PT  - JOURNAL ARTICLE
AU  - Matthew R Maltese
AU  - Michael Leshner
TI  - Carbon dioxide rebreathing induced by crib bumpers and mesh liners using an infant manikin
AID  - 10.1136/bmjpo-2018-000374
DP  - 2019 Apr 01
TA  - BMJ Paediatrics Open
PG  - e000374
VI  - 3
IP  - 1
4099  - http://bmjpaedsopen.bmj.com/content/3/1/e000374.short
4100  - http://bmjpaedsopen.bmj.com/content/3/1/e000374.full
SO  - BMJ Paediatrics Open2019 Apr 01; 3
AB  - 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.