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Original research
Carbon dioxide rebreathing induced by crib bumpers and mesh liners using an infant manikin
  1. Matthew R Maltese1,2,
  2. Michael Leshner3
  1. 1 Department of Anesthesiology and Critical Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  2. 2 Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
  3. 3 Leshner and Associates, Inc, Elkton, Maryland, USA
  1. Correspondence to Dr Matthew R Maltese; maltese{at}


Objectives Quantify impaired respiration in currently marketed crib bumpers (CBs), mesh liners (MLs) and alternative products (ALTs) used to attenuate the interaction between the baby and the crib sides and elucidate the relationship between impaired respiration and permeability.

Methods We experimentally quantified carbon dioxide rebreathing (CO2RB) via an infant manikin and air permeability via previously published test protocols, in commercially available CBs, MLs and ALTs.

Results Differences in CO2RB in ML (median [m]=8.2%, 25th percentile [P25]=6.8, 75th percentile [P75]=8.6), ALT (m=10.5%, P25=9.8, P75=10.7) and CB (m=11.6%, P25=10.2, P75=14.3) were significant (p<0.0001). For comparison, manikin tests with a pacifier yielded CO2RB of 5.6%–5.9%, blanket draped over the face/torso yielded CO2RB of 7.7%–8.6% and stuffed animal in various positions yielded CO2RB from 6.1% to 16.1%. Differences in permeability between ML (m=529.5 cubic feet per minute [CFM], P25=460, P75=747.5), ALT (m=29.0 CFM, P25=27.7, P75=37.7) and CB (m=46.6 CFM, P25=30.1, P75=58.7) groups were significant (p<0.0001). CO2RB was poorly correlated with air permeability (max R2=0.36). In a subset of tests, CB CO2RB increased by 50%–80% with increasing penetration force, whereas the ML CO2RB was nominally unchanged.

Conclusions Government agencies and standards organisations are presently considering regulation of bedding including CBs. As paediatricians are consulted in the development of such regulations, our findings that permeability by itself was a poor predictor of CO2RB should be considered.

  • crib
  • rebreathing
  • CO2
  • SIDS
  • bumper

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  • Contributors MRM and ML designed and conducted all experiments. ML was primarily responsible for design and fabrication of the experimental apparatus. MRM was primarily responsible for data analysis and writing the manuscript, with editing by ML.

  • Funding This research was supported by BreathableBaby, LLC, which provided salary support for study design, data analysis and manuscript preparation, and the costs of laboratory testing. At the time of project inception and before data collection began, the sponsors and the authors decided to submit the data for publication in the peer-reviewed literature.

  • Competing interests The authors report personal fees from BreathableBaby, LLC, during the conduct of the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data from figures 3 and 4 are available in the online materials.

  • Patient consent for publication Not required.

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