TABLE 1 - uploaded by Peter John Fleming
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Thermal resistance (tog value) of clothing and bedding typically used for infants
Source publication
Several studies have highlighted the potential importance of the thermal environment in the etiology of sudden infant death syn-drome. In a case-control study, it was shown that having a mother who was worried about the possibility of her baby becoming too cold was a risk factor for sudden infant death syndrome. In a longitudinal study of normal, h...
Context in source publication
Context 1
... all studies, the thermal resistance of bedding and clothing was measured and recorded in 'tog' units (see Table 1 for examples). Tog units are a unit of measure of thermal insulation used in the textile trade; the tog value of a fabric object is equal to 10 times the temper- ature difference (in degrees Celsius) between its two surfaces when the flow of heat is equal to 1 W/m 2 . ...
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Citations
... Room temperature was warmer for the P epi-Pod infants, and one explanation may be that parents who smoke tend to sleep infants in warmer rooms. 16 Higher room temperature and subsequent peripheral vasodilation may explain why P epi-Podinfants had less time with cooler shin temperature 17 and could have contributed to the higher average heart rate in P epi-Pod. 18 Although higher rates of maternal smoking in the P epi-Podgroup might contribute to altered autonomic function, higher heart rates have not been described in infants of smoking mothers. ...
Aim:
The aim of this study was to identify the potential risks and benefits of sleeping infants in a Pēpi-Pod distributed to families with high risk of sudden unexpected death in infancy compared to a bassinet.
Methods:
Forty-five mostly indigenous Māori mothers who were referred by local health providers to receive a Pēpi-Pod were surveyed at recruitment, 1 and 3 months. A sleep study at 1 month included infrared video, oximetry and temperature measures.
Results:
When compared with 89 historical bassinet controls, an intention-to-treat analysis of questionnaires showed no increase in direct bed sharing but demonstrated significantly less sharing of the maternal bedroom at both interviews, with the majority of those not sleeping in the maternal bedroom, actually sleeping in the living room. The 1 month 'as-used' analysis showed poorer maternal sleep quality. The 'as-used' analysis of video data (24 Pēpi-Pod and 113 bassinet infants) also showed no increase in direct bed sharing, head covering or prone/side sleep position. Differences in oxygen saturation were not significant, but heart rate was higher in the Pēpi-Pod infants by 8.37 bpm (95% confidence interval 4.40, 12.14). Time in the thermal comfort zone was not different between groups despite Pēpi-Pod infants being situated in significantly warmer rooms.
Conclusions:
Overall, we found that most differences in infant risk behaviours in a Pēpi-Pod compared to a bassinet were small, with confidence intervals excluding meaningful differences. We noted poorer maternal sleep quality at 1 month. Higher infant heart rates in the Pēpi-Pod group may be related to higher room temperatures. The Pēpi-Pod appears physiologically safe but is associated with lower reported maternal sleep quality.
... Chu et al. (2011) propose that it is not cold as such that could contribute to SIDS but the physiological stress resulting from sudden temperature changes. Fleming et al. (2006) found that infants who slept in colder night-time conditions were more prone to infections and these infections are also linked to SIDS risk Molony et al., 1999). ...
... One of the major concerns of harmful thermal care practices in the UK is that overheating may increase susceptibility to SIDS Fleming et al., 2006). There is widespread awareness of heat as a risk factor for SIDS, which has been emphasised in SIDS awareness campaigns. ...
Purpose
– Overheating is considered a modifiable risk factor for sudden infant death syndrome (SIDS). The purpose of this paper is to explore differences in infant thermal care beliefs between mothers of South Asian and white British origin in Bradford, UK.
Design/methodology/approach
– This study employed face-to-face interviews with semi-structured and structured questions with 51 white British and 51 South-Asian mothers in the Bradford District, UK.
Findings
– White British mothers were more concerned about overheating causing SIDS whereas South-Asian mothers were more concerned about cold causing respiratory infections. However concerns around hypothermia and chills causing colds were expressed in both groups. White British mothers were significantly more likely to be concerned about their infant getting too hot than too cold and South-Asian mothers about both heat and cold (p0.001), but white British mothers on lower incomes and with poorer education expressed concern about cold more so than their better off, better educated peers indicating a possible link to fuel poverty.
Research limitations/implications
– It was not possible to observe actual night-time practices and that South Asian as a cultural category is limited because could be regarded as too broad.
Practical implications
– Whilst there guidance available to prevent infants overheating to prevent SIDS there is little or none about infants getting cold and how temperature affects other conditions.
Social implications
– Thermal care behaviours and beliefs differ between ethnic groups. SIDS and overheating is only one concern for mothers in providing thermal care for their infants. More policy and research is needed to explore the wider impact of thermal care on infant health and survival.
Originality/value
– This topic is rarely addressed despite the wide ranging implications of heat and cold to infant well-being.
... The overnight fall in core temperature was not correlated with changes in room temperature during this period (Spearman' r=0.18, p=0.54), but was similar to the pattern previously described in healthy 3-4-month-old infants. [15][16][17][18][19] Strikingly, this nocturnal fall in core body temperature was absent in swaddled infants. Figure 3B shows the corresponding diurnal pattern seen when the values of median peripheral temperature from sequential 15 min periods for these infants are plotted. ...
... A marked fall in core temperature during the night-time was observed for 3-month-old infants in sleeping-bags living in Gers. This fall in core temperature at this age is expected [16][17][18][19][20] and was accompanied by a rise in peripheral temperature, showing that it was not an effect of cold stress (which leads to peripheral vasoconstriction and thus a fall in peripheral temperatures) but rather to the normal process previously reported in infants from around this age: that of active peripheral vasodilatation with increased heat loss leading to a fall in core temperature during the early part of the night-time hours, and with a reversal of this process during the latter part of the night. [15][16][17][18][19][20][21][22] The indoor temperature fell, but the core temperature fall was independent of the minimum indoor temperature, which commonly occurred at the time core infant temperature was rising. ...
... This fall in core temperature at this age is expected [16][17][18][19][20] and was accompanied by a rise in peripheral temperature, showing that it was not an effect of cold stress (which leads to peripheral vasoconstriction and thus a fall in peripheral temperatures) but rather to the normal process previously reported in infants from around this age: that of active peripheral vasodilatation with increased heat loss leading to a fall in core temperature during the early part of the night-time hours, and with a reversal of this process during the latter part of the night. [15][16][17][18][19][20][21][22] The indoor temperature fell, but the core temperature fall was independent of the minimum indoor temperature, which commonly occurred at the time core infant temperature was rising. Thus, the greater fall in the core temperature of infants in sleeping-bags reflects the development of a normal diurnal pattern of temperature changes with age. ...
Objective:
To investigate thermal balance of infants in a Mongolian winter, and compare the effects of traditional swaddling with an infant sleeping-bag in apartments or traditional tents (Gers).
Design:
A substudy within a randomised controlled trial.
Setting:
Community in Ulaanbaatar, Mongolia.
Subjects:
A stratified randomly selected sample of 40 swaddled and 40 non-swaddled infants recruited within 48 h of birth.
Intervention:
Sleeping-bags and baby outfits of total thermal resistance equivalent to that of swaddled babies.
Outcome measure:
Digital recordings of infants' core, peripheral, environmental and microenvironmental temperatures at 30-s intervals over 24 h at ages 1 month and 3 months.
Results:
In Gers, indoor temperatures varied greatly (<0->25°C), but remained between 20°C and 22°C, in apartments. Despite this, heavy wrapping, bed sharing and partial head covering, infant core and peripheral temperatures were similar and no infants showed evidence of significant heat or cold stress whether they were swaddled or in sleeping-bags. At 3 months, infants in sleeping-bags showed the 'mature' diurnal pattern of a fall in core temperature after sleep onset, accompanied by a rise in peripheral temperature, with a reverse pattern later in the night, just before awakening. This pattern was not related to room temperature, and was absent in the swaddled infants, suggesting that the mature diurnal pattern may develop later in them.
Conclusions:
No evidence of cold stress was found. Swaddling had no identifiable thermal advantages over sleeping-bags during the coldest times, and in centrally heated apartments could contribute to the risk of overheating during the daytime.
Trial registration number:
ISRTN01992617.
... 40 Close physical contact between mothers and infants has effects upon the diurnal fall in core temperature, with lower core temperatures observed when infants are bedsharing compared to when sleeping alone, despite a warmer environment when bedsharing. 38 ...
Despite the fact that infants spend more time asleep than awake, an understanding of the importance and effects of sleep on the pathophysiology of illness in infancy is a relatively recent development, and is commonly overlooked in paediatric training. In this review we describe some of the characteristics of sleep in infancy, with particular reference to normal developmental physiology and its relevance to the signs, symptoms and pathophysiology of illness in this age group.
... Boys were commonly more heavily wrapped than girls [39]. In a prospective longitudinal laboratory study of mothers and infants sharing a room or sharing a bed for overnight sleep we showed that, despite a much warmer microenvironment, infants thermoregulated more effectively, with a slightly greater diurnal fall in rectal temperature when bedsharing with their mother than when sleeping in a cot adjacent to the mother's bed [40]. ...
... The development of the diurnal fall in core temperature occurs at ages between approximately 3 and 4 months, occurring earlier in girls and breastfed infants than in boys or bottle fed infants (ref). It is not clear whether this represents an innate physiological characteristic, or is a marker of boys and bottle fed infants commonly being kept in a warmer environment [39,40,41]. ...
Unexpected death in infancy may be a consequence of recognisable pathophysiological processes, or may remain unexplained after thorough investigation. We review the appropriate investigations that should be performed after unexpected infant deaths, and the recent changes to UK law that will make such investigations mandatory from 2008. Current knowledge of the epidemiology and pathophysiology of unexpected infant deaths, together with knowledge of infant developmental physiology leads to an emphasis on the importance of a range of potential gene-environment interactions occurring in vulnerable infants at vulnerable stages of their development.
Understanding the epidemiology and etiology of sudden and unexplained infant death requires a thorough multiprofessional investigation. This article describes the approach to such investigations developed and implemented in the United Kingdom. The authors also review current knowledge of the epidemiology and contributory factors to sudden infant deaths, together with the current understanding of the role played by interactions between common genetic polymorphisms, developmental physiology, and environmental factors.
