Bedsharing between infants and parents interacts with many factors to increase the risk of SIDS, eg maternal smoking, alcohol or drug consumption, overtiredness, excessive bedding and younger infant. However, bedsharing also encourages breastfeeding, settles babies, reduces parental tiredness and increases mother-baby interactions. We studied infants in the natural setting of their own home, in their usual situation (bedsharing or cot-sleeping) to identify risks and benefits, and to understand how bedsharing could be made safer for all infants.
Methods: Overnight home video and physiological recordings of 40 bedshare infants (5-27 weeks), were compared with 40 cot infants matched for age and study season. Video data provided a log of infant/parent sleep positions, movements and interactions. The physiological recordings measured respiratory pattern, respiratory airflow, inspired CO2, oxygen saturation (SaO2), heart rate and core, peripheral and environmental temperatures.
Results: All infants maintained normal core temperatures overnight although bedshare infants had a higher shin temperature [35.43 vs 34.60°C at 2hrs after sleep onset (difference 0.83, 95% CI: 0.18 to 1.49)]. Bedshare infants had thicker bedding (RR:2.35 (95% CI:1.76 to 3.14) and more face covered time [0.9h/night vs 0.2 (RR:5.62, 95% CI: 3.08 to 10.25)]. Awakenings in the bedshare group were more common, of shorter duration, and caused less change in infant temperatures.
Exposure to >3% CO2 occurred in 18 bedshare infants and 1 swaddled, cot-sleep infant. The maximum exposure time was the same for both groups (60mins). These levels of CO2 significantly (p<0.05) elevated breathing rate and maintained normal SaO2. Central apnoeas of 5-10 seconds resulted in drops in SaO2 <90% (BS mean 6.8/night vs cot: 3.1, p<0.001). SaO2 rarely fell below 85% and heart rate did not ever fall below 90bpm.
Bedshare infants commonly slept on their side, while cot infants slept supine. Prone sleeping was rare (BS:5 infants, 1.6-3.5h/night vs cot:2, 8.9-10.2) and for bedshare infants involved sleeping on mother�s chest. Bedshare infants woke and fed more frequently (mean wake times/night: 4.6 vs 2.5), but total sleep time was not different. Maternal checks were more frequent in the bedshare group (median:10, IQ range:7-23, max:55) than cot ( 4, 3-6, 16) and bedshare mothers frequently responded to infant initiated movements. During bedsharing baby and mother usually slept facing each other, touching, with infants at mothers� breast level. Father (or sibling) contact was rare.
Conclusions: Bedshare infants sleep in a warmer environment and experience more potentially dangerous events such as head-covering and rebreathing. However, all infants in this study maintained normal rectal temperature and SaO2 suggesting they were protected by homeostatic responses. Infant safety is also facilitated by frequent maternal checking and maternal responses to infant movements. The mother-infant proximity during bedsharing allows prompt responses, reduces time infants are upset, and minimises disruption from frequent breast feeding - aspects valued by many. It is not known if infants of smoking mothers or parents with impaired responses eg due to alcohol, respond adequately to the potentially dangerous situations identified.
Outcome: The results of this study will be used to formulate recommendations to parents for improving the safety of bedsharing.
| Identifer | oai:union.ndltd.org:ADTP/217458 |
| Date | January 2005 |
| Creators | Baddock, Sally Anne, n/a |
| Publisher | University of Otago. Dunedin School of Medicine |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | http://policy01.otago.ac.nz/policies/FMPro?-db=policies.fm&-format=viewpolicy.html&-lay=viewpolicy&-sortfield=Title&Type=Academic&-recid=33025&-find), Copyright Sally Anne Baddock |
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