Running head: PROJECT PROPOSAL: THE TOXIC GAS THEORY
Project Proposal: The Toxic Gas Theory
Jennifer Dixon
Washburn University
November 24, 2012
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PROJECT PROPOSAL: THE TOXIC GAS THEORY
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Project Proposal: The Toxic Gas Theory
The thought of a healthy baby dying suddenly and unexpectedly is one that 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
(www.cdc.gov/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” (www.cdc.gov/sids). Sudden infant death syndrome (SIDS), also called crib 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” (www.cdc.gov/sids). 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 (www.cdc.gov/sids). SIDS is the leading cause of death in infants aged one to
twelve months of age in the United States (Corwin, 2012, p. 1). 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 nobody yet knows what
exactly causes 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
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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, but this research has been largely ignored by the
medical society and SIDS organizations denying parents the knowledge of this theory. Research
done by Jim Sprott and Barry Richardson theorizes that poisonous gases arise from the
mattresses where the baby sleeps and has been termed the toxic gas theory for SIDS. Based on
this research, interventions such as mattress wrapping have been used with great 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, p. 221). 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.
For my graduate project, I am proposing to do a review of literature on Sudden Infant
Death Syndrome and the toxic gas theory in order to write a manuscript for a nursing journal on
the toxic gas theory with the intention to educate nurses and health care providers on the theory
and preventative measures so that they in turn can educate parents on ways to protect their
infants from toxic gas in order to decrease the cases of sudden infant death syndrome. Parents
are being denied knowledge that could prevent their infant from dying of SIDS and nurses and
health care providers are in a position to educate new parents and others in the field of infant
care. Parents have the right to know about this research so they can make their own decisions on
preventative measures. The project objective is to write a manuscript that is accepted for
publication in a nursing journal. By informing providers of the research that has been done in
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Great Britain and New Zealand and the success the interventions have had in decreasing SIDS,
this can be used to decrease the SIDS rate in the United States. “The success of mattresswrapping 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).
In 1988, Barry Richardson, a British consulting scientist specializing in preventing the
degradation of materials, and Peter Mitchell, proprietor of a marquee company, met by chance
and were working on Mitchell’s problem of his deteriorating marquees (Sprott, 1996, p. 13).
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 funguses such as
Scopulariopsis brevicaulis (Sprott, 1996, p. 15). 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 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 very deadly especially to infants and are described as being one hundred
times more poisonous than hydrogen cyanide and a thousand times more so than carbon
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monoxide (Sprott, 1996, Chapter 4). Phosphines, arsines and stibines are denser than air and
odorless making it easy to accumulate on top of the mattress (Richardson, 1994, p. 202). 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).
In 1986, Jim Sprott, 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 bed but could not identify the specific gas (Sprott, 1996, p. 9).
In 1991, Jim Sprott learned of Barry Richardson’s research and the two began corresponding.
Jim 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, p. 223). During a 10-year period of
mattress wrapping, no cot death has been reported when a baby was sleeping on a mattress
wrapped according to the protocol (Sprott, 2004, p. 224).
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, mattresswrapping, 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.
The first article reviewed was a study done by BA Richardson, which hypothesized that
poisoning by phosphines, arsines and stibines, might be the primary cause of sudden infant death
syndrome (SIDS) (Richardson, 1994). In this study 50 mattresses from 45 SIDS incidents were
tested by placing small samples on malt/soya Petri dish plates and identifying generated gases
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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 established that the hypothesis that the primary cause of SIDS is
inhalation of phosphines, arsines and stibines generated by biodeterioration of mattress materials
containing phosphorus, arsenic and antimony compounds, is consistent with all the established
features of SIDS.
The second study reviewed was a corollary study done by T.J. Sprott (Sprott, 2004). 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
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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 600 reports of cot death in
New Zealand but not one of those deaths occurred on a wrapped mattress. 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.
The third study 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 is not a cause of
sudden infant death.
The theoretical framework being used for this project is Milio’s Theory of Prevention.
Nancy Milio developed a framework for prevention that includes concepts of communityoriented, population-focused care (Milio, 1976). The basic dissertation is that behavioral
patterns of populations and individuals who make up populations are a result of selection from
limited choices. She challenged the common notion that a main determinant for unhealthful
behavioral choice is lack of knowledge. She states health choices have been limited by what is
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actually available to groups of people. This theoretical framework fits this project well because I
also believe that patients need to be given knowledge in order to make informed choices about
their own health and the health of their children. Governmental and institutional policies, she
said set the range of options for personal choice making. The medical community and SIDS
organizations may have ignored the toxic gas theory for SIDS but parents have the right to know
about this research so they can make their own decisions. Using Milio’s theory, parents must be
aware of new options to prevent SIDS and what they can gain by selecting an unconventional
way to prevent SIDS, such as mattress wrapping, as opposed to the standard information
available by SIDS organizations.
The proposed project of conducting an integrative review of literature and writing a
published paper for a nursing journal would provide information on the toxic gas theory to health
care providers in order for them to educate new parents on ways to prevent SIDS in their infants,
specifically mattress wrapping. This project does not require an IRB approval and there is no
cost associated with conducting the project. I propose the project output would be submitting a
manuscript to MCN, The Journal of Maternal Child Nursing for possible publication by the end
of February 2013. The mission of MCN is to provide the most timely, relevant information to
nurses practicing in perinatal, neonatal, midwifery and pediatric specialties. MCN is a peerreviewed journal which meets its mission by publishing clinically relevant practice and research
manuscripts aimed at assisting nurses toward evidence-based practice. The dissemination plan
is a power point presentation in May 2013 along with the manuscript submitted for publication.
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References
Corwin, M. J. (2012). Patient information: Sudden infant death syndrome (SIDS) (Beyond the
Basics). Retrieved November 17, 2012, from www.uptodate.com
Milio, N. (1976, May 1976). A Framework for Prevention: Changing Health-Damaging to
Health-Generating Life Patterns. American Journal of Public Health, 66, 435-439.
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
www.nichd.nih.gov/sids/
Sprott, T. J. (1996). The Cot Death Cover-Up? 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.
Sudden Infant Death Syndrome. (2012). Retrieved from www.lung.org/lung-disease/suddeninfant-death-syndrome/understanding-sids.html
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.