hypoxic and hypercapnic events in young infants during bed-sharing
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/1.jpg)
Hypoxic and Hypercapnic Events in Young Infants During Bed-SharingSCH Journal Club
Elspeth FergusonST5 Paediatrics
![Page 2: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/2.jpg)
Aim• To determine if there is any difference in
physiological parameters of bed-sharing and non-bed sharing infants during sleep
![Page 3: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/3.jpg)
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
![Page 4: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/4.jpg)
What we know about SIDS• 300 deaths/year• Risk factors
–Prematurity–LBW–Smoking–Sleep environment
![Page 5: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/5.jpg)
What is the mechanism of SIDS• Not well understood• Presumed particular vulnerability• ?Upper airway compromise• ?Hypoxia• ?Abnormalities of brainstem function
![Page 6: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/6.jpg)
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
![Page 7: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/7.jpg)
Clinical Question• P Infants• I Bed-sharing (co-sleeping)• C Cot-sleeping (non co-sleeping)• O Hypoxia/Hypercapnia
• Study design Case-control study
![Page 8: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/8.jpg)
Hypoxic and Hypercapnic Events in Young Infants During Bed-SharingBaddock, S.A., Galland, B.C., Bolton, D.P.G., Williams, S.M & Taylor, B.JPediatrics 2012 130:237-244
![Page 9: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/9.jpg)
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
![Page 10: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/10.jpg)
Outcome Measures• Desaturation events
– <90% ≥1second• Re-breathing events
– CO2 >3%• CO2 exposure
– CO2 >2/3/4% ≥ 3 seconds
![Page 11: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/11.jpg)
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
![Page 12: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/12.jpg)
3. Were the cases recruited in an acceptable way?
• Media advertising & Postnatal groups– Who responds to adverts?– Who attends postnatal groups?– ?incentives
![Page 13: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/13.jpg)
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
![Page 14: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/14.jpg)
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
![Page 15: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/15.jpg)
6. Confounding factors• Matched for age and season of recruitment• Smoking• Alcohol• Drug use• Birth weight• Gestation• Socioeconomic status• Method of feeding
![Page 16: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/16.jpg)
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)
![Page 17: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/17.jpg)
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
![Page 18: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/18.jpg)
What are the results? & How precise are they?• CO2 exposure
– Infants exposed to ≥ 2% CO2 BS 27 VS CS 2
![Page 19: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/19.jpg)
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
![Page 20: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/20.jpg)
10. Can the results be applied to the local population?
• Majority of European descent• Socio-economic status or group• Rates of breast-feeding
![Page 21: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/21.jpg)
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
![Page 22: Hypoxic and Hypercapnic Events in Young Infants During Bed-Sharing](https://reader035.vdocuments.net/reader035/viewer/2022062323/568164c9550346895dd6e5c8/html5/thumbnails/22.jpg)
Summary• Bed-sharing infants experience more
episodes of desaturation, rebreathing and raised CO2 exposure than cot-sleeping infants
• BUT are these episodes of concern?