RESUMEN
Fibrotic hypersensitivity pneumonitis (HP) has a poor prognosis when no antigen is identified, which occurs in many cases. We present a case of HP due to foam exposure in bedding, an unrecognised cause of HP. A woman was referred for dyspnoea and cough. High-resolution chest computed tomography (HRCT) showed a three-density pattern with gas trapping. Pulmonary function tests (PFTs) revealed restriction and reduced diffusing capacity. Bronchoalveolar lavage showed lymphocytosis (43%) and lung cryobiopsy showed fibrosis, lymphocytic infiltration and multinucleated giant cells. She had foam in mattress and pillows but no other exposures. Her symptoms, PFTs, and imaging improved after avoiding foam in her bedding. After re-exposure to a foam pillow, her symptoms, PFTs, and HRCT worsened. Microbiological analysis of the foam pillow reported Penicillium spp, known to cause HP. Foam exposure is a novel cause of HP, and foam avoidance can prevent disease progression and death.
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Alveolitis Alérgica Extrínseca , Ropa de Cama y Ropa Blanca , Penicillium , Tomografía Computarizada por Rayos X , Humanos , Alveolitis Alérgica Extrínseca/etiología , Alveolitis Alérgica Extrínseca/diagnóstico , Femenino , Ropa de Cama y Ropa Blanca/efectos adversos , Lechos/efectos adversos , Pruebas de Función Respiratoria , Persona de Mediana Edad , Pulmón/diagnóstico por imagen , Pulmón/patología , Disnea/etiologíaRESUMEN
INTRODUCTION: During 2022-2023, the UK found itself in the midst of a domestic energy crisis, with the average domestic gas and electricity bill rising by 75% between 2019 and 2022. As a result, the use of hot water bottles, radiant heaters, and electric blankets increased. An unintended consequence of this may be an increase in burn injuries caused by misfortune, misuse, or the use of items in a state of disrepair. PURPOSE: The aim of this study was to explore any increase in referrals to a single burns centre in England for injuries caused by hot water bottles, radiant heaters, or electric blankets. METHODS: This was a retrospective study of a prospectively maintained database of referrals. All referrals between January 2022 and January 2023 were selected and compared with the same period from 2020-2021 (before the rise in energy prices). Referrals were screened for the terms "hot water bottle," "electric heater," "electric blanket," and "heater." Total referrals in each period, demographic data (age, gender), anatomical location and the mechanism of injury were compared between cohorts. RESULTS: We found a statistically significant increase in the number of burns relating to heating implements between 2020/21 and 2022/23, rising from 54 to 81 (p = 0.03) - a 50% increase in injuries. Injuries in working age adults increased significantly (52% to 69%, p < 0.05). The most frequently injured area was the leg (30%) followed by the hand (18%). The commonest type of injury described was scald (72%). We found a moderately-strong correlation between the number of referrals and the average cost of energy in 2022-23. CONCLUSION: The number of injuries sustained by people using personal heating equipment is significantly increasing, which correlated with the rise in domestic energy prices. The most affected demographic appears to be working age adults, with wider implications around lost work-time yet to be explored. Further prospective, population-based work is indicated to assess the strength of the correlation seen in this study.
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Quemaduras , Calefacción , Derivación y Consulta , Humanos , Quemaduras/epidemiología , Quemaduras/etiología , Quemaduras/economía , Masculino , Femenino , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Adolescente , Adulto Joven , Calefacción/instrumentación , Calefacción/economía , Calefacción/efectos adversos , Niño , Derivación y Consulta/estadística & datos numéricos , Inglaterra/epidemiología , Anciano , Preescolar , Lactante , Unidades de Quemados/economía , Ropa de Cama y Ropa Blanca/efectos adversos , Ropa de Cama y Ropa Blanca/economía , Quemaduras por Electricidad/epidemiología , Quemaduras por Electricidad/etiología , Quemaduras por Electricidad/economía , Calor/efectos adversosRESUMEN
Salt-sensitive hypertension, increases in blood pressure in response to increased salt intake, is associated with an increased risk of morbidity, mortality, and end-organ damage compared with salt-resistant hypertension. The Dahl salt-sensitive (SS) rat mimics the phenotypic characteristics observed in human hypertension when rats are challenged with a high-salt diet. Our previous work demonstrated that environmental factors, such as dietary protein, alter the severity of salt sensitivity in Dahl SS rats and should be an important consideration in experimental design. The present study investigated how the bedding on which animals were maintained (wood vs. corncob) could impact the SS phenotype in the Dahl SS rat. Animals that were maintained on corncob bedding exhibited a significant attenuation in blood pressure and renal end-organ damage in response to a high-salt diet compared with animals maintained on wood bedding. This attenuation was associated with an improvement in renal function and reduction in immune cell infiltration into the kidneys of Dahl SS rats maintained on corncob bedding. These results indicate that the type of bedding impacts the SS phenotype in the Dahl SS rat and that the bedding used in experiments can be a confounding factor to consider during data interpretation and experimental design.NEW & NOTEWORTHY Results from our present study demonstrate the profound effect of animal bedding on the severity of salt-sensitive hypertension, renal damage, and inflammation in Dahl salt-sensitive rats. This study highlights the important consideration that should be given to environmental factors, namely, the type of bedding in animal facilities, in experimental design and data interpretation.
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Hipertensión , Cloruro de Sodio Dietético , Humanos , Ratas , Animales , Cloruro de Sodio Dietético/metabolismo , Ratas Endogámicas Dahl , Riñón/metabolismo , Presión Sanguínea , Ropa de Cama y Ropa Blanca/efectos adversosRESUMEN
BACKGROUND: Feather duvet lung (FDL) is an underestimated form of acute and chronic hypersensitivity pneumonitis. Serological tests for FDL need to be validated. We investigated the ability of recombinant pigeon Proproteinase E (r-PROE) and Immunoglobulin-lambda-like-polypeptide-1 (r-IGLL1) proteins to support the serological diagnosis of FDL, and propose them as a serological tool for clinicians to differentiate cases from FDL and Bird fancier's lung (BFL). METHODS: Specific IgG antibodies against r-PROE and r-IGLL1, analyzed with ELISA, were measured in patients diagnosed with FDL (n=31), BFL (n=15) controls exposed (n=15) and unexposed to feathers (n=15). RESULTS: The sensitivity and specificity of the r-PROE ELISA for the serological diagnosis of FDL cases versus exposed and unexposed controls were 74.2% and 86.7% respectively, with an index threshold of 0.5 (AUC: 0.89). In addition, this serological test was effective to support the serological diagnosis of FDL and BFL cases with significantly different thresholds. The r-IGLL1 ELISA was only effective for the serological diagnosis of BFL. Also, these two serological tests were useful for the diagnosis of both chronic and acute forms. CONCLUSIONS: The new diagnostic test for FDL using r-PROE protein should help to detect overt and hidden cases of FDL. The combination of both test will help the clinician in distinguish between the etiology of birds or feathers duvet.
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Pulmón de Criadores de Aves , Plumas , Alérgenos , Animales , Ropa de Cama y Ropa Blanca/efectos adversos , Pulmón de Criadores de Aves/diagnóstico , Pulmón de Criadores de Aves/etiología , Humanos , Pulmón , Metilcelulosa , Proyectos Piloto , Pruebas Serológicas/efectos adversosRESUMEN
BACKGROUND: Forced-air warming (FAW) is an effective method of preventing inadvertent perioperative hypothermia (IPH). However, its warming effects can be influenced by the style and position of the FAW blanket. This study aimed to compare the effects of underbody FAW blankets being placed under or over patients in preventing IPH. METHODS: Patients (n=100) undergoing elective arthroscopic shoulder surgery in the lateral decubitus position were randomized into either under body (UB) group or the over body (OB) group (50 per group). The body temperature of the patients was recorded from baseline to the end of anesthesia. The incidences of postoperative hypothermia and shivering were also collected. RESULTS: A steady decline in the body temperature was observed in both groups up to 60 minutes after the start of FAW. After 60 minutes of warming, the OB group showed a gradual increase in the body temperature. However, the body temperature still decreased in UB group until 75 minutes, with a low of 35.7â ± 0.4â. Then the body temperature increased mildly and reached 35.8â ± 0.4â at 90 minutes. After 45 minutes of warming, the body temperature between the groups was significantly different (P < 0.05). The incidence of postoperative hypothermia in the UB group was significantly higher than that in the OB group (P = 0.023). CONCLUSIONS: The body temperature was significantly better with the use of underbody FAW blankets placed over patients than with them placed under patients. However, there was not a clinically significant difference in body temperature. The incidence of postoperative hypothermia was much lower in the OB group. Therefore, placing underbody FAW blankets over patients is recommended for the prevention of IPH in patients undergoing arthroscopic shoulder surgery. TRIAL REGISTRATION: This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 13/1/2021 with the registration number ChiCTR2100042071 . It was conducted from 14/1/2021 to 30/10/2021 as a single, blinded trial in Sichuan Provincial Orthopedic Hospital.
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Hipotermia , Ropa de Cama y Ropa Blanca/efectos adversos , Temperatura Corporal , Humanos , Hipotermia/etiología , Hipotermia/prevención & control , Estudios Prospectivos , Hombro/cirugíaRESUMEN
BACKGROUND: Surgery under general anesthesia results in temperature decrease due to the effect of anesthetics and peripheral vasodilation on thermoregulatory centers. Perioperative temperature control is therefore an issue of high importance. In this study, we aimed to compare the warming effect of underbody and overbody blankets in patients undergoing surgery in the lithotomy position under general anesthesia. METHODS: From September 2018 to October 2019, 99 patients undergoing surgery for colorectal cancer in the lithotomy position were included in this randomized controlled trial and assigned to the intervention group (underbody blanket) or control group (overbody blanket). RESULTS: The central temperature was significantly higher in the underbody blanket group than in the overbody blanket group at 90 min after the beginning of the surgery (p = 0.02); also in this group, the peripheral temperature was significantly higher 60 min after the beginning of the surgery (p = 0.02). Regarding postoperative factors, the underbody blanket group had a significantly lower frequency of postoperative shivering (p < 0.01) and a significantly shorter postoperative hospital stay (p = 0.04) than the overbody blanket group. CONCLUSIONS: We recommend the use of underbody blankets for intraoperative temperature control in patients undergoing surgery in the lithotomy position under general anesthesia. Underbody blankets showed improved rise and maintenance of central and peripheral temperature, decreased the incidence of postoperative shivering, and shortened the postoperative length of hospital stay.
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Calefacción , Hipotermia , Anestesia General/efectos adversos , Ropa de Cama y Ropa Blanca/efectos adversos , Temperatura Corporal , HumanosRESUMEN
ABSTRACT: Selecting the appropriate support surface for patients continues to challenge clinicians and facilities. The Support Surface Standards Committee has developed and published test methods that allow for informed comparisons among support surface characteristics. The first published standards address the performance characteristics of immersion/envelopment, shear/friction, and microclimate management. This article describes the full body support surface standards development and provides guidance on the use of the outcomes from those standard tests for clinicians and facilities to make more informed choices for patients and patient populations.
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Ropa de Cama y Ropa Blanca/normas , Úlcera por Presión/prevención & control , Ropa de Cama y Ropa Blanca/efectos adversos , HumanosRESUMEN
ABSTRACT: Briquette-based kotatsu, a traditional Japanese heating system, is still used in rural areas and has been linked to the development of acute carbon monoxide (CO) poisoning. This study aimed to investigate the occurrence of delayed neurologic sequelae (DNS) in patients with acute CO poisoning caused by briquette-based kotatsu.This retrospective study included 17 patients treated for acute CO poisoning due to briquette-based kotatsu, between April 2017 and March 2020. Patients were divided into either a sequelae group (3 patients) or a non-sequelae group (14 patients) based on the presence or absence, respectively, of DNS. Demographic data, kotatsu characteristics, clinical findings, and therapies were compared between the 2 groups.Significant differences were noted in patient posture during their initial discovery. Specifically, all non-sequelae patients only had their legs under the kotatsu quilt and all sequelae patients had their entire bodies under the kotatsu quilt (Pâ=â.001). There were no statistically significant differences in carbon monoxide levels in hemoglobin (CO-Hb) or the creatine-kinase myocardial band (CK-MB), between the 2 groups; however, troponin-I levels were significantly higher in the sequelae group (Pâ=â.026). Abnormal head imaging findings were noted in 2 sequelae-group patients, with a significant difference between the groups (Pâ=â.025).We speculate that acute CO poisoning, caused by briquette-based kotatsu, may lead to DNS more frequently in patients in who cover their entire body with the kotatsu quilt and are found in this position. Patients should be warned about the dangers of acute CO poisoning when using briquette-based kotatsu.
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Ropa de Cama y Ropa Blanca/efectos adversos , Intoxicación por Monóxido de Carbono/etiología , Calefacción/efectos adversos , Enfermedades del Sistema Nervioso/etiología , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Intoxicación por Monóxido de Carbono/sangre , Estudios de Casos y Controles , Forma MB de la Creatina-Quinasa/sangre , Femenino , Calefacción/métodos , Humanos , Japón , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/sangre , Estudios Retrospectivos , Factores de Tiempo , Troponina I/sangreRESUMEN
AIMS: To evaluate the effect of postoperative forced-air warming (FAW) on the incidence of excessive bleeding (ExB), arrhythmia, acute myocardial infarction (AMI), and blood product transfusion in hypothermic patients following on-pump CABG and compare temperatures associated with the use of FAW and warming with a sheet and wool blanket. METHODS AND RESULTS: A randomized clinical trial conducted with 200 patients undergoing isolated on-pump CABG from January to November 2018. Patients were randomly assigned into an Intervention Group (IG, FAW, n = 100) and Control Group (CG, sheet and blanket, n = 100). The tympanic temperature of all patients was measured over a 24-h period. ExB was the primary outcome, while arrhythmia, AMI, and blood product transfusion were secondary outcomes. The effect of the interventions on the outcomes was investigated through using bivariate logistic regression, with a level of significance of 5%. The IG was 79% less likely to experience bleeding than the CG [odds ratio (OR) = 0.21, confidence interval (CI) 95% 0.12-0.39, P < 0.001]; the occurrence of AMI in the IG was 94% lower than that experienced by the CG (OR = 0.06, CI 95% 0.01-0.48, P < 0.001); and the IG was also 77% less likely to experience arrhythmia than the CG (OR = 0.23, CI 95% 0.12-0.47, P < 0.001); no difference was found between groups in terms of blood product transfusion (P < 0.279). CONCLUSIONS: These findings show that FAW can be used following CABG until patients reach normothermia to avoid undesirable clinical outcomes. TRIAL REGISTRATION: REBeC RBR-5t582g.
Asunto(s)
Hipotermia , Ropa de Cama y Ropa Blanca/efectos adversos , Temperatura Corporal , Puente de Arteria Coronaria/efectos adversos , Humanos , Hipotermia/etiología , Hipotermia/prevención & control , Recalentamiento/efectos adversos , Recalentamiento/métodosRESUMEN
PURPOSE: We aimed to assess whether insulating covers and warming systems cause artifacts in fluoroscopy, and whether they alter the radiation dose. METHODS: Eight insulating and warming systems were wrapped around the phantom in order to obtain images in fluoroscopy, and to measure the absorbed and scattered radiation dose. A dosimeter, endovascular catheters, and stents were placed into a phantom. The other dosimeter was placed outside of a C-arm table, at the operator's and anesthesiologist's locations. RESULTS: Most of the insulating covers did not cause artifacts in the fluoroscopy and led to a significant decrease in both the absorbed and scattered radiation dose. The highest decrease in the absorbed dose was observed with metalized foil (- 2.09%; p = 0.001) and in the scattered dose with Helios cover (- 55%; p < 0.001). Only one heating system (Ready Heat combined with Hypothermia Prevention and Management Kit cover) caused significant artifacts and increased radiation up to 99% (p < 0.001). CONCLUSION: Thermal insulation may be maintained during X-ray-guided emergency endovascular procedures in trauma victims. Self-heating blankets should be replaced with another warming system.
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Artefactos , Ropa de Cama y Ropa Blanca/efectos adversos , Procedimientos Endovasculares , Dosis de Radiación , Fluoroscopía , Humanos , Hipotermia/prevención & control , Fantasmas de Imagen , Heridas y Lesiones/diagnóstico por imagen , Heridas y Lesiones/cirugíaRESUMEN
BACKGROUND: Nurses are caring for increasing numbers of infants diagnosed with neonatal abstinence syndrome (NAS). The recommended initial line of treatment to alleviate NAS symptoms includes nonpharmacologic interventions; however, there is little rigorous evidence on the effectiveness of nonpharmacologic interventions. PURPOSE: The purpose of this study was to assess the safety, feasibility, and effectiveness of weighted blankets in the care of NAS infants. METHODS: This pilot study was a crossover randomized nonblinded controlled trial conducted at a level III neonatal intensive care unit. Infants' care included 30-minute sessions utilizing either a nonweighted or weighted blanket, with infants serving as their own controls. RESULTS: A total of 16 patients were enrolled for a total of 67 weighted blanket sessions. To address safety, no adverse events were observed, the weighted blankets were never removed due to infant distress, and infants experienced no significant temperature change. To address feasibility, 94% of approached mothers were receptive to the use of weighted blankets and staff reported no obstacles to using the blanket. Finally, to assess effectiveness, there was a significant decrease in the infant's heart rate and Finnegan score when a weighted blanket was used. There was no significant change in respiratory rate with the use of a weighted blanket. IMPLICATIONS FOR PRACTICE: Weighted blankets may be safe, feasible, and effective in decreasing NAS symptoms. IMPLICATIONS FOR RESEARCH: Larger studies are needed to thoroughly study the use of weighted blankets in this population and examine additional outcomes, such as need for pharmacologic intervention, length of hospital stay, and cost of hospital stay.
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Ropa de Cama y Ropa Blanca , Síndrome de Abstinencia Neonatal/terapia , Ropa de Cama y Ropa Blanca/efectos adversos , Estudios Cruzados , Equipos y Suministros de Hospitales/efectos adversos , Estudios de Factibilidad , Femenino , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Masculino , Proyectos Piloto , SeguridadAsunto(s)
Ropa de Cama y Ropa Blanca , Seguridad de Productos para el Consumidor , Equipo Infantil , Opinión Pública , Adolescente , Adulto , Anciano , Ropa de Cama y Ropa Blanca/efectos adversos , Ropa de Cama y Ropa Blanca/economía , Ropa de Cama y Ropa Blanca/normas , Seguridad de Productos para el Consumidor/legislación & jurisprudencia , Seguridad de Productos para el Consumidor/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos , Adulto JovenRESUMEN
BACKGROUND: Clothing fabrics interact closely with the skin to shape our cutaneous microenvironment. Cotton and silk have been traditionally recommended for patients with atopic dermatitis because of reported patient comfort. New synthetic fabrics combine anti-microbial, anti-inflammatory, moisture-wicking, and soothing properties that may augment conventional management strategies in atopic patients. OBJECTIVE: We review existing and emerging evidence for fabric selection in patients with atopic dermatitis including cotton, wool, lyocell, silk, anionic, cellulosic/cellulose based, zinc oxide coated, citric acid coated, chitosan coated, silver coated, borage seed oil coated, ethylene vinyl, and polyurethane and offer practical suggestions for clothing and bedding choices. METHODS: A systematic search was conducted on PubMed and EMBASE electronic databases for articles from 1 January, 1994 to 1 January, 2020. Studies were included based on the following inclusion criteria: clinical trial, published in English, and fabric as the main agent being evaluated. Case reports, case series, conference abstracts, reviews, animal studies, and duplicates were excluded. Studies were then manually screened by title, abstract, and full-text articles and selected to specifically describe the effects of fabrics in patients with atopic dermatitis. Both adult and pediatric patient studies were included. RESULTS: There appears to be an advantage to modern fabric manufacturing and processing techniques that have created smaller diameter, smoother fibers such as super- and ultrafine merino wool and anti-microbial finishes. Traditional cotton and silk fabrics have mixed evidence in improving atopic dermatitis symptoms and severity but have shown to be generally safe. Large-diameter wool has been shown to induce itching and irritation; ultra- or superfine merino wool is non-pruritic and may be recommended as an alternative. Emerging fabrics with potential efficacy in reducing atopic dermatitis severity and Staphylococcus aureus burden include silver-coated, chitosan-coated, and cellulose-based fabrics. Zinc oxide-coated, acid-coated, polyurethane-coated, borage seed oil-coated, anionic, lyocell, and ethylene vinyl fabrics have sparse evidence and require further study before conclusions can be made. CONCLUSIONS: Appropriate fabric selection can reduce the symptom severity and exacerbations of atopic dermatitis.
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Ropa de Cama y Ropa Blanca/efectos adversos , Vestuario/efectos adversos , Dermatitis Atópica/prevención & control , Textiles/efectos adversos , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/etiología , Humanos , Ciencia de los Materiales , Índice de Severidad de la Enfermedad , Piel/inmunologíaRESUMEN
Nurses have the capacity and opportunity to alter their organization's environmental footprint. This article addresses how they can strengthen efficiency and environmental sustainability initiatives in their facilities by engaging in, monitoring, and supporting environmentally friendly clinical practices and programs at the point of care. Included are practical tips and examples of projects in which nurses identified sources of waste-the relaundering of unused linens; disposal of unused products; and improper sorting of pharmaceutical waste, recycling, and regulated medical waste-and realized significant cost savings as well as improved efficiency and environmental sustainability.
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Administración de Residuos/métodos , Ropa de Cama y Ropa Blanca/efectos adversos , Ropa de Cama y Ropa Blanca/normas , Restauración y Remediación Ambiental/métodos , Restauración y Remediación Ambiental/tendencias , Recursos en Salud/tendencias , Humanos , Reciclaje/métodos , Reciclaje/tendenciasRESUMEN
OBJECTIVES: To describe infant deaths where a u-shaped pillow was under or around an infant and to describe cases classified as Explained Suffocation. METHODS: We examined demographics and circumstances of 141 infant deaths during 2004-2015 in the US National Fatality Review Case Reporting System with u-shaped pillows in the sleep environment. RESULTS: Most infants were < 6 months old (92%), male (58%), non-Hispanic White (53%), and of the nine explained suffocation deaths, four occurred when the u-shaped pillow obstructed the infant's airway; five occurred when the infant rolled off the pillow and their airway was obstructed by another object. CONCLUSIONS FOR PRACTICE: Although infrequent, infant deaths with u-shaped pillows have occurred. Health care providers may include discussion of the importance of caregivers following infant product packaging precautions and warning labels for commonly used consumer products, such as u-shaped pillows in their advice to caregivers.
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Asfixia/diagnóstico , Ropa de Cama y Ropa Blanca/clasificación , Asfixia/epidemiología , Ropa de Cama y Ropa Blanca/efectos adversos , Causas de Muerte/tendencias , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Factores de Riesgo , Muerte Súbita del Lactante/diagnóstico , Muerte Súbita del Lactante/epidemiología , Estados Unidos/epidemiologíaRESUMEN
A 43-year-old non-smoker was referred with a 3-month history of malaise, fatigue and breathlessness. Blood avian precipitins were strongly positive. Lung function testing confirmed a restrictive pattern with impaired gas transfer. A 'ground glass' mosaic pattern was seen on CT imaging, suggestive of hypersensitivity pneumonitis. Although he had no pet birds, on closer questioning he had recently acquired a duvet and pillows containing feathers. His symptoms, chest radiograph and lung function tests improved after removal of all feather bedding, and he was also started on oral corticosteroid therapy. Our case reinforces the importance of taking a meticulous exposure history and asking about domestic bedding in patients with unexplained breathlessness. Prompt recognition and cessation of antigen exposure may prevent the development of irreversible lung fibrosis.
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Ropa de Cama y Ropa Blanca/efectos adversos , Pulmón de Criadores de Aves/diagnóstico , Plumas/inmunología , Adulto , Animales , Pulmón de Criadores de Aves/etiología , Angiografía por Tomografía Computarizada , Diagnóstico Tardío , Disnea/etiología , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Anamnesis , Pruebas de Función RespiratoriaRESUMEN
OBJECTIVES: To investigate whether decreased otoacoustic emission (OAE) signal recordings in the right ear are associated with an increased risk of sudden infant death syndrome (SIDS) and to monitor any temporal changes in risk factors. DESIGN: Retrospective case-control study. SETTING: Telephone interviews with families recruited in England between July 2016 and October 2017 who experienced the unexpected death of a child <4 years old since 2008 and control families recruited from maternity wards in Bristol and Birmingham. PARTICIPANTS: We recruited 91 (89%) of the 102 bereaved families who made initial contact, 64 deaths were under 1 year (sudden unexpected death in infancy) of which 60 remained unexplained (SIDS). Of the 220 control families, 194 (88%) follow-up interviews were conducted. We had analysable hearing data for 24 SIDS infants (40%) and 98 controls (51%). RESULTS: OAE signals were marginally increased rather than decreased among SIDS infants for the right ear, especially at lower frequencies, but not significantly so. The strongest predictors of SIDS were bed-sharing in hazardous (infant sleeping next to a carer who smoked, drank alcohol or slept on a sofa) circumstances (35% vs 3% controls, p<0.0001), infants found prone (33% vs 3% controls, p<0.0001) and infants whose health in the final week was 'not good' (53% vs 9% controls, p<0.0001). The prevalence of maternal smoking during pregnancy among both SIDS mothers (20%) and controls (10%) was much lower than previous studies. CONCLUSIONS: Hearing data were difficult to obtain; larger numbers would be needed to determine if asymmetrical differences between the right and left ear were a marker for SIDS. A national prospective registry for monitoring and a renewed campaign to a new generation of parents needs to be considered underlining the initial message to place infants on their backs for sleep and the more recent message to avoid bed-sharing in hazardous circumstances.
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Pruebas Auditivas , Emisiones Otoacústicas Espontáneas , Muerte Súbita del Lactante/epidemiología , Adulto , Ropa de Cama y Ropa Blanca/efectos adversos , Estudios de Casos y Controles , Preescolar , Inglaterra/epidemiología , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Factores de RiesgoAsunto(s)
Ropa de Cama y Ropa Blanca/efectos adversos , Conducta del Lactante , Educación del Paciente como Asunto/métodos , Evaluación de Programas y Proyectos de Salud/métodos , Sueño , Muerte Súbita del Lactante/prevención & control , Adulto , Femenino , Humanos , Recién Nacido , Estudios Longitudinales , Estudios Prospectivos , Población Urbana , VirginiaRESUMEN
Despite significant reductions in incidence since the introduction of safe infant sleeping recommendations, sudden infant death syndrome is still the major cause of neonatal death in western countries. In the United States, over 2500 infants die suddenly and unexpectedly each year with nearly 100 deaths annually in Australia. Health professionals play a critical role in advising parents how to sleep their infants safely to minimise the risk of sudden infant death syndrome and sleeping accidents. Infants should be placed supine to sleep in a cot with a firm well-fitting mattress in the parental bedroom with no soft or loose bedding which could obstruct the airway. Exposure to smoking both before and after birth should be minimised. Breastfeeding should be encouraged, as should immunisation. Dummies can be recommended after breastfeeding has been established. This review outlines the evidence behind these recommendations.