airway compromise

?Hypoxia

?Abnormalities of brainstem function

current advice for parents
Current Advice for Parents

Back to sleep

Feet to foot

Don’t smoke

Don’t share a bed

Baby to sleep in your room for first 6 months

Don’t let your baby get too hot

Breastfeed

?dummy

clinical question
Clinical Question

P Infants

I Bed-sharing (co-sleeping)

C Cot-sleeping (non co-sleeping)

O Hypoxia/Hypercapnia

Study design Case-control study

hypoxic and hypercapnic events in young infants during bed sharing1

Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing

Baddock, S.A., Galland, B.C., Bolton, D.P.G., Williams, S.M & Taylor, B.J

Pediatrics 2012 130:237-244

methods
Methods
  • 40 bed-sharing infants, 40 cot-sharing infants
  • Monitoring over 2 nights in home environment
    • Video recordings
    • Physiological recordings
    • Maternal questionnaire for demographic data
outcome measures
Outcome Measures
  • Desaturation events
    • <90% ≥1second
  • Re-breathing events
    • CO2 >3%
  • CO2 exposure
    • CO2 >2/3/4% ≥ 3 seconds
casp analysis
CASP Analysis

1. Did the study address a clearly focused issue?

✓Yes

2. Did the authors use an appropriate method to answer their question?

✓Yes

3 were the cases recruited in an acceptable way
3. Were the cases recruited in an acceptable way?
  • Media advertising & Postnatal groups
    • Who responds to adverts?
    • Who attends postnatal groups?
    • ?incentives
4 were the controls recruited in an acceptable way
4. Were the controls recruited in an acceptable way?

Postnatal ward

Different group from bed-sharing individuals – why?

Matched for age and season of study

5 was the exposure accurately measured to minimise bias
5. Was the exposure accurately measured to minimise bias?
  • Bed-sharing at least 5 hr per night
  • ?how this was determined
  • Regularly
  • Blinding not possible
    • ?infants affected by monitoring equipment
    • ?mother’s actions altered
6 confounding factors
6. Confounding factors

Matched for age and season of recruitment

Smoking

Alcohol

Drug use

Birth weight

Gestation

Socioeconomic status

Method of feeding

what are the results how precise are they
What are the results? & How precise are they?
  • Desaturation events
    • BS 255 VS CS 123
    • Characteristics of events comparable
    • Mean events per infant BS 6.8 (0-44) VS CS 3.1 (0-16)
    • Relative risk of event 2.17(1.75 – 2.69)
    • When adjusted for temperature RR 1.54 (1.17-2.02)
    • 1 degree increase in temperature = 60% increase in desaturation events (95% CI 31-96)
what are the results how precise are they1
What are the results? & How precise are they?
  • Rebreathing events
    • Infants experiencing episodes BS 22 VS CS 1
    • Median rebreathing per night = 19min
    • Majority associated with head covering
    • Increases in heart rate and respiratory rate observed
what are the results how precise are they2
What are the results? & How precise are they?
  • CO2 exposure
    • Infants exposed to ≥ 2% CO2 BS 27 VS CS 2
9 do you believe the results
9. Do you believe the results

Significantly more desaturations in bed-sharing infants

Temperature seems to have a key role

Significance values for raised CO2 and rebreathing episodes unclear

10 can the results be applied to the local population
10. Can the results be applied to the local population?

Majority of European descent

Socio-economic status or group

Rates of breast-feeding

11 do the results of this study fit with other available evidence
11. Do the results of this study fit with other available evidence?

Suggest sleep ‘events’ more frequent in bed-sharing

Highlights importance of temperature regulation

May suggest a mechanism by which bed-sharing leads to an increased risk of SIDS

summary
Summary

Bed-sharing infants experience more episodes of desaturation, rebreathing and raised CO2 exposure than cot-sleeping infants

BUT are these episodes of concern?