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Legare JM, Smid CJ, Modaff P, Pauli RM. Achondroplasia is associated with increased occurrence of apparent life-threatening events. Acta Paediatr 2021; 110:1842-1846. [PMID: 33452838 DOI: 10.1111/apa.15760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/01/2021] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
AIM To assess the clinical picture underlying apparent life-threatening events (ALTEs) occurring in infants with achondroplasia and provide guidance for evaluation after an event. METHODS A population of 477 individuals with achondroplasia was retrospectively reviewed, and information regarding possible ALTEs was recorded in a REDCap database. RESULTS ALTEs occurred in the first year of life in 18 of 477 individuals (3.8%). Most (14/18, 78%) occurred in the first 6 months of life and presented as episodes of apnoea and/or seizures. Of affected infants, 8/18 (44%) had more than one episode. Many of the initial ALTEs arose while infants were in car seats (11/18, 61%). Assessment following ALTEs most often demonstrated either craniocervical junction concerns and/or seizures, with 12/18 (67%) patients undergoing cervicomedullary decompression and 5/18 (28%) starting on anti-epileptic medications after the event. CONCLUSION Although this study is limited in size and was retrospective, it shows that infants with achondroplasia appear to be at high risk for ALTEs. Evaluation after an event should include neuroimaging of the foramen magnum, inpatient hospital observation including respiratory monitoring and electroencephalography, and a car seat challenge.
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Affiliation(s)
- Janet M. Legare
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Cory J. Smid
- Children's Hospital of Wisconsin Medical College of Wisconsin Milwaukee WI USA
| | - Peggy Modaff
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Richard M. Pauli
- University of Wisconsin School of Medicine and Public Health Madison WI USA
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2
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Use of car beds for infant travel: a review of the literature. J Perinatol 2018; 38:1287-1294. [PMID: 30097654 DOI: 10.1038/s41372-018-0195-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/16/2018] [Accepted: 07/27/2018] [Indexed: 11/08/2022]
Abstract
Discharging neonates in a proper car safety seat is standard of care in the United States and many other countries. However, not every neonate can be safely positioned in a standard semi-upright car seat. In these cases, providers may opt for a travel device that allows the infant to lie flat, either supine or prone, known as a car bed. Minimal evidence exists to guide providers on car bed safety and help determine which infants would benefit from discharge in a car bed. In this article, we provide a comprehensive summary of existing literature on the safety of car beds for motor vehicle travel, car bed use in specific patient populations, and car beds vs. car seats for infants at risk of adverse cardiorespiratory events, including preterm infants with Hg-O2 desaturations in the car seat. We discuss recommendations for the follow-up of infants discharged in a car bed in order to safely transition back to a car seat.
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3
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Jensen EA, Foglia EE, Dysart KC, Aghai ZH, Cook A, Greenspan JS, DeMauro SB. Car Seat Tolerance Screening in the Neonatal Intensive Care Unit: Failure Rates, Risk Factors, and Adverse Outcomes. J Pediatr 2018; 194:60-66.e1. [PMID: 29269198 PMCID: PMC5826836 DOI: 10.1016/j.jpeds.2017.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 10/11/2017] [Accepted: 11/01/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To characterize the epidemiology of Car Seat Tolerance Screening (CSTS) failure and the association between test failure and all-cause 30-day postdischarge mortality or hospital readmission in a large, multicenter cohort of preterm infants receiving neonatal intensive care. STUDY DESIGN This retrospective cohort study used the prospectively collected Optum Neonatal Database. Study infants were born at <37 weeks of gestation between 2010 and 2016. We identified independent predictors of CSTS failure and calculated the risk-adjusted odds of all-cause 30-day mortality or hospital readmission associated with test failure. RESULTS Of 7899 infants cared for in 788 hospitals, 334 (4.2%) failed initial CSTS. Greater postmenstrual age at testing and African American race were independently associated with decreased failure risk. Any treatment with an antacid medication, concurrent use of caffeine or supplemental oxygen, and a history of failing a trial off respiratory support were associated with increased failure risk. The mean adjusted post-CSTS duration of hospitalization was 3.1 days longer (95% CI, 2.7-3.6) among the infants who failed the initial screening. Rates of 30-day all-cause mortality or readmission were higher among infants who failed the CSTS (2.4% vs 1.0%; P = .03); however, the difference was not significant after confounder adjustment (OR, 0.38; 95% CI, 0.11-1.31). CONCLUSION CSTS failure was associated with longer post-test hospitalization but no difference in the risk-adjusted odds for 30-day mortality or hospital readmission. Whether CSTS failure unnecessarily prolongs hospitalization or results in appropriate care that prevents adverse postdischarge outcomes is unknown. Further research is needed to address this knowledge gap.
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Affiliation(s)
- Erik A. Jensen
- Department of Pediatrics, Division of Neonatology, The Children’s Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Elizabeth E. Foglia
- Department of Pediatrics, Division of Neonatology, The Children’s Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kevin C. Dysart
- Department of Pediatrics, Division of Neonatology, The Children’s Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Zubair H. Aghai
- Division of Neonatology, Nemours/Sidney Kimmel Medical College at Thomas, Jefferson University, Philadelphia, Pennsylvania
| | | | - Jay S. Greenspan
- Division of Neonatology, Nemours/Sidney Kimmel Medical College at Thomas, Jefferson University, Philadelphia, Pennsylvania
| | - Sara B. DeMauro
- Department of Pediatrics, Division of Neonatology, The Children’s Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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4
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Rholdon R. Understanding the Risks Sitting and Carrying Devices Pose to Safe Infant Sleep. Nurs Womens Health 2017; 21:225-230. [PMID: 28599744 DOI: 10.1016/j.nwh.2017.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/30/2017] [Indexed: 11/25/2022]
Abstract
There have been various campaigns and recommendations to decrease the incidence of sudden unexpected infant death. Despite this, caregivers continue to place infants in unsafe sleeping environments. These environments, such as sitting devices, slings, carriers, and car seats, pose a significant risk to an infant's safety because of the risk from suffocation and cardiorespiratory instability. It is important for health care providers to understand the appropriate use of car seats, slings, and other sitting devices, to model appropriate behaviors, and to educate parents and caregivers. All parents, hospital staff, and other caregivers should understand the potential dangers associated with the inappropriate use of sitting devices for routine sleep.
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5
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Arya R, Williams G, Kilonback A, Toward M, Griffin M, Blair PS, Fleming P. Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle. Arch Dis Child Fetal Neonatal Ed 2017; 102:F136-F141. [PMID: 27694399 PMCID: PMC5339573 DOI: 10.1136/archdischild-2016-310730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/23/2016] [Accepted: 06/27/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE The American Academy of Pediatrics recommends that preterm infants complete a predischarge 'car seat challenge' observation for cardiorespiratory compromise while in a car seat. This static challenge does not consider the more upright position in a car or the vibration of the seat when the car is moving. This pilot study was designed to assess the cardiorespiratory effects of vibration, mimicking the effect of being in a moving car, on preterm and term infants. METHODS A simulator was designed to reproduce vertical vibration similar to that in a rear-facing car seat at 30 mph. 19 healthy newborn term and 21 preterm infants, ready for hospital discharge, underwent cardiorespiratory measurements while lying flat in a cot (baseline), static in the seat (30°), simulator (40°) and during motion (vibration 40°). RESULTS Median test age was 13 days (range 1-65 days) and median weight was 2.5 kg (IQR: 2.1-3.1 kg).Compared with baseline observations, only the total number of desaturations was significantly increased when infants were placed at 30° (p=0.03). At 40°, or with vibration, respiratory and heart rates increased and oxygen saturation decreased significantly. Profound desaturations <85% significantly increased during motion, regardless of gestational age. CONCLUSIONS This is the first study to assess the effect of motion on infants seated in a car safety seat. Term and preterm infants showed significant signs of potentially adverse cardiorespiratory effects in the upright position at 40°, particularly with simulated motion, not identified in the standard challenge. A larger study is required to investigate the significance of these results.
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Affiliation(s)
- Renu Arya
- Department of Paediatrics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Georgina Williams
- Department of Paediatrics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Anna Kilonback
- Department of Paediatrics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Martin Toward
- Institute of Sound and Vibration Research, University of Southampton, Southampton, UK
| | - Michael Griffin
- Institute of Sound and Vibration Research, University of Southampton, Southampton, UK
| | - Peter S Blair
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Peter Fleming
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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6
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Rosati P, Porzsolt F, Ricciotti G, Testa G, Inglese R, Giustini F, Fiscarelli E, Zazza M, Carlino C, Balassone V, Fiorito R, D'Amico R. Major discrepancies between what clinical trial registries record and paediatric randomised controlled trials publish. Trials 2016; 17:430. [PMID: 27659549 PMCID: PMC5034459 DOI: 10.1186/s13063-016-1551-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 08/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whether information from clinical trial registries (CTRs) and published randomised controlled trial (RCTs) differs remains unknown. Knowing more about discrepancies should alert those who rely on RCTs for medical decision-making to possible dissemination or reporting bias. To provide help in critically appraising research relevant for clinical practice we sought possible discrepancies between what CTRs record and paediatric RCTs actually publish. For this purpose, after identifying six reporting domains including funding, design, and outcomes, we collected data from 20 consecutive RCTs published in a widely read peer-reviewed paediatric journal and cross-checked reported features with those in the corresponding CTRs. METHODS We collected data for 20 unselected, consecutive paediatric RCTs published in a widely read peer-reviewed journal from July to November 2013. To assess discrepancies, two reviewers identified and scored six reporting domains: funding and conflict of interests; sample size, inclusion and exclusion criteria or crossover; primary and secondary outcomes, early study completion, and main outcome reporting. After applying the Critical Appraisal Skills Programme (CASP) checklist, five reviewer pairs cross-checked CTRs and matching RCTs, then mapped and coded the reporting domains and scored combined discrepancy as low, medium and high. RESULTS The 20 RCTs were registered in five different CTRs. Even though the 20 RCTs fulfilled the CASP general criteria for assessing internal validity, 19 clinical trials had medium or high combined discrepancy scores for what the 20 RCTs reported and the matched five CTRs stated. All 20 RCTs selectively reported or failed to report main outcomes, 9 had discrepancies in declaring sponsorship, 8 discrepancies in the sample size, 9 failed to respect inclusion or exclusion criteria, 11 downgraded or modified primary outcome or upgraded secondary outcomes, and 13 completed early without justification. The CTRs for seven trials failed to index automatically the URL address or the RCT reference, and for 12 recorded RCT details, but the authors failed to report the results. CONCLUSIONS Major discrepancies between what CTRs record and paediatric RCTs publish raise concern about what clinical trials conclude. Our findings should make clinicians, who rely on RCT results for medical decision-making, aware of dissemination or reporting bias. Trialists need to bring CTR data and reported protocols into line with published data.
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Affiliation(s)
- Paola Rosati
- G.A.L.I.L.E.O. Gruppo per l'Apprezzamento della Letteratura e l'Implementazione dei Livelli di Evidenza in Ospedale, Bambino Gesù Children's Hospital IRCCS, Rome, 00165, Italy. .,Unit of Clinical Epidemiology, Bambino Gesù Children's Hospital IRCCS, Rome, 00165, Italy.
| | - Franz Porzsolt
- G.A.L.I.L.E.O. Gruppo per l'Apprezzamento della Letteratura e l'Implementazione dei Livelli di Evidenza in Ospedale, Bambino Gesù Children's Hospital IRCCS, Rome, 00165, Italy.,Health Care Research, General and Visceral Surgery, University Hospital Ulm, President Institute of Clinical Economics (ICE) e.V., Ulm, 89070, Germany
| | - Gabriella Ricciotti
- G.A.L.I.L.E.O. Gruppo per l'Apprezzamento della Letteratura e l'Implementazione dei Livelli di Evidenza in Ospedale, Bambino Gesù Children's Hospital IRCCS, Rome, 00165, Italy
| | - Giuseppina Testa
- G.A.L.I.L.E.O. Gruppo per l'Apprezzamento della Letteratura e l'Implementazione dei Livelli di Evidenza in Ospedale, Bambino Gesù Children's Hospital IRCCS, Rome, 00165, Italy
| | - Rita Inglese
- G.A.L.I.L.E.O. Gruppo per l'Apprezzamento della Letteratura e l'Implementazione dei Livelli di Evidenza in Ospedale, Bambino Gesù Children's Hospital IRCCS, Rome, 00165, Italy
| | - Ferruccio Giustini
- G.A.L.I.L.E.O. Gruppo per l'Apprezzamento della Letteratura e l'Implementazione dei Livelli di Evidenza in Ospedale, Bambino Gesù Children's Hospital IRCCS, Rome, 00165, Italy
| | - Ersilia Fiscarelli
- G.A.L.I.L.E.O. Gruppo per l'Apprezzamento della Letteratura e l'Implementazione dei Livelli di Evidenza in Ospedale, Bambino Gesù Children's Hospital IRCCS, Rome, 00165, Italy
| | - Marco Zazza
- G.A.L.I.L.E.O. Gruppo per l'Apprezzamento della Letteratura e l'Implementazione dei Livelli di Evidenza in Ospedale, Bambino Gesù Children's Hospital IRCCS, Rome, 00165, Italy
| | - Cecilia Carlino
- G.A.L.I.L.E.O. Gruppo per l'Apprezzamento della Letteratura e l'Implementazione dei Livelli di Evidenza in Ospedale, Bambino Gesù Children's Hospital IRCCS, Rome, 00165, Italy.,Faculty of Medicine and Surgery, La Sapienza University, Rome, 00185, Italy
| | - Valerio Balassone
- G.A.L.I.L.E.O. Gruppo per l'Apprezzamento della Letteratura e l'Implementazione dei Livelli di Evidenza in Ospedale, Bambino Gesù Children's Hospital IRCCS, Rome, 00165, Italy
| | - Roberto Fiorito
- General Surgery and Transplantation Department, University Tor Vergata, Rome, 00133, Italy
| | - Roberto D'Amico
- G.A.L.I.L.E.O. Gruppo per l'Apprezzamento della Letteratura e l'Implementazione dei Livelli di Evidenza in Ospedale, Bambino Gesù Children's Hospital IRCCS, Rome, 00165, Italy.,Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, 41124, Italy
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7
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Sudden deaths in adult-worn baby carriers: 19 cases. Eur J Pediatr 2015; 174:1665-70. [PMID: 26174105 DOI: 10.1007/s00431-015-2593-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/28/2015] [Accepted: 07/05/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Soft infant carriers such as slings have become extremely popular in the west and are usually considered safe. We report 19 cases of sudden unexpected death in infancy (SUDI) linked to infant carrier. Most patients were healthy full-term babies less than 3 months of age, and suffocation was the most frequent cause of death. CONCLUSION Infant carriers represent an underestimated cause of death by suffocation in neonates. WHAT IS KNOWN • Sudden unexpected deaths in infancy linked to infant carrier have been only sparsely reported. WHAT IS NEW • We report a series of 19 cases strongly suggesting age of less than 3 months as a risk factor and suffocation as the mechanism of death.
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8
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Davis NL. Screening for cardiopulmonary events in neonates: a review of the infant car seat challenge. J Perinatol 2015; 35:235-40. [PMID: 25675050 DOI: 10.1038/jp.2015.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/16/2014] [Accepted: 01/05/2015] [Indexed: 11/09/2022]
Abstract
The infant car seat challenge (ICSC), or period of observation in a car safety seat before discharge to monitor for episodes of apnea, bradycardia and desaturation, is one of the most common tests performed on preterm neonates in the United States. However, the utility of the ICSC to identify infants at risk for adverse cardiopulmonary events in the car seat remains unclear. Minimal evidence exists to guide clinicians in performance of this test including appropriate inclusion criteria and failure criteria. In this article, the origins of the ICSC are discussed as well as potential etiologies of desaturations and bradycardia in the car seat position. Current literature on implementation, inclusion and failure criteria, incidence of failure and data on the meaning of a 'passed' vs 'failed' ICSC are discussed. Emphasis is made on minimizing time in car seats and seated devices given concern over the risk of desaturations.
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Affiliation(s)
- N L Davis
- Department of Pediatrics, Division of Neonatology, University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
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9
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Chiu K, Tonkin SL, Gunn AJ, McIntosh CC. Are baby hammocks safe for sleeping babies? A randomised controlled trial. Acta Paediatr 2014; 103:783-7. [PMID: 24766353 DOI: 10.1111/apa.12663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 04/11/2014] [Accepted: 04/22/2014] [Indexed: 11/26/2022]
Abstract
AIM Two reports of infants found dead after sleeping in baby hammocks have raised international concern about the safety of infant hammocks. We therefore tested whether hammock sleep affected oxygenation in infants, when they were at an age of high risk of sudden, unexpected infant death. METHODS Healthy, full-term 4- to 8-week-old infants were randomised to sleep either in a commercially available hammock (n = 14) or a standard bassinet (n = 9), and sleep state, oxygen desaturation (a fall in peripheral haemoglobin oxygen saturation (SpO2 ) ≥ 4%, for ≥ 4 sec from baseline to nadir), apnoea and hypopnoea, and mean SpO2 were analysed. RESULTS There was no significant difference in mean SpO2 (both 98.5%) or rate of oxygen desaturation events between the hammock and the bassinet cot (mean ± SD, 24 ± 20 vs. 28 ± 23 events per hour), but infants slept less in the hammock (59 ± 31 vs. 81 ± 34 min, p < 0.02). CONCLUSION When correctly used, the hammock sleep position did not compromise the upper airway of sleeping infants. The significance of shorter duration of sleep in the hammocks is unclear. These findings should not be applied to all baby hammocks, nor to older babies, particularly once the infant can roll. Given that it is not possible to predict when an infant will be able to roll, we strongly recommend that hammocks should not be used for unsupervised sleep.
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Affiliation(s)
- Karen Chiu
- Department of Physiology; Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Shirley L. Tonkin
- Department of Physiology; Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Alistair J. Gunn
- Department of Physiology; Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Christine C. McIntosh
- Department of Physiology; Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
- Crawford Medical Centre; Howick Auckland
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10
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Freyne B, Hamilton K, Mc Garvey C, Shannon B, Matthews TG, Nicholson AJ. Sudden unexpected death study underlines risks of infants sleeping in sitting devices. Acta Paediatr 2014; 103:e130-2. [PMID: 24175953 DOI: 10.1111/apa.12488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 09/17/2013] [Accepted: 10/28/2013] [Indexed: 12/13/2022]
Affiliation(s)
- B Freyne
- RCSI Department of Paediatrics; Children's University Hospital; Dublin Ireland
| | - K Hamilton
- National Paediatric Mortality Register; Children's University Hospital; Dublin Ireland
| | - C Mc Garvey
- National Paediatric Mortality Register; Children's University Hospital; Dublin Ireland
| | - Brenda Shannon
- Department of Public Health; HSE Dublin Mid-Leinster; Longford
| | - TG Matthews
- National Paediatric Mortality Register; Children's University Hospital; Dublin Ireland
| | - AJ Nicholson
- RCSI Department of Paediatrics; Children's University Hospital; Dublin Ireland
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