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Do some SIDS victims actually suffocate?

At least 37 babies have died while sleeping on bean-bag infant cushions -- cloth sacks loosely filled with plastic beads. Many of these babies were found with their faces buried in the soft, pillow-like cushions. Although most autopsy reports concluded they had died of sudden infant-death syndrome (SIDS), the Consumer Product Safety Commission nonetheless recalled the infant bean-bags last year, citing them as a potential asphyxiation hazard. A new investigation of 25 of the deaths strengthens that conclusion with laboratory tests suggesting most of the infants died of accidental suffocation.

"Our findings challenge the basic assumptions used to distinguish SIDS from accidental suffocation and emphasize the need for new safety regulatios for [all] infant bedding," assert James S. Kemp and Bradley T. Thach of Washington University in St. Louis.

SIDS and accidental suffocation "are indistinguishable on postmortem examination," they maintain. Physicians generally assume that healthy infants will turn their heads to get air when their bedding threatens suffocation, and "posture is thus considered coincidental" in the sudden deaths of infants found with their faces straight down, the researchers say. Indeed, 20 of the 25 deaths they studied had been attributed to SIDS.

Kemp and Thach began their investigation two years ago when the mother of an alleged SIDS victim came to them with suspicions that one of these cushions had asphyxiated her child. Using cushions from two different makers, the team analyzed the extent to which they would resist the airflow of a child laying face down, how long a rabbit could survive breathing into the cushions, and the extent to which a face-down infant would "rebreathe" exhaled carbon dioxide.

The rabbits died within three hours, their suffocation confirmed by low oxygen levels in the blood. The researchers conclude that both products studied would trap exhaled air, allowing infants to rebreathe potentially lethal amounts of carbon dioxide. Kemp notes that one commonly cited early study suggested that infants will roll their heads to the side if positioned with their faces directly into bedding. But the new work indicates that babies attempting to turn aside from a bean-bag pillow "would only have deepened their rebreathing pocket without gaining access to fresh air," Kemp and Thach write in the June 27 NEW ENGLAND JOURNAL OF MEDICINE.

As retailers pulled the bean-bags from their shelves last year, the Consumer Product Safety Commission issued warnings to the purchasers of the 950,000 infant cushions already sold in the United States: Destroy them or stop using them with infants. Next week, the commission will consider banning the manufacture of the cushions.

Kemp and Thach call for broad-scale revisions in infant-bedding standards to account for the threat of "rebreathed" air. Kemp would begin by limiting the products' softness and ability to conform to a child's head. The team also calls for studies "to reassess the cause of death in the 28 to 52 percent of SIDS victims who are found with their faces straight down."
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Title Annotation:sudden infant-death syndrome associated with bean-bag infant cushions
Author:Raloff, Janet
Publication:Science News
Date:Jun 29, 1991
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