Sudden Infant Death Related to Toxic Gases in Infant Mattresses

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SUDDEN INFANT DEATH

Sudden Infant Death Related to Toxic Gases in Infant Mattresses

Callouts:

1. Parents have a right to know about SIDS research.

2. Are parents being denied important findings?

3. Have factors related to SIDS been identified?

4. Is baby bedding creating toxic nerve gas?

5. What are preventive Nurse Practitioner actions associated with SIDS?

Key words:

Cot death

Crib death

SIDS

Sudden Infant Death Syndrome

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SUDDEN INFANT DEATH

Abstract

Approximately 4,200 infants in the United States continue to die of SIDS each year. Yet parents may lack current knowledge of SIDS research that is not currently accepted by the mainstream medical community. This article is a review of literature on the subject of the toxic gas theory related to sudden infant death syndrome. By educating nurses and healthcare providers on the toxic gas theory and preventative measures, they in turn can educate parents on ways to protect their infants from toxic gases that are being generated in infant mattresses in order to prevent SIDS by toxic gases.

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SUDDEN INFANT DEATH

Sudden Infant Death Related to Toxic Gases in Infant Mattresses

The thought of a healthy baby dying suddenly and unexpectedly keeps many parents awake at night fearing the worst. Sadly, this is the reality for far too many families, as approximately 4,200 infants die unexpectedly each year in the United States. An average of 6 infants die every day from SIDS( Sudden unexpected infant death (SUID) is defined by the Centers for Disease Control and Prevention (CDC) as, “the death of an infant, less than one year of age that occurs suddenly and unexpectedly. After a case investigation, these deaths may be diagnosed as suffocation, asphyxia, entrapment, infection, ingestions, metabolic diseases, cardiac arrhythmias, trauma, or SIDS” ( Sudden infant death syndrome (SIDS), also called crib death or cot death, is defined as, “the sudden death of an infant less than one year of age that cannot be explained after a thorough investigation is conducted, including a complete autopsy, examination of the death scene, and a review of the clinical history” ( SIDS is not a single illness or disease but rather a diagnosis given when an apparently healthy baby dies without warning. A baby’s death is not described as SIDS if a specific cause such as an accident is found. SIDS is a type of sudden unexpected infant death that constitutes half of all SUID cases, meaning approximately 2,300 infants die suddenly and unexpectedly every year for no apparent reason ( SIDS is the leading cause of death in infants aged one to twelve months of age in the United States (Corwin, 2012). SIDS is most likely to occur in infants between two and four months of age with 90% of cases occurring by 6 months of age (American Lung Association, 2012). After decades of research there is not an agreed upon cause of SIDS, only speculation about the possible risk factors. The Back to Sleep campaign which started in the United States in 1994, urged parents and caregivers to place infants on their back to sleep, has decreased the rate of SIDS by approximately 50% (Eunice Kennedy Shriver National Institute of Child Health & Human Development, 2012). Research done over the past 23 years in Great Britain and New Zealand claims that SIDS is due to environmental poisoning in the crib mattress. This research has been largely ignored by the medical society in the United States and SIDS organizations do not advocate sharing this knowledge and theory with parents. Research done by Sprott and Richardson theorize that poisonous gases arise from the mattresses where the baby sleeps and has been termed the toxic gas theory for SIDS. Based on their research, interventions such as mattress wrapping have been used with success in Britain and New Zealand. This intervention has been so successful in fact that there has not been one reported case of an infant dying on a properly wrapped mattress during a 10-year intervention period in New Zealand (Sprott, 2004). Far too many infants in the United States continue to die of SIDS but by educating parents and caregivers on the toxic gas theory and ways to prevent toxic gases from reaching infants the problem of sudden infant deaths could be eliminated. The research that has been done in Great Britain and New Zealand and the success the interventions have had in decreasing SIDS, may guide low cost interventions in the United States to decrease the SIDS rate. “The success of mattress-wrapping for the prevention of cot death is such that it behooves all people and organizations who provide advice to parents about cot death prevention to inform parents of the New Zealand experience using this technique” (Sprott, 2004, p. 221).

Richardson (1988), a British consulting scientist specializing in preventing the degradation of materials, and Mitchell, proprietor of a marquee company, met by chance and were working on Mitchell’s problem of his deteriorating marquees (Sprott, 1996). While investigating, the manufacturer of Mitchell’s marquees made the critical remark that the arsenical biocide OBPA (oxybisphenoxyarsine) was perfectly safe and “it’s even approved for use in babies’ mattresses” (Sprott, 1996, p. 14). This got Mitchell thinking that this could be a possible cause of SIDS and learned from Richardson that these same chemicals could be converted into toxic nerve gases when consumed by common household fungi such as Scopulariopsis brevicaulis (Sprott, 1996). Mitchell and Richardson decided there might be a possible connection to SIDS and Richardson began research immediately.

The chemicals of concern are phosphorus, arsenic, and antimony, which are added to baby mattress covers as plasticizers, preservatives and fire retardants when manufactured. When a baby sweats, spits up, dribbles or urinates it warms up and accumulates in the mattress causing the common household fungus, Scopulariopsis brevicaulis, to become established in the mattress. Once this fungus is established it begins to consume the chemicals phosphorus, arsenic, and antimony, which result in the production of phosphine, arsine, and stibine. All three of these nerve gases can be deadly to infants with immature nervous systems, and are described as being one hundred times more poisonous than hydrogen cyanide and a thousand times more so than carbon monoxide (Sprott, 1996). Phosphines, arsines and stibines are denser than air, odorless, and colorless making it easy to accumulate on top of the mattress (Richardson, 1994). These gases are described as being anticholinesterase agents that interfere with nerve synapses that cause disturbance in the immature central nervous system of infants reducing cardiac activity until the heart eventually stops (Richardson, 1994, p. 199).

Sprott (1986), a highly respected consulting chemist and forensic scientist, arrived at the conclusion that cot death was due to inadvertent and unsuspected gaseous poisoning by toxic nerve gas within the infant’s mattress but could not identify the specific gas (Sprott, 1996). In 1991, Sprott learned of Richardson’s research and the two began corresponding. Sprott established the guidelines for wrapping mattresses with polythene wrap and using cotton bedding to protect babies from any gases generated within mattresses. This became known as the Cotlife 2000 Specifications (Sprott, 2004). During a 10-year period of mattress wrapping, not one case of cot death has been reported when a baby was sleeping on a mattress wrapped according to the protocol (Sprott, 2004). New Zealand passed legislation over 10 years ago that requires every daycare center to meet the standard for mattress wrapping protocol. Since that legislation was enacted not a single SIDS event has occurred in a daycare.

A literature search was conducted in CINAHL, Cochrane Database of Systemic Reviews, PubMed, and SAGE using the search terms of “SIDS, sudden infant death, cot death, mattress-wrapping, sudden infant death AND toxic gas, toxic gas AND mattresses, sudden infant death syndrome, sudden infant death AND toxic gas, infant death AND toxic gas, and sudden infant death syndrome AND the toxic gas hypothesis”. Articles to be reviewed were selected based on research done specifically with infant mattresses and toxic gases as it relates to SIDS. Review of literature parameters of the English language and within the time frame of 1994 to current were also used.

Richardson (1994) hypothesized that poisoning by phosphines, arsines and stibines, might be the primary cause of sudden infant death syndrome (SIDS). 50 mattresses from 45 SIDS incidents were tested by placing small samples on malt/soya Petri dish plates and identifying generated gases using small strips of silver nitrate and mercuric bromide papers. The mattresses included one cotton-covered, 26 PVC-covered, 15 PVC-covered with exposed foam at one or both ends, and 8 exposed foam alone. There were also 25 small mattresses from carrycots or Moses Baskets and 25 larger mattresses from drop-side cots analyzed. All of the mattresses were found to be infected by the fungus S. brevicaulis, and all generated phospines, arsines or stibines or mixtures of these gases from the area affected by the warmth and perspiration of the sleeping infants. Further investigation was conducted on more than 100 mattresses from both SIDS incidents and from normal situations not associated with deaths. In all cases the results were the same. The rate of gas generation was also investigated. It was discovered that an increase in mattress temperature from 37 degrees to about 42 degrees Celsius indicated an increase in gas generation of 10 to 20 times for the limited temperature changes. Based on this finding, it is suggested that temperature dependence suggests a greatly increased risk to infants affected by hyperthermia through a high environmental temperature, overwrapping or fever. Blood samples from three infants who had died on mattresses which were infected by S. brevicaulis and generating only stibine were analyzed with the result suggesting the blood antimony level was increased by stibine poisoning. This study supported the hypothesis that a primary cause of SIDS is inhalation of phosphines, arsines and stibines generated by bio deterioration of mattress materials containing phosphorus, arsenic and antimony compounds, is consistent with all the established features of SIDS.

A corollary study by Sprott (2004) explains that in December 1994 the mattress-wrapping program was widely publicized throughout New Zealand. Two groups of babies were analyzed; the babies not sleeping on wrapped mattresses were considered the control group. In this study it is shown that mattress wrapping for cot death prevention is an obvious corollary to the toxic gas explanation for cot death based on the fact that during a 10-year period there was a 100% success rate, there was not one reported cot death of an infant on a mattress wrapped according to protocol. The overall cot death rate during this same time period fell by 52%. During this time period there were 970 reports of cot death in New Zealand but not one of the deaths occurred on a wrapped mattress. If mattress wrapping did not prevent SIDS, many infant deaths would by now have occurred in New Zealand on polythene-wrapped mattresses and no such death has been reported. This study also shows a rising rate of cot death from one sibling to the next. If the fungus has become established in the mattress during previous use by another baby, generation of toxic gas commences sooner and in greater volume when the mattress is reused meaning the more times an unwrapped mattress is used from one baby to the next, the greater the risk of SIDS.

Warnock et al. (1995) looked at 23 PVC (polyvinyl chloride) mattress samples from cot death case, looking for the presence of microbial generation of toxic gases from antimony, arsenic or phosphorus in compounds used as fire retardants in cot mattresses (Warnock et al., 1995). Of the 23 mattress covers analyzed, 18 had antimony and 19 had phosphorus. The predominant microbial organisms found on several covers were Aspergillus, Cladosporium, and Penicillium spp and one mattress contained S. brevicaulis. The findings of this study did not support the hypothesis that toxic gases derived from antimony, arsenic, or phosphorus are a possible cause of sudden infant death.

Lehr et al. (2003) investigated pure cultures of the aerobic microorganisms extant on sheepskin bedding materials, which were isolated and monitored for the formation of methylated arsenic species. Four pieces of sheepskin bedding materials were examined;a healthy infant had used one and an infant who died of SIDS had used one and the other two were new pieces. The skin and the wool of the sheepskin bedding materials were analyzed for arsenic. The findings of the study show that it is possible that exposure to low levels of organic and inorganic materials, generated from or present in bedding materials, could be such a stressor and could be harmful to susceptible infants especially at the critical three month development state of the brain (Lehr, Polishchuk, Delisle, Franz, & Cullen, 2003).

Based on the integrated review of literature it is recommended that all parents continue to follow current SIDS prevention recommendations as well as be advised by health care providers to wrap their babies’ mattresses in an inexpensive, gas-impermeable polythene, non-toxic protective cover to prevent the exposure of the baby to the toxic gases in order to prevent the incidence of SIDS. Parents should be provided with this information by nurse practitioners so that they are able to decide for themselves whether they want to wait for the SIDS research organizations or the government to endorse mattress-wrapping or to go ahead and wrap their babies’ mattresses based on the highly successful results in New Zealand. Protective mattress covers can be purchased through Serendipity Mattress Covers and through BabeSafe Covers. Mattress covers can also be purchased for bassinets, co-sleepers, pack-n-plays, and portable crib mattresses. It is also recommended to use a pure cotton mattress cover over the polythene mattress wrap and tuck it in securely. The bedding should be made of pure cotton sheets and blankets. It is recommended to not use sheepskin, moisture-resistant mattress protectors, acrylic under blanket, sleeping bag or duvet in an infants’ crib. Based on the Sprott and Richardson studies and the prevention campaign that continues in New Zealand, the proof is overwhelming that wrapping a baby’s mattress is the number one low cost, low risk intervention SIDS prevention technique that all parents must practice and nurse practitioners should include in parent education. The risk of SIDS can be decreased if health care providers recommend these simple precautions to all parents.

Corwin, M. J. (2012). Patient information: Sudden infant death syndrome (SIDS) (Beyond the Basics). Retrieved November 17, 2012, from

Lehr, C. R., Polishchuk, E., Delisle, M., Franz, C., & Cullen, W. R. (2003). Arsenic methylation by microorganisms isolated from sheepskin bedding materials. Human & Experimental Toxicology, 22, 325-334.

Richardson, B. A. (1994). Sudden Infant Death Syndrome: a possible primary cause. Journal of the Forensic Science Society, 34, 199-204.

Safe to Sleep Public Education Campaign. (2012). Retrieved November 7, 2012, from

Sprott, T. J. (1996). The Cot Death Cover-Up?Auckland 10, New Zealand: Penguin Books.

Sprott, T. J. (2004, September 2004). Cot Death-Cause and Prevention Experiences in New Zealand 1995-2004. Journal of Nutritional & Environmental Medicine, 14, 221-232. DOI: 10.1080/13590840400016836

Sudden Infant Death Syndrome. (2012). Retrieved from

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Warnock, D. W., Delves, H. T., Campbell, C. K., Croudace, I. W., Davey, K. G., Johnson, E. M., & Sieniawska, C. (1995, December 9, 1995). Toxic Gas Generation from Plastic Mattresses and Sudden Infant Death Syndrome. Lancet, 346, 1516-1520