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Hauck FR, Moon RY, Kerr SM, Corwin MJ, Heeren T, Colson E, Parker MG, Kellams A. Mothers Falling Asleep During Infant Feeding. Pediatrics 2024; 154:e2024066072. [PMID: 39483051 PMCID: PMC11608999 DOI: 10.1542/peds.2024-066072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 09/18/2024] [Accepted: 09/19/2024] [Indexed: 11/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Falling asleep while feeding (FAF) infants is common. Our primary objectives were to examine (1) maternally reported prevalence of FAF and if planned; (2) association between FAF and sociodemographic factors, feeding method, and sleep location; and (3) if receipt of education about safe sleep and bedsharing risks was associated with FAF. METHODS In the Social Media and Risk-reduction Training study, US mothers of newborns were randomized to educational messaging promoting infant safe sleep or breastfeeding. We analyzed data from 1259 mothers who responded to the postpartum survey (mean infant age, 11.2 weeks). We used generalized estimating equation logistic regression models to examine the extent that sociodemographic characteristics, feeding type, usual nighttime feeding location, and intervention group were associated with FAF. RESULTS A total of 28.2% of mothers reported FAF usually or sometimes in the last 2 weeks, 83.4% of whom reported that FAF was unplanned. There were no differences in the odds of FAF by sociodemographic factors. Compared with mothers whose nighttime feeding location was their bed, mothers who reported feeding in a chair were less likely to FAF (33.6% versus 16.8%; adjusted odds ratio, 0.41; 95% confidence interval, 0.31-0.56). FAF was reported less frequently by mothers who received safe sleep interventions (15.6%), compared with mothers who received breastfeeding interventions (33.0%; adjusted odds ratio, 0.40; 95% confidence interval, 0.25-0.65). CONCLUSIONS FAF is reported commonly among US mothers and is predominantly unplanned. Mothers who received safe sleep messaging were less likely to report FAF. New parents need guidance on planning for optimal safety during infant feeding.
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Affiliation(s)
| | - Rachel Y. Moon
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Stephen M. Kerr
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | | | - Timothy Heeren
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Eve Colson
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Margaret G. Parker
- Department of Pediatrics, UMass Chan School of Medicine, Worcester, Massachusetts
| | - Ann Kellams
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
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2
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Sangaré LR, Kaufman L, Bardwell RA, Nichols D, Bryan M. The risk of sleep-related death in an inclined sleep environment. BMC Public Health 2024; 24:2186. [PMID: 39135049 PMCID: PMC11320768 DOI: 10.1186/s12889-024-19731-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 08/08/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Unsafe sleep environments are the primary modifiable risk factor for sudden unexpected infant death (SUID). Despite this knowledge, products that deviate from the American Academy of Pediatrics (AAP) safe sleep recommendations continue to be commonplace, such as inclined sleepers. Analyses to estimate risk among these products are lacking, perpetuating their presence in the marketplace. We present a method of comparing risk of SUID in an inclined sleeper to an AAP-recommended sleep environment. METHODS A case-control analysis using publicly available and previously published survey data was conducted for SUID events occurring between January 1, 2018 and April 12, 2019 (the date of the first inclined sleeper recall). SUID deaths were categorized as occurring in an AAP-recommended sleep environments or in an inclined sleeper. Exposure Odds Ratios (OR) are reported as the risk of SUID among infants using inclined sleepers relative to an AAP-recommended sleep environment. RESULTS During the study period, 4,900,573 births and 4,363 SUID deaths occurred in the US. Control characteristics were similar between previous night users of an AAP-recommended sleep environment (24%) and inclined sleepers (3.8%). Inclined sleepers were associated with a 5-fold (OR: 5.1; 95% CI: 3.2, 7.9) increased risk of SUID among infants < 12 months compared to infants in an AAP-recommended sleep environment. This risk was greatest among infants ≥ 4 months (RR: 10.4; 95% CI: 5.1, 21.5). CONCLUSIONS This novel analysis fills a longstanding gap in risk assessments of inclined infant sleep products. More timely risk analyses may improve the safety of the marketplace.
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Affiliation(s)
- Laura R Sangaré
- EpiAdvantage, Portland, OR, US.
- University of Washington, Seattle, Washington, US.
| | | | | | | | - Mersine Bryan
- University of Washington, Seattle, Washington, US
- Seattle Children's Research Institute, Seattle, Washington, US
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3
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Erck Lambert AB, Shapiro-Mendoza CK, Parks SE, Cottengim C, Faulkner M, Hauck FR. Characteristics of Sudden Unexpected Infant Deaths on Shared and Nonshared Sleep Surfaces. Pediatrics 2024; 153:e2023061984. [PMID: 38374785 PMCID: PMC11117443 DOI: 10.1542/peds.2023-061984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Describe characteristics of sudden unexpected infant deaths (SUID) occurring on shared or nonshared sleep surfaces. METHODS We examined SUID among residents of 23 US jurisdictions who died during 2011 to 2020. We calculated frequencies and percentages of demographic, sleep environment, and other characteristics by sleep surface sharing status and reported differences of at least 5% between surface sharing and nonsharing infants. RESULTS Of 7595 SUID cases, 59.5% were sleep surface sharing when they died. Compared with nonsharing infants, sharing infants were more often aged 0 to 3 months, non-Hispanic Black, publicly insured, found supine, found in an adult bed or chair/couch, had a higher number of unsafe sleep factors present, were exposed to maternal cigarette smoking prenatally, were supervised by a parent at the time of death, or had a supervisor who was impaired by drugs or alcohol at the time of death. At least 76% of all SUID had multiple unsafe sleep factors present. Among surface-sharing SUID, most were sharing with adults only (68.2%), in an adult bed (75.9%), and with 1 other person (51.6%). Surface sharing was more common among multiples than singletons. CONCLUSIONS Among SUID, surface sharing and nonsharing infants varied by age at death, race and ethnicity, insurance type, presence of unsafe sleep factors, prenatal smoke exposure, and supervisor impairment. Most SUID, regardless of sleep location, had multiple unsafe sleep factors present, demonstrating the need for comprehensive safe sleep counseling for every family at every encounter.
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Affiliation(s)
- Alexa B. Erck Lambert
- Centers for Disease Control and Prevention, Division of
Reproductive Health, Atlanta, Georgia
- DB Consulting Group, Inc., Silver Springs, Maryland
| | | | - Sharyn E. Parks
- Centers for Disease Control and Prevention, Division of
Reproductive Health, Atlanta, Georgia
| | - Carri Cottengim
- Centers for Disease Control and Prevention, Division of
Reproductive Health, Atlanta, Georgia
| | - Meghan Faulkner
- Michigan Public Health Institute, Center for National
Prevention Initiatives, Okemos, Michigan
| | - Fern R. Hauck
- Unversity of Virginia, Department of Family Medicine,
Charlottesville, Virginia
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de Visme S, Korevaar DA, Gras-Le Guen C, Flamant A, Bevacqua M, Stanzelova A, Trinh NTH, Ciobanu DA, Carvalho AA, Kyriakoglou I, Fuentes M, Refes Y, Briand-Huchet E, Sellier AL, Harrewijn I, Cohen JF, Chalumeau M. Inconsistency Between Pictures on Baby Diaper Packaging in Europe and Safe Infant Sleep Recommendations. J Pediatr 2024; 264:113763. [PMID: 37778411 DOI: 10.1016/j.jpeds.2023.113763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To describe the level of inconsistency between pictures on baby diaper packaging and safe infant sleep recommendations (SISRs) in Europe. STUDY DESIGN We attempted to identify all packaging of baby diapers sold in 11 European countries for infants weighing less than 5 kg through internet searches from July 2022 through February 2023. For each type of package, we extracted whether there was a picture depicting a baby, whether the baby was sleeping, and whether the picture of the sleeping baby was inconsistent with ≥1 of 3 SISRs: (i) nonsupine sleeping position, (ii) soft objects or loose bedding, or (iii) sharing a sleep surface with another person. Data were aggregated at the country level, and a random-effects meta-analysis of proportions was used to obtain summary estimates. The outcome was the summary estimate of the proportion of pictures that were inconsistent with SISRs. RESULTS We identified 631 baby diaper packaging types of which 49% (95% CI: 42-57; n = 311) displayed a picture of a sleeping baby. Among those 311 packages, 79% (95% CI 73-84) were inconsistent with ≥1 SISR, including a nonsupine sleeping position, 45% (95% CI 39-51), soft objects or loose bedding such as pillows or blankets, 51% (95% CI 46-57), and sharing a sleep surface with another person, 10% (95% CI 4-18). CONCLUSIONS Pictures on baby diaper packaging in Europe are often inconsistent with SISRs. The prevention of sudden unexpected death in infancy requires action from manufacturers and legislators to stop parents' exposure to misleading images that may lead to dangerous practices.
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Affiliation(s)
- Sophie de Visme
- Epidemiology and Statistics Research Center, Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Université Paris Cité, Paris, France; CHU de Nantes, INSERM, Department of General Pediatrics and Pediatric Emergencies, CIC1413, Nantes Université, Nantes, France
| | - Daniel A Korevaar
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Christèle Gras-Le Guen
- Epidemiology and Statistics Research Center, Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Université Paris Cité, Paris, France; CHU de Nantes, INSERM, Department of General Pediatrics and Pediatric Emergencies, CIC1413, Nantes Université, Nantes, France; CHU de Nantes, Department of General Pediatrics and Pediatric Emergencies, Nantes Université, Nantes, France
| | - Alix Flamant
- Department of General Pediatrics, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Martina Bevacqua
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Anna Stanzelova
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Independent Researcher, Galway, Ireland
| | - Nhung T H Trinh
- Department of Pharmacy, PharmacoEpidemiology and Drug Safety Research Group, University of Oslo, Oslo, Norway
| | - Dalia-Alexandra Ciobanu
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Children's Hospital "Doctor Victor Gomoiu", Bucharest, Romania
| | - Ana Araújo Carvalho
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Centro Hospitalar e Universitário de Lisboa Central, Hospital Dona Estefânia, Paediatric Department, Lisboa, Portugal
| | - Ifigeneia Kyriakoglou
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Department of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Fuentes
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Department of Pediatric Emergencies, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Yacine Refes
- Epidemiology and Statistics Research Center, Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Université Paris Cité, Paris, France
| | - Elisabeth Briand-Huchet
- Naître et Vivre, National Association for the Support of Bereaved Parents and the Fight Against Sudden Unexpected Death in Infancy, Paris, France
| | | | - Inge Harrewijn
- Department of Neonatal Pediatrics and Intensive Care, Montpellier University Hospital, University of Montpellier, Montpellier, France.
| | - Jérémie F Cohen
- Epidemiology and Statistics Research Center, Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Université Paris Cité, Paris, France; Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Martin Chalumeau
- Epidemiology and Statistics Research Center, Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Université Paris Cité, Paris, France; Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
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Ramos PV, Hoogerwerf PJ, Smith PK, Finley C, Okoro UE, Jennissen CA. Pre- and postnatal safe sleep knowledge and planned as compared to actual infant sleep practices. Inj Epidemiol 2023; 10:55. [PMID: 37885011 PMCID: PMC10601097 DOI: 10.1186/s40621-023-00467-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Our objectives were to compare safe sleep knowledge, attitudes and planned vs. actual infant sleep practices among expectant mothers before and after their infant's birth and to determine whether differences (if present) were associated with any demographic variables. METHODS Study participants were surveyed at their 28-week prenatal and 6-week postpartum obstetric clinic visits from November 2019-February 2021. Due to COVID-19 pandemic cancellation of in-person postpartum visits, many participants received text messaging encouraging them to take the follow-up survey online. Frequency and comparative analyses were performed. RESULTS 355 women (44%) completed both pre- and postnatal surveys. Many participants increased their safe sleep knowledge during the study. For example, of those who were unsure or thought it safe for a baby to sleep in a baby swing/bouncy seat, two-thirds (67/102, 66%) stated it was unsafe on the postnatal survey. In addition, many who were unsure or planned sleep practices considered unsafe prenatally reported utilizing safe sleep practices on their postnatal survey. For example, of those unsure or planning to use a crib bumper (17% of the total), almost all (88%) were not using one postnatally. Conversely, some participants who reported they would be following safe sleep practices prenatally were not doing so postpartum. For example, 13% of those stating they would place their child on their back reported using another sleep position on the postnatal survey. Certain demographics had higher proportions reporting this reversal for specific safe sleep practices. For example, non-Hispanic Whites (19%) as compared to other races/ethnicities (5%) and those with incomes ≥ $75,000 (21%) as compared with those with less income (9%) had higher proportions stating their infant would sleep in the same room but then reported postnatally they were sleeping in a different room, p = 0.0094 and p = 0.0138, respectively. CONCLUSIONS We observed increases in safe sleep knowledge and that some participants followed safer sleep practices than they had planned. However, there were also participants who planned to use safe sleep practices prenatally who were not doing so after their baby's birth. Our study identified demographics for which targeted safe sleep education and more effective interventions may be needed.
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Affiliation(s)
- Paula Valiño Ramos
- Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Medical Scientist Training Program, Washington University in St. Louis, St. Louis, MO, USA
| | - Pamela J Hoogerwerf
- Injury Prevention and Community Outreach, University of Iowa Stead Family Children's Hospital, University of Iowa, Iowa City, IA, USA
| | - Penny K Smith
- Iowa's Statewide Perinatal Care Program, University of Iowa Stead Family Children's Hospital, University of Iowa, Iowa City, IA, USA
| | - Carolyn Finley
- University of Iowa Stead Family Children's Hospital, University of Iowa, Iowa City, IA, USA
| | - Uche E Okoro
- Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Charles A Jennissen
- Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
- Department of Pediatrics, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
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Pease A, Turner N, Ingram J, Fleming P, Patrick K, Williams T, Sleap V, Pitts K, Luyt K, Ali B, Blair P. Changes in background characteristics and risk factors among SIDS infants in England: cohort comparisons from 1993 to 2020. BMJ Open 2023; 13:e076751. [PMID: 37832988 PMCID: PMC10582842 DOI: 10.1136/bmjopen-2023-076751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVES Using the National Child Mortality Database, this work aims to investigate background characteristics and risk factors in the sleeping environment associated with sudden infant death syndrome (SIDS) and compare the prevalence with previous English SIDS case-control studies. DESIGN Cohort of SIDS in 2020 compared with a combined analysis of two case-control studies conducted in 1993-1996 and 2003-2006. SETTING England, UK PARTICIPANTS: 138 SIDS deaths in 2020 compared with 402 SIDS deaths and 1387 age-equivalent surviving controls, combined from previous studies. RESULTS The increased vulnerability of SIDS infants identified in previous studies has become more marked. The infants who died in 2020 were younger (median=66 days (IQR: 34-118) vs 86 days (IQR: 52-148), p=0.003) with an increased prevalence of low birth weight (30.5% vs 21.6%, p=0.04) and preterm births (29.6% vs 19.3%, p=0.012). The excess of socioeconomically deprived families, male infants and high levels of maternal smoking during pregnancy were still evident. Among recent deaths, fewer infants were put down or found on their side; however, there was no significant change in the proportion of infants who were put down (15.6% vs 14.6%, p=0.81) and found prone (40.4% vs 35.3%, p=0.37), despite population wide risk reduction advice over three decades. The proportional increase observed in 2003-2006 of half the deaths occurring while sleeping next to an adult was maintained in 2020, and for the vast majority (90%), this was in hazardous circumstances (adult had consumed alcohol, smoked, slept on a sofa, or the infant was premature or low birth weight and less than 3 months old). More deaths also occurred when there was a disruption in infant care routine compared with previous observations (52.6% vs 20.7%, p<0.001). CONCLUSIONS A more targeted approach is needed with vulnerable families emphasising the importance of sleeping infants on their back and proactive planning infant sleep when there are disruptions to the normal routine, in particular to avoid hazardous co-sleeping.
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Affiliation(s)
- Anna Pease
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Nicholas Turner
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Jenny Ingram
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Peter Fleming
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Karen Patrick
- Research and Development, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Tom Williams
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Vicky Sleap
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | | | - Karen Luyt
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Becky Ali
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Peter Blair
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
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Wojcik MH, Poduri AH, Holm IA, MacRae CA, Goldstein RD. The fundamental need for unifying phenotypes in sudden unexpected pediatric deaths. Front Med (Lausanne) 2023; 10:1166188. [PMID: 37332751 PMCID: PMC10273404 DOI: 10.3389/fmed.2023.1166188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/03/2023] [Indexed: 06/20/2023] Open
Abstract
A definitive, authoritative approach to evaluate the causes of unexpected, and ultimately unexplained, pediatric deaths remains elusive, relegating final conclusions to diagnoses of exclusion in the vast majority of cases. Research into unexplained pediatric deaths has focused primarily on sudden infant deaths (under 1 year of age) and led to the identification of several potential, albeit incompletely understood, contributory factors: nonspecific pathology findings, associations with sleep position and environment that may not be uniformly relevant, and the elucidation of a role for serotonin that is practically difficult to estimate in any individual case. Any assessment of progress in this field must also acknowledge the failure of current approaches to substantially decrease mortality rates in decades. Furthermore, potential commonalities with pediatric deaths across a broader age spectrum have not been widely considered. Recent epilepsy-related observations and genetic findings, identified post-mortem in both infants and children who died suddenly and unexpectedly, suggest a role for more intense and specific phenotyping efforts as well as an expanded role for genetic and genomic evaluation. We therefore present a new approach to reframe the phenotype in sudden unexplained deaths in the pediatric age range, collapsing many distinctions based on arbitrary factors (such as age) that have previously guided research in this area, and discuss its implications for the future of postmortem investigation.
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Affiliation(s)
- Monica H. Wojcik
- Robert’s Program for Sudden Unexpected Death in Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Annapurna H. Poduri
- Robert’s Program for Sudden Unexpected Death in Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, United States
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ingrid A. Holm
- Robert’s Program for Sudden Unexpected Death in Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Calum A. MacRae
- Harvard Medical School, Boston, MA, United States
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Richard D. Goldstein
- Robert’s Program for Sudden Unexpected Death in Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States
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Parks SE, DeSisto CL, Kortsmit K, Bombard JM, Shapiro-Mendoza CK. Risk Factors for Suffocation and Unexplained Causes of Infant Deaths. Pediatrics 2023; 151:e2022057771. [PMID: 36464994 PMCID: PMC9942004 DOI: 10.1542/peds.2022-057771] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Observational studies have improved our understanding of the risk factors for sudden infant death syndrome, but separate examination of risk for sleep-related suffocation and unexplained infant deaths has been limited. We examined the association between unsafe infant sleep practices and sudden infant deaths (sleep-related suffocation and unexplained causes including sudden infant death syndrome). METHODS We conducted a population-based case-control study using 2016 to 2017 Centers for Disease Control and Prevention data. Controls were liveborn infants from the Pregnancy Risk Assessment Monitoring System; cases were from the Sudden Unexpected Infant Death Case Registry. We calculated risk factor prevalence among cases and controls and crude and adjusted odds ratios. RESULTS We included 112 sleep-related suffocation cases with 448 age-matched controls and 300 unexplained infant death cases with 1200 age-matched controls. Adjusted odds for sleep-related suffocation ranged from 18.7 (95% confidence interval [CI]: 6.8-51.3) among infants not sharing a room with their mother or caregiver to 1.9 (95% CI: 0.9-4.1) among infants with nonsupine sleep positioning. Adjusted odds for unexplained death ranged from 7.6 (95% CI: 4.7-12.2) among infants not sharing a room with their mother or caregiver to 1.6 (95% CI: 1.1-2.4) among nonsupine positioned infants. COCLUSIONS We confirmed previously identified risk factors for unexplained infant death and independently estimated risk factors for sleep-related suffocation. Significance of associations for suffocation followed similar patterns but was of larger magnitude. This information can be used to improve messaging about safe infant sleep.
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Assessing infant sleep practices and other risk factors of SIDS in Zambia: a cross-sectional survey of mothers in Lusaka, Zambia. BMC Pediatr 2022. [PMCID: PMC9664809 DOI: 10.1186/s12887-022-03712-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Having infants sleep with their parents and sleeping face down or on their sides are the two most proximate and modifiable risk factors for sudden infant death syndrome (SIDS). Little is known about the burden of SIDS or the prevalence of these risk factors in Africa. Our primary objective was to determine the prevalence of modifiable risk factors of SIDS in Lusaka, Zambia.
Methods
We conducted cross-sectional surveys with recent mothers of infants aged < 1 year across two busy urban clinic sites in Lusaka, Zambia. We used log-binomial regression analysis to identify factors predictive of bedsharing and prone sleeping.
Results
Surveys were conducted with 478 mothers between April-May 2021. The sleep-related risk factors, bedsharing and side sleeping, were widely prevalent. 89.5% of respondents indicated that they share a bed with the infant during sleep, 73.0% preferred putting their baby on its side, and 19.9% preferred the prone position. Only 6.7% of respondents described using the safer, supine position. Age of infant was the only factor which was predictive of prone sleeping. Infants > 2 months old were twice as likely to be put to sleep in a prone position compared to infants aged less than 2 months old. Mothers reported that they rarely (24.1%) received advice from medical caregivers to use the supine position. Maternal use of alcohol (12.0%) and tobacco (0.8%) during pregnancy were uncommon.
Conclusions
Bedsharing and placing the infant to sleep on the side were commonly reported among the mothers we interviewed. Whether this represents an opportunity to reduce SIDS in Zambia is unclear since accurate data on the burden of SIDS in Zambia is not available. There is a need for increased awareness of SIDS and more prospective data collection on its burden and related risk factors in these African populations.
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Moon RY, Carlin RF, Hand I. Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths. Pediatrics 2022; 150:188305. [PMID: 35921639 DOI: 10.1542/peds.2022-057991] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Every year in the United States, approximately 3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Statistical Classification of Diseases and Related Health Problems 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths have remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. In addition, additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, which is included in this issue.
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Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Rebecca F Carlin
- Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York City, New York
| | - Ivan Hand
- Department of Pediatrics, SUNY-Downstate College of Medicine, NYC Health + Hospitals, Kings County, Brooklyn, New York
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11
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Moon RY, Carlin RF, Hand I. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics 2022; 150:188304. [PMID: 35726558 DOI: 10.1542/peds.2022-057990] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Each year in the United States, ∼3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Classification of Diseases, 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths has remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. Additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is also included. The recommendations and strength of evidence for each recommendation are included in this policy statement. The rationale for these recommendations is discussed in detail in the accompanying technical report.
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Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Rebecca F Carlin
- Department of Pediatrics, Division of Pediatric Critical Care and Hospital Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, New York
| | - Ivan Hand
- Department of Pediatrics, SUNY-Downstate College of Medicine, NYC Health + Hospitals
- Kings County, Brooklyn, New York
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12
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Sodini C, Paglialonga L, Antoniol G, Perrone S, Principi N, Esposito S. Home Cardiorespiratory Monitoring in Infants at Risk for Sudden Infant Death Syndrome (SIDS), Apparent Life-Threatening Event (ALTE) or Brief Resolved Unexplained Event (BRUE). Life (Basel) 2022; 12:883. [PMID: 35743914 PMCID: PMC9227273 DOI: 10.3390/life12060883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022] Open
Abstract
Sudden infant death syndrome (SIDS) is defined as the sudden death of an infant younger than one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history. About 90% of SIDS occur before six months of age, the peak incidence is between two and four months, and the median age for death is elven weeks. The clinical, social, and economic relevance of SIDS, together with the evidence that prevention of this syndrome was possible, has significantly stimulated research into risk factors for the development of SIDS in the hope of being able to introduce new effective preventive measures. This narrative review discusses the potential relationships between apparent life-threatening events (ALTE) or brief resolved unexplained events (BRUE) and SIDS development, and when a home cardiorespiratory monitor is useful for prevention of these conditions. A literature analysis showed that home cardiorespiratory monitoring has been considered a potential method to identify not only ALTE and BRUE but SIDS also. ALTE and BRUE are generally due to underlying conditions that are not detectable in SIDS infants. A true relationship between these conditions has never been demonstrated. Use of home cardiorespiratory monitor is not recommended for SIDS, whereas it could be suggested for children with previous ALTE or severe BRUE or who are at risk of the development of these conditions. However, use of home cardiorespiratory monitors assumes that family members know the advantages and limitations of these devices after adequate education and instruction in their use.
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Affiliation(s)
- Chiara Sodini
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (C.S.); (L.P.); (G.A.)
| | - Letizia Paglialonga
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (C.S.); (L.P.); (G.A.)
| | - Giulia Antoniol
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (C.S.); (L.P.); (G.A.)
| | - Serafina Perrone
- Neonatology Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (C.S.); (L.P.); (G.A.)
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13
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Plancoulaine S, Guyon A, Inocente CO, Germe P, Zhang M, Robert P, Lin JS, Franco P. Cerebrospinal Fluid Histamine Levels in Healthy Children and Potential Implication for SIDS: Observational Study in a French Tertiary Care Hospital. Front Pediatr 2022; 10:819496. [PMID: 35450108 PMCID: PMC9016218 DOI: 10.3389/fped.2022.819496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/09/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE A defect of the waking systems could constitute a factor of vulnerability for sudden infant death syndrome (SIDS). A decrease in orexin levels, which promotes wakefulness and activates histaminergic neurons (another hypothalamic wake-promoting system) has already been demonstrated between 2 and 6 months. This work aims to study the levels of histamine (HA), tele-methylhistamine (t-MeHA), its direct metabolite, and t-MeHA/HA ratio in the cerebrospinal fluid (CSF) of healthy children, to evaluate the maturation of the histaminergic system and its possible involvement in SIDS. METHODS Seventy Eight French children between 0 and 20 years (48.7% boys) were included, all of whom had a clinical indication for lumbar puncture, but subsequently found to be normal. Measurements of HA and t-MeHA in CSF were performed by reverse phase liquid chromatography coupled to mass spectrometry detection. Statistical analyses were performed using Spearman correlations and Non-parametric pairwise ranking tests. RESULTS A negative correlation was found between age and CSF HA (r = -0.44, p < 10-4) and t-MeHA (r = -0.70, p < 10-4) levels. In pairwise comparisons, no difference in CSF HA and t-MeHA levels was observed between youngest age groups (i.e., 0-2 mo vs. 3-6 mo), but CSF HA and t-MeHA levels were significantly lower in older children (i.e., >6 mo vs. 0-6 mo). The CSF HA decrease with age was only observed in boys, who also presented global lower CSF HA levels than girls. CONCLUSION CSF HA and t-MeHA levels decrease with age in boys, and global levels are lower in boys than in girls. These results reveal changes in histaminergic transmission and metabolism during maturation. Whether lower CSF histamine values in boys compared to girls could contribute to their higher risk of SIDS warrants further research.
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Affiliation(s)
| | - Aurore Guyon
- Integrative Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, University Lyon 1, Lyon, France.,Bioprojet Biotech, Saint-Grégoire, France
| | - Clara-Odilia Inocente
- Integrative Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, University Lyon 1, Lyon, France
| | - Philippine Germe
- Integrative Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, University Lyon 1, Lyon, France
| | - Min Zhang
- Integrative Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, University Lyon 1, Lyon, France
| | | | - Jian-Sheng Lin
- Integrative Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, University Lyon 1, Lyon, France
| | - Patricia Franco
- Integrative Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, University Lyon 1, Lyon, France.,Pediatric Sleep Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, University Lyon 1, Lyon, France
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14
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Bach V, Libert JP. Hyperthermia and Heat Stress as Risk Factors for Sudden Infant Death Syndrome: A Narrative Review. Front Pediatr 2022; 10:816136. [PMID: 35498814 PMCID: PMC9051231 DOI: 10.3389/fped.2022.816136] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/24/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Heat stress and hyperthermia are common findings in sudden infant death syndrome (SIDS) victims. It has been suggested that thermal stress can increase the risk of SIDS directly via lethal hyperthermia or indirectly by altering autonomic functions. Major changes in sleep, thermoregulation, cardiovascular function, and the emergence of circadian functions occur at the age at which the risk of SIDS peaks-explaining the greater vulnerability at this stage of development. Here, we review the literature data on (i) heat stress and hyperthermia as direct risk factors for SIDS, and (ii) the indirect effects of thermal loads on vital physiological functions. RESULTS Various situations leading to thermal stress (i.e., outdoors temperatures, thermal insulation from clothing and bedding, the prone position, bed-sharing, and head covering) have been analyzed. Hyperthermia mainly results from excessive clothing and bedding insulation with regard to the ambient thermal conditions. The appropriate amount of clothing and bedding thermal insulation for homeothermia requires further research. The prone position and bed-sharing do not have major thermal impacts; the elevated risk of SIDS in these situations cannot be explained solely by thermal factors. Special attention should be given to brain overheating because of the head's major role in body heat losses, heat production, and autonomic functions. Thermal stress can alter cardiovascular and respiratory functions, which in turn can lead to life-threatening events (e.g., bradycardia, apnea with blood desaturation, and glottal closure). Unfortunately, thermal load impairs the responses to these challenges by reducing chemosensitivity, arousability, and autoresuscitation. As a result, thermal load (even when not lethal directly) can interact detrimentally with vital physiological functions. CONCLUSIONS With the exception of excessive thermal insulation (which can lead to lethal hyperthermia), the major risk factors for SIDS appears to be associated with impairments of vital physiological functions when the infant is exposed to thermal stress.
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Affiliation(s)
- Véronique Bach
- PeriTox, UMR_I 01, UPJV/INERIS, Jules Verne University of Picardy, Amiens, France
| | - Jean-Pierre Libert
- PeriTox, UMR_I 01, UPJV/INERIS, Jules Verne University of Picardy, Amiens, France
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15
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Cole R, Young J, Kearney L, Thompson JMD. Challenges parents encounter when implementing infant safe sleep advice. Acta Paediatr 2021; 110:3083-3093. [PMID: 34297875 DOI: 10.1111/apa.16040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/21/2021] [Indexed: 01/21/2023]
Abstract
AIM To understand which safe sleep recommendations parents find most challenging to implement, identifying common barriers encountered; and investigate whether challenges are associated with practices employed. METHODS A cross-sectional survey of 3341 Australian families with young infants who birthed a live baby during April-May 2017. Caregivers were asked about infant care practices and family characteristics. Qualitative free-text items explored challenges faced with current safe sleep recommendations. RESULTS Nearly one-third (n = 1033, 31%) of caregivers reported difficulty with at least one safe sleep recommendation. Infant sleep position and avoiding bed-sharing were identified as the most challenging recommendations. Caregivers described barriers which influenced consistency in uptake of advice. Families who described difficulty with a recommendation were significantly less likely to consistently employ that advice compared to those who did not report difficulty (sleep position: 198/473,42% vs 2548/2837,90% [p < 0.0001]; own sleep space: (269/344,78% vs 1331/2884,46% [p < 0.0001]). When families encountered challenges, they often proposed alternate strategies with an inference their substitute action compensated potential increased risk. CONCLUSION Many families encounter difficulties implementing safe sleep advice; these challenges negatively impact care practices. Effective interventions meeting individual family needs, to provide safe sleep environments consistently, are necessary to improve sleep-related infant care and further reduce infant mortality.
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Affiliation(s)
- Roni Cole
- School of Nursing, Midwifery and Paramedicine University of the Sunshine Coast Sippy Downs Australia
- Sunshine Coast Health Institute Sunshine Coast Hospital and Health Service Birtinya Australia
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine University of the Sunshine Coast Sippy Downs Australia
- Sunshine Coast Health Institute Sunshine Coast Hospital and Health Service Birtinya Australia
| | - Lauren Kearney
- School of Nursing, Midwifery and Paramedicine University of the Sunshine Coast Sippy Downs Australia
- Sunshine Coast Health Institute Sunshine Coast Hospital and Health Service Birtinya Australia
| | - John M. D. Thompson
- School of Nursing, Midwifery and Paramedicine University of the Sunshine Coast Sippy Downs Australia
- Paediatrics: Child and Youth Health School of Medicine University of Auckland Auckland New Zealand
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Abstract
We looked at existing recommendations and supporting evidence for successful strategies to prevent the sudden infant death syndrome (SIDS). We conducted a literature search up to the 14th of December 2020 by using key terms and manual search in selected sources. We summarized the recommendations and the strength of the recommendation when and as reported by the authors. We summarized the main findings of systematic reviews with the certainty of the evidence as reported. Current evidence supports statistical associations between risk factors and SIDS, but there is globally limited evidence by controlled studies assessing the effect of the social promotion strategies to prevent SIDS through knowledge, attitude and practices, due to obvious ethical reasons. A dramatic decline in SIDS incidence has been observed in many countries after the introduction of “Back to Sleep” campaigns for prevention of SIDS. All infants should be placed to sleep in a safe environment including supine position, a firm surface, no soft objects and loose bedding, no head covering, no overheating, and room-sharing without bed-sharing. Breastfeeding on demand and the use of pacifier during sleep time protect against SIDS and should be recommended. Parents should be advised against the use of tobacco, alcohol and illicit drugs during gestation and after birth.
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Affiliation(s)
- Sophie Jullien
- Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain.
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17
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Simon M, Levy EI, Vandenplas Y. Safety considerations when managing gastro-esophageal reflux disease in infants. Expert Opin Drug Saf 2020; 20:37-49. [PMID: 33115255 DOI: 10.1080/14740338.2020.1843630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Gastro-esophageal reflux disease (GERD) in infants is worldwide diagnosed with increasing frequency, resulting in an increasing number of infants exposed to treatment. In this review, we focus on the safety of therapeutic options. Areas covered: English articles were searched from 1990 until May 2020 in PubMed and Google Scholar. Evidence suggests that non-pharmacological treatment is often effective and safe. Guidelines restrict pharmacological treatment to acid-suppressive medication, which is associated with adverse effects, often related to gastro-intestinal dysbiosis and consequences of the latter. Aluminum-free alginates have some efficacy and are not associated with relevant adverse effects. Especially in infants, GERD is often nonacid related. Prokinetics are not recommended because of lack of efficacy and numerous adverse effects. Expert opinion: Pediatric trials are underpowered regarding adverse effects. The number of infants exposed to anti-secretory agents is increasing worldwide, often without indication. Informing healthcare providers about adverse effects of acid-secretory medication may contribute to a more rational use. Acid inhibiting agents such as alginates are a drug class associated with limited efficacy and devoid of serious adverse effects. Regarding prokinetics, the risk of adverse effects outweighs the benefit. Reassurance of parents and nutritional management of GERD in infants is effective and safe.
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Affiliation(s)
- Melina Simon
- KidZ Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels, Belgium
| | - Elvira Ingrid Levy
- KidZ Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels, Belgium
| | - Yvan Vandenplas
- KidZ Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels, Belgium
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18
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Müller-Nordhorn J, Schneider A, Grittner U, Neumann K, Keil T, Willich SN, Binting S. International time trends in sudden unexpected infant death, 1969-2012. BMC Pediatr 2020; 20:377. [PMID: 32781989 PMCID: PMC7418369 DOI: 10.1186/s12887-020-02271-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/03/2020] [Indexed: 12/04/2022] Open
Abstract
Background Sudden unexpected infant death (SUID) - including sudden infant death syndrome (SIDS) - continues to be a major contributor to infant mortality worldwide. Our objective was to analyse time trends and to identify country-clusters. Methods The National Statistical Offices of 52 countries provided the number of deaths and live births (1969–2012). We calculated infant mortality rates per 1000 live births for SUID, SIDS, and all-cause mortality. Overall, 29 countries provided sufficient data for time course analyses of SUID. To sensitively model change over time, we smoothed the curves of mortality rates (1980–2010). We performed a hierarchical cluster analysis to identify clusters of time trends for SUID and SIDS, including all-cause infant mortality. Results All-cause infant mortality declined from 28.5 to 4.8 per 1000 live births (mean 12.4; 95% confidence interval 12.0–12.9) between 1969 and 2012. The cluster analysis revealed four country-clusters. Clusters 1 and 2 mostly contained countries showing the typical peak of SUID mortality during the 1980s. Cluster 1 had higher SUID mortality compared to cluster 2. All-cause infant mortality was low in both clusters but higher in cluster 1 compared to cluster 2. Clusters 3 and 4 had low rates of SUID without a peak during the 1980s. Cluster 3 had the highest all-cause infant mortality of all clusters. Cluster 4 had an intermediate all-cause infant mortality. The time trends of SUID and SIDS mortality were similar. Conclusions The country-specific time trends in SUID varied considerably. The identification of country-clusters may promote research into how changes in sleep position, smoking, immunisation, or other factors are related to our findings.
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Affiliation(s)
- Jacqueline Müller-Nordhorn
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstr. 57, 10117, Berlin, Germany.,Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Nuremberg, Germany
| | - Alice Schneider
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Konrad Neumann
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Thomas Keil
- Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany.,Institute for Health Resort Medicine and Health Promotion, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany
| | - Stefan N Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstr. 57, 10117, Berlin, Germany
| | - Sylvia Binting
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstr. 57, 10117, Berlin, Germany.
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19
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Villani LA, Pavalagantharajah S, D'Souza R. Variations in reported outcomes in studies on vasa previa: a systematic review. Am J Obstet Gynecol MFM 2020; 2:100116. [PMID: 33345867 DOI: 10.1016/j.ajogmf.2020.100116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/14/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate reported outcomes of published studies on the diagnosis and management of vasa previa in pregnancy. MATERIALS AND METHODS Databases such as MEDLINE, Embase, Cochrane, PubMed, and ClinicalTrials.gov were searched up to March 2018 for all published studies on vasa previa using combinations of the following medical subject headings and key words: vasa previa, placenta previa, low-lying placenta, succenturiate lobe or placenta, bilobed or bilobate placenta, and velamentous insertion. All original human research that described maternal, obstetric, placental, fetal or neonatal outcomes relating to pregnancies with vasa previa were included for analysis. Title and abstract screening and data extraction was conducted independently and in duplicate by 2 reviewers for all studies until total agreement for eligibility was achieved. Data extraction was also conducted in duplicate in approximately 50% of studies reviewed. RESULTS A total of 160 published studies (1004 pregnancies) were included. There was a wide range of reported outcomes, many of which were sparingly reported. The most commonly reported maternal outcomes included mode of delivery, presence of antepartum hemorrhage, time of diagnosis, and rupture of membranes. The presence of known risk factors for vasa previa such as a low-lying placenta, succenturiate or bilobed placenta, and (velamentous) cord insertion was incorrectly reported as "outcomes" in many studies. The most commonly reported fetal/neonatal outcomes included fetal heart rate, gestational age at delivery, birthweight, Apgar score, presence of neonatal anemia, cord blood gas measurements, need for blood transfusion, and death. Of note, only 3 studies reported outcomes related to life impact, maternal social and emotional functioning, perceived delivery of care, or resource utilization. CONCLUSION Despite the profound effect the diagnosis of vasa previa has on pregnant women, families, and healthcare systems, studies on vasa previa seldom report outcomes related to life impact and resource utilization. There is a need for the development of a core outcome set-a minimum standard set of outcomes deemed important by pregnant women and other stakeholders involved in their care-to standardize outcome reporting in future studies on vasa previa.
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Affiliation(s)
- Linda A Villani
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; University of Utah School of Medicine, Salt Lake City, UT
| | - Sureka Pavalagantharajah
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Rohan D'Souza
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
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20
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Goldwater PN. SIDS, prone sleep position and infection: An overlooked epidemiological link in current SIDS research? Key evidence for the "Infection Hypothesis". Med Hypotheses 2020; 144:110114. [PMID: 32758900 PMCID: PMC7366103 DOI: 10.1016/j.mehy.2020.110114] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022]
Abstract
Mainstream researchers explain the etiology of SIDS with the cardiorespiratory paradigm. This has been the focus of intense study for many decades without providing consistent supporting data to link CNS findings to epidemiological risk factors or to the usual clinicopathological findings. Despite this, and the apparent oversight of the link between prone sleep position and respiratory infection, papers citing CNS, cardiac and sleep arousal findings continue to be published. Discovery of the prone sleep position risk factor provided tangential support for the cardiorespiratory control hypothesis which defines the mainstream approach. Despite many decades of research and huge expenditure, no aetiological answer has been forthcoming. In asking why?This paper exposes some of the shortcomings regarding this apparent oversight by mainstream SIDS researchers and examines the role of respiratory infection and puts the case for the “Infection Hypothesis.” In addition, the paper provides encouragement to neuropathologists to examine the potential link between CNS findings and cardiac function (as opposed to respiratory function) in relation to infection and to examine possible correlates between CNS findings and established risk factors such as recent infection, contaminated sleeping surfaces, maternal/obstetric/higher birth, ethnicity, non-breast-feeding, male gender, etc. or with the usual gross pathological findings of SIDS (intrathoracic petechial hemorrhages, liquid blood, congested lungs). The shortcomings exposed through this review invite questions over current research directions and hopefully encourage research into other more plausible hypotheses, such as the infection paradigm.Mainstream SIDS researchers appear to have overlooked the key relationship between prone sleep position and infection. This omission has major implications for current and future SIDS research.
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Affiliation(s)
- Paul N Goldwater
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia.
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21
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Kahan T, Adesman A. Common parenting misconceptions regarding infant care: setting the record straight for parents (and some pediatricians). Curr Opin Pediatr 2019; 31:874-880. [PMID: 31693600 DOI: 10.1097/mop.0000000000000835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW First-time parents often turn to friends and family for advice regarding feeding, sleeping, bathing, diapering and toilet training, and childhood illnesses. Unfortunately, parents may at times be given incorrect and potentially dangerous advice as several widely embraced parenting practices are no longer deemed appropriate. In addition, young children are cared for by family and friends - many of whom are older and may still subscribe to outdated parenting practices.Parents and grandparents are not the only ones who subscribe to child care myths and misconceptions. Pediatricians also believe in the effectiveness of some outdated child care practices. Although some of these parenting myths are relatively benign, others may indeed pose a significant health risk or safety hazard to a young child. The purpose of this article is to review 10 commonly held myths or misconceptions regarding infant care. RECENT FINDINGS In this review article, we not only highlight many of the studies that document which outdated health beliefs are still endorsed by parents and/or pediatricians, but also review the specific health risks associated with these parenting myths or misconceptions. SUMMARY It is important that pediatricians educate parents and other primary caregivers about the potential risks of following outdated parenting practices.
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Affiliation(s)
- Tamara Kahan
- Developmental & Behavioral Pediatrics, Steven & Alexandra Cohen Children's Medical Center of New York, New Hyde Park
| | - Andrew Adesman
- Developmental & Behavioral Pediatrics, Steven & Alexandra Cohen Children's Medical Center of New York, New Hyde Park
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Konstat-Korzenny E, Cohen-Welch A, Fonseca-Portilla R, Morgenstern-Kaplan D. Sudden Unexpected Infant Death: Review and Analysis of Adherence to Recommendations. Cureus 2019; 11:e6076. [PMID: 31832293 PMCID: PMC6892570 DOI: 10.7759/cureus.6076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/05/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Sudden Unexpected Infant Death (SUID) is a term that englobes the sudden and unexpected death of an infant less than 12 months, which can be explained by organic or traumatic causes, or that can't be explained such as cases of Sudden Infant Death Syndrome (SIDS). Although many risk factors have been associated with this syndrome, one of the most widely associated and studied are incorrect sleeping techniques and practices. In 2016, the American Academy of Pediatrics (AAP) updated their safe-sleeping guidelines and sleeping environment recommendations and strategies to prevent SIDS. Methods We conducted a cross-sectional study to analyze the sleeping environments in infants that attended both the inpatient and outpatient services at a public pediatric hospital in Mexico City. A 6-item questionnaire was applied to the parent or guardian to assess the sleeping habits of infants in their homes. Results A total of 184 infants were included in the study, with a mean age of 5.87 months. Overall, the number of parents that follow safe sleeping practices was very low, with no parents following all the AAP recommendations, and over 10% not following any. Although there is uncertainty about the pathogenesis of this syndrome, the focus has shifted to prevention, especially regarding the modifiable risk factors. Conclusions It was demonstrated that our population did not know about the proper and safe sleeping techniques. In the nearby future, our goal is for health authorities in our country to implement a strategy to make the AAP recommendations part of government health campaigns.
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Affiliation(s)
- Enrique Konstat-Korzenny
- Centro De Investigación En Ciencias De La Salud Anáhuac (CICSA), Facultad De Ciencias De La Salud, Universidad Anahuac Mexico, Mexico City, MEX
| | - Ariel Cohen-Welch
- Centro De Investigación En Ciencias De La Salud Anáhuac (CICSA), Facultad De Ciencias De La Salud, Universidad Anáhuac Mexico, Mexico City, MEX
| | - Rodrigo Fonseca-Portilla
- Centro De Investigación En Ciencias De La Salud Anáhuac (CICSA), Facultad De Ciencias De La Salud, Universidad Anáhuac Mexico, Mexico City, MEX
| | - Dan Morgenstern-Kaplan
- Centro De Investigación En Ciencias De La Salud Anáhuac (CICSA), Facultad De Ciencias De La Salud, Universidad Anáhuac Mexico, Mexico City, MEX
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Carlin RF, Abrams A, Mathews A, Joyner BL, Oden R, McCarter R, Moon RY. The Impact of Health Messages on Maternal Decisions About Infant Sleep Position: A Randomized Controlled Trial. J Community Health 2019; 43:977-985. [PMID: 29637434 DOI: 10.1007/s10900-018-0514-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Sudden infant death syndrome (SIDS) rates in African-Americans are more than twice national rates, and historically, African-American parents are more likely than other groups to place infants prone, even when they are aware of supine sleep recommendations. Prior studies have shown African-Americans have low self-efficacy against SIDS but high self-efficacy against suffocation. This study aimed to determine the impact of a specific health message about suffocation prevention on African-American parental decisions regarding infant sleep position. We conducted a randomized controlled trial of 1194 African-American mothers, who were randomized to receive standard messages about safe sleep practices to reduce the risk of SIDS, or enhanced messages about safe sleep practices to prevent SIDS and suffocation. Mothers were interviewed about knowledge and attitude, self-efficacy and current infant care practices when infants were 2-3 weeks, 2-3 months and 5-6 months old. Analyses of covariance were conducted to estimate the change in knowledge, attitudes and practice in each group, and chi square tests were used to compare sleep position with each variable. Over the first 6 months, the proportion of African-American infants placed supine gradually decreased and was unchanged by enhanced education about SIDS, suffocation risk and sleep safety. While initially high self-efficacy against SIDS and suffocation correlated with supine positioning, by 5-6 months self-efficacy did not correspond to sleep position in either group.
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Affiliation(s)
- Rebecca F Carlin
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Anna Abrams
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA
| | - Anita Mathews
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA
| | - Brandi L Joyner
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA
| | - Rosalind Oden
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA
| | - Robert McCarter
- Center for Translational Science, Children's National Medical Center, Washington, DC, USA.,Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA
| | - Rachel Y Moon
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.
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Bennett T, Martin LJ, Heathfield LJ. Global trends in the extent of death scene investigation performed for sudden and unexpected death of infant (SUDI) cases: A systematic review. Forensic Sci Int 2019; 301:435-444. [PMID: 31229847 DOI: 10.1016/j.forsciint.2019.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/25/2019] [Accepted: 06/09/2019] [Indexed: 11/28/2022]
Abstract
Sudden unexpected death of infants (SUDI) is the rapid and unexpected death of an infant aged less than 1year old. These deaths are referred for a medico-legal investigation to establish cause of death. National and regional protocols for the investigation of SUDI cases have been established in some countries and these typically include a death scene investigation component. However, there is a paucity of literature detailing the nature and extent of death scene investigation protocols. A systematic review was conducted to review the scope of death scene investigation of SUDI cases worldwide. Relevant articles (n=74) were identified by searching four literature databases, three discipline-specific journals, as well as each article's reference list, until saturation was reached. Of the 16 countries represented by the included articles, seven made specific reference to the standardised protocol used, which included photography, interviews and/or scene re-enactments. The remaining 54 studies appeared to include a subset of these analyses during death scene investigation, which varied between countries, and between SUDI admissions. This may be attributed to the differing socio-economic standings of countries, and the resources available. Only four studies were from developing countries, three of which originated from South Africa. Overall, where a standardised death scene investigation was performed, it added value to the post-mortem investigation; as such, death scene investigation should be encouraged in SUDI investigation. To this end, protocols should be established nationally, and contain core analyses, which could be expanded depending on the needs and resources of the country.
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Affiliation(s)
- Tracy Bennett
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa.
| | - Lorna J Martin
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa.
| | - Laura J Heathfield
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa.
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25
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Goodstein MH, Lagon E, Bell T, Joyner BL, Moon RY. Stock Photographs Do Not Comply With Infant Safe Sleep Guidelines. Clin Pediatr (Phila) 2018; 57:403-409. [PMID: 28868896 DOI: 10.1177/0009922817728698] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated images in popular stock photography websites for adherence with American Academy of Pediatrics (AAP) guidelines for safe infant sleep practices. Three top stock photo websites were used to collect photographs generated from key phrases. All images depicting an infant sleep environment were analyzed for consistency with AAP guidelines. Descriptive statistics, chi-square and z test of proportions, were conducted. A total of 1233 of 1947 stock photographs showed sleeping infants on a flat surface. In all, 627 (50.8%) photographs showed the infant in the supine position and 79 (5%) of all infant sleep environments were adherent with AAP recommendations. Bedding inconsistent with safe sleep recommendations was identified in 1133 images (71.3%), with blankets noted in 49.5%. Images depicting sleeping infants on stock photography sites do not routinely adhere to AAP recommendations. Media messages inconsistent with health care messages create confusion and misinformation about infant sleep safety and may lead inadvertently to unsafe practices.
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Affiliation(s)
| | - Elena Lagon
- 2 University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Brandi L Joyner
- 3 Goldberg Center for Community Pediatric Health, Washington, DC, USA
| | - Rachel Y Moon
- 2 University of Virginia School of Medicine, Charlottesville, VA, USA
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26
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McDonald EM, Mack K, Shields WC, Lee RP, Gielen AC. Primary Care Opportunities to Prevent Unintentional Home Injuries: A Focus on Children and Older Adults. Am J Lifestyle Med 2018; 12:96-106. [PMID: 27141210 PMCID: PMC4850836 DOI: 10.1177/1559827616629924] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/10/2016] [Accepted: 01/11/2016] [Indexed: 01/17/2023] Open
Abstract
Unintentional injuries are a persistent public health problem in the United States. A new health care landscape has the potential to create a clinical environment that fosters greater involvement by health care providers in injury prevention. The aim of this article is to provide evidence supporting the need for engagement by primary care providers in unintentional home injury prevention along with examples of how this could be accomplished. We know a great deal about what population groups are at risk for certain types of injuries. We also know that many injuries can be prevented through policies, programs, and resources that ensure safe environments and promote safe behaviors. For example, the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative comprises clinical decision support tools and educational materials for health care providers. Two effective interventions that have demonstrated a reduction in falls among children are the redesign of baby walkers (engineering) and the mandated use of window guards (enforcement). Primary care clinicians can play a key role in promoting their patient's safety. Taken collectively, a focused attention on preventing unintentional home injuries by primary care providers can contribute to the reduction of injuries and result in optimal health for all.
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Affiliation(s)
- Eileen M. McDonald
- Eileen M. McDonald, MS, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Room 731, Baltimore, MD 21205; e-mail:
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Moon RY, Mathews A, Joyner BL, Oden RP, He J, McCarter R. Health Messaging and African-American Infant Sleep Location: A Randomized Controlled Trial. J Community Health 2018; 42:1-9. [PMID: 27470122 DOI: 10.1007/s10900-016-0227-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Infant-parent bedsharing increases the risk of SIDS and other sleep-related deaths. Despite AAP recommendations to avoid bedsharing, public health efforts have been unsuccessful in changing behaviors. African-American infants are more than twice as likely to die from SIDS and other sleep-related deaths, and are also twice as likely to bedshare with their parents. Further, African-American parents have a high degree of self-efficacy with regards to preventing infant suffocation, but low self-efficacy with regards to SIDS risk reduction. It is unclear whether messages emphasizing suffocation prevention will decrease bedsharing. To evaluate the impact of specific health messages on African-American parental decisions regarding infant sleep location. We conducted a randomized, controlled trial of African-American mothers of infants. The control group received standard messaging emphasizing AAP-recommended safe sleep practices, including avoidance of bedsharing, for the purposes of SIDS risk reduction. The intervention group received enhanced messaging emphasizing safe sleep practices, including avoidance of bedsharing, for both SIDS risk reduction and suffocation prevention. Participants completed interviews at 2-3 weeks, 2-3 months, and 5-6 months after the infant's birth. 1194 mothers were enrolled in the study, and 637 completed all interviews. Bedsharing, both usually (aOR 1.005 [95 % CI 1.003, 1.006]) and last night (aOR 1.004 [95 % CI 1.002, 1.007]) increased slightly but statistically significantly with infant age (p < 0.001). Receipt of the enhanced message did not impact on sleep location. Maternal belief that bedsharing increased the risk of SIDS or suffocation declined over 6 months (p < 0.001) and did not differ by group assignment. African-American mothers who received an enhanced message about SIDS risk reduction and suffocation prevention were no less likely to bedshare with their infants. CLINICAL TRIALS REGISTRATION Clinical Trials.gov identifier NCT01361880.
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Affiliation(s)
- Rachel Y Moon
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA.
- Center for Translational Science, Children's National Medical Center, Washington, DC, USA.
- Department of Pediatrics, George Washington University, Washington, DC, USA.
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.
- Division of General Pediatrics, University of Virginia, PO Box 800386, Charlottesville, VA, 22908, USA.
| | - Anita Mathews
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA
| | - Brandi L Joyner
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA
| | - Rosalind P Oden
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA
| | - Jianping He
- Center for Translational Science, Children's National Medical Center, Washington, DC, USA
| | - Robert McCarter
- Center for Translational Science, Children's National Medical Center, Washington, DC, USA
- Department of Pediatrics, George Washington University, Washington, DC, USA
- Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA
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28
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Pease AS, Blair PS, Ingram J, Fleming PJ. Mothers' knowledge and attitudes to sudden infant death syndrome risk reduction messages: results from a UK survey. Arch Dis Child 2018; 103:33-38. [PMID: 28814422 DOI: 10.1136/archdischild-2017-312927] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/22/2017] [Accepted: 07/04/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate mothers' knowledge of reducing the risks for sudden infant death syndrome (SIDS) and attitudes towards safer sleep practices. DESIGN AND SETTING A cross-sectional survey was carried out in deprived areas of Bristol, UK. Recruitment took place in 2014 at local health visitor-led baby clinics. PARTICIPANTS Of 432 mothers approached, 400 (93%) completed the face-to-face survey. Participants with infants at 'higher' risk of SIDS (using an algorithm based on a previous observational study) were compared with those at 'lower' risk. MAIN OUTCOME MEASURES The survey asked participants to recall three SIDS risk reduction strategies (unprompted), and scored responses to 14 SIDS risk-related infant sleep scenarios (prompted). RESULTS Overall, 48/400 (12%) mothers were classified as higher risk. Mothers in the higher risk group were less likely to breast feed (multivariate OR=3.59(95% CI 1.46 to 8.86)), less likely to be able to cite two or more unprompted correct SIDS risk reduction strategies (multivariate OR=2.05(95% CI 1.02 to 4.13)) and scored lower on prompted safer sleep scenarios overall.Notably, only 206/400 (52%) of all mothers surveyed (33% in the higher risk group) from these deprived areas in Bristol identified infant sleep position as a risk reduction strategy for SIDS, despite 25 years of campaigns. CONCLUSIONS Mothers in the higher risk group were disadvantaged when it came to some aspects of knowledge of SIDS risk reduction and attitudes to safer sleep. The initial 'Back-to Sleep' message that dramatically reduced these deaths a generation ago needs more effective promotion for today's generation of mothers.
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Affiliation(s)
- Anna S Pease
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Peter S Blair
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jenny Ingram
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Peter J Fleming
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Erdoğan Ç, Turan T. Risky Behaviors of Mothers with Infants on Sudden Infant Death Syndrome in Turkey. J Pediatr Nurs 2018; 38:e2-e6. [PMID: 29208338 DOI: 10.1016/j.pedn.2017.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Sudden infant death syndrome is the most common cause of death during the post-neonatal period. Factors such as sleeping position, bed sharing, pillow use, smoking during pregnancy and the breastfeeding period constitute risk factors for sudden infant death syndrome. This study aims to identify the risky behaviors of mothers with infants that may put their children at risk for sudden infant death syndrome. DESIGN AND METHODS This is a cross-sectional, descriptive study. Data were collected using a questionnaire that was developed by the researchers. The questionnaire was filled out by 456 mothers who applied to the family health center between October 2014 and January 2015. RESULTS The greatest risk factor is the infant's sleeping position. A total of 77.9% of the mothers put their babies in bed in a non-supine position; 65.8% used a pillow when they put their babies in bed, 52.9% used a soft mattress, and 28.5% shared their beds with their babies. Prone sleeping was more likely to occur when smoke was present in the home or a pillow was used. CONCLUSION Nurses should notify families of the risky behaviors that can cause sudden infant death syndrome and plan appropriate nursing care.
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Affiliation(s)
- Çiğdem Erdoğan
- Pamukkale University, Faculty of Health Sciences, Pediatric Nursing Department, Turkey.
| | - Türkan Turan
- Pamukkale University, Faculty of Health Sciences, Pediatric Nursing Department, Turkey
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Shipstone R, Young J, Kearney L. New Frameworks for Understanding Sudden Unexpected Deaths in Infancy (SUDI) in Socially Vulnerable Families. J Pediatr Nurs 2017; 37:35-41. [PMID: 28697921 DOI: 10.1016/j.pedn.2017.06.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/16/2017] [Accepted: 06/30/2017] [Indexed: 12/29/2022]
Abstract
THEORETICAL PRINCIPLES Sociological frameworks may enhance understanding of the complex and multidimensional nature of disadvantage, which is prevalent among families who experience Sudden Unexpected Death in Infancy (SUDI). PHENOMENA ADDRESSED SUDI is the largest category of postneonatal death and largely associated with the social determinants of health. The highly successful 'Back to Sleep' campaign has resulted in a more than 85% decrease in SUDI. However, social inequalities have accompanied this decrease, and the burden of SUDI now lies with the most disadvantaged and socially vulnerable families. A considerable body of research on the phenomena of SUDI and disadvantage has been published over the last decade, demonstrating the widening social gradient in SUDI, and the importance in recognising structural factors and the multifactorial nature of disadvantage. Gaps in understanding of risk factors and scepticism about the received wisdom of health professionals have emerged as central themes in understanding why socially vulnerable families may adopt unsafe infant care practices. The direct impact of social disadvantage on infant care has also been recognised. RESEARCH LINKAGES The translation of epidemiological findings regarding SUDI risk into public health recommendations for health professionals and families alike has to date focused on eliminating individual level risk behaviours. Unfortunately, such a model largely ignores the broader social, cultural, and structural contexts in which such behaviours occur. Translating the new knowledge offered by sociological frameworks and the principles of behavioural economics into evidence based interventions may assist in the reduction of SUDI mortality in our most socially vulnerable families.
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Affiliation(s)
- Rebecca Shipstone
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Queensland, Australia
| | - Jeanine Young
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Queensland, Australia.
| | - Lauren Kearney
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Queensland, Australia; Women and Families Service Group, Sunshine Coast Hospital and Health Service, Australia
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Affiliation(s)
- Rosemary S C Horne
- Senior Principal Research Fellow and Professor, The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne Australia; Chair, National Scientific Advisory Group of SIDS and Kids, Australia.
| | - Fern R Hauck
- Spencer P. Bass MD Twenty-First Century Professor of Family Medicine, Professor of Public Health Sciences, Director, International Family Medicine Clinic University of Virginia; Member, American Academy of Pediatrics Task Force on SIDS
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Low cerebrospinal fluid hypocretin levels during sudden infant death syndrome (SIDS) risk period. Sleep Med 2017; 33:57-60. [DOI: 10.1016/j.sleep.2016.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/15/2016] [Accepted: 12/17/2016] [Indexed: 11/20/2022]
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Roberts SAG, Symonds JD, Chawla R, Toman E, Bishop J, Solanki GA. Positional plagiocephaly following ventriculoperitoneal shunting in neonates and infancy-how serious is it? Childs Nerv Syst 2017; 33:275-280. [PMID: 27848003 PMCID: PMC5352750 DOI: 10.1007/s00381-016-3275-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 10/07/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE We test the hypothesis that ventriculoperitoneal (VP) shunt insertion significantly increases contralateral positional plagiocephaly. METHODS We reviewed 339 children who had a VP shunt inserted at Birmingham Children's Hospital between 2006 and 2013, noting laterality of shunt insertion and frontal or occipital position. We ascertained the presence of post-operative positional plagiocephaly using the cranial vault asymmetry index. Multinomial logistic regression modelling was used to examine relationships between plagiocephaly, shunt position, gender and age. Adjusted odds and risk ratios for effect of variables on plagiocephaly were calculated. RESULTS Children with occipital VP shunts are at significant risk of developing contralateral positional plagiocephaly, particularly in the first 12 months of life. CONCLUSIONS We recommend careful follow-up and advice regarding head positioning following surgery. There should be consideration for active monitoring to avoid plagiocephaly, including physiotherapy and health visitor interventions. Endoscopic third ventriculostomy in selected cases or anterior shunt placement could be considered. A larger national study would be of interest to evaluate the extent of an otherwise correctable problem.
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Affiliation(s)
- Stuart A G Roberts
- Department of Paediatric Neurosurgery, Birmingham Children's Hospital, Birmingham, West Midlands, UK.
- The Computational, Cognitive and Clinical Neuroimaging Laboratory (C3NL), The Hammersmith Hospital, 3rd Floor, Burlington Danes Building, Du Cane Road, W12 0NN, London, UK.
| | - Joseph D Symonds
- Fraser of Allander Neurosciences Unit, Royal Hospital for Children, G51 4TF, Glasgow, UK
| | - Reema Chawla
- Department of Paediatric Neurosurgery, Birmingham Children's Hospital, Birmingham, West Midlands, UK
| | - Emma Toman
- National Institute for Health Research (NIHR), Surgical Reconstruction & Microbiology Research Centre (SRMRC), Birmingham, UK
| | - Jonathan Bishop
- Birmingham Clinical Trials Unit, Robert Aitken Institute, University of Birmingham, B15 2TT, Edgbaston, UK
| | - Guirish A Solanki
- Department of Paediatric Neurosurgery, Birmingham Children's Hospital, Birmingham, West Midlands, UK
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Pease A, Ingram J, Blair PS, Fleming PJ. Factors influencing maternal decision-making for the infant sleep environment in families at higher risk of SIDS: a qualitative study. BMJ Paediatr Open 2017; 1:e000133. [PMID: 29637151 PMCID: PMC5862195 DOI: 10.1136/bmjpo-2017-000133] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Qualitative interviews with mothers of babies at higher risk of sudden infant death syndrome (SIDS) were carried out to understand their views and decision-making process on the infant sleep environment and safe sleep messages. DESIGN AND SETTING Twenty semi-structured interviews were conducted between February and November 2014 in deprived areas of Bristol, UK. Mothers were asked about their decision-making for the infant sleep environment and safe sleep messages including infant sleep position, co-sleeping, smoking, dummy use, feeding and disrupted routines. The interviews were transcribed, coded and thematic analysis carried out. PARTICIPANTS Participants were invited based on an algorithm developed in a previous SIDS case control study that identified an increased risk of SIDS from four demographic characteristics: young maternal age, smoking during pregnancy, three or more children, and a measure of deprivation. The presence of three, or more characteristics led to being invited to take part in the qualitative study. RESULTS Factors influencing mothers' adherence to the safe sleep messages included previous experience and the credibility of the advice given. They described disrupted routines that led to risky scenarios with a belief that occasional risks were acceptable. Where circumstances made following the advice more difficult they found alternative strategies to reduce the risk, including the use of movement monitors, regular checking and a belief that lighter maternal sleep in the presence of a baby was protective. CONCLUSIONS Safer sleep messages should be tailored to fit with the lived realities of mothers, especially those at higher risk. The traditional list of 'do's' and 'don'ts' was not well accepted by this group. Interventions that seek to influence this higher-risk group should acknowledge mothers' own protective instincts and consider their beliefs and understanding behind the safer sleep messages if they are to be effective and encourage this group to change.
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Affiliation(s)
- Anna Pease
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jenny Ingram
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Peter S Blair
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Peter J Fleming
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Comparison of Infant Sleep Practices in African-American and US Hispanic Families: Implications for Sleep-Related Infant Death. J Immigr Minor Health 2016; 17:834-42. [PMID: 24705738 DOI: 10.1007/s10903-014-0016-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
African-American and Hispanic families share similar socioeconomic profiles. Hispanic rates of sleep-related infant death are four times lower than African-American rates. We conducted a cross-sectional, multi-modal (surveys, qualitative interviews) study to compare infant care practices that impact risk for sleep-related infant death in African-American and Hispanic families. We surveyed 422 African-American and 90 Hispanic mothers. Eighty-three African-American and six Hispanic mothers participated in qualitative interviews. African-American infants were more likely to be placed prone (p < 0.001), share the bed with the parent (p < 0.001), and to be exposed to smoke (p < 0.001). Hispanic women were more likely to breastfeed (p < .001), while African-American women were more knowledgeable about SIDS. Qualitative interviews indicate that, although African-American and Hispanic parents had similar concerns, behaviors differed. Although the rationale for infant care decisions was similar for African-American and Hispanic families, practices differed. This may help to explain the racial/ethnic disparity seen in sleep-related infant deaths.
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Moon RY. SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment. Pediatrics 2016; 138:peds.2016-2940. [PMID: 27940805 DOI: 10.1542/peds.2016-2940] [Citation(s) in RCA: 371] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS), ill-defined deaths, and accidental suffocation and strangulation in bed. After an initial decrease in the 1990s, the overall sleep-related infant death rate has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, use of a firm sleep surface, room-sharing without bed-sharing, and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence and rationale for recommendations are presented for skin-to-skin care for newborn infants, bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. In addition, expanded recommendations for infant sleep location are included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment," which is included in this issue.
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de Luca F, Hinde A. Effectiveness of the 'Back-to-Sleep' campaigns among healthcare professionals in the past 20 years: a systematic review. BMJ Open 2016; 6:e011435. [PMID: 27694485 PMCID: PMC5051431 DOI: 10.1136/bmjopen-2016-011435] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES From the late 1980s 'Back-to-Sleep' (BTS) campaigns were run in most developed countries to increase awareness of the supine position's protective effect against sleep-related infant deaths. Once the media awareness-raising action associated with these campaigns ended, healthcare professionals' role became crucial. The goal of this paper is to determine if healthcare professionals' knowledge and parent advice consistent with evidence-based infant sleep recommendations have changed over the past 20 years. SETTING All studies investigating healthcare professionals' knowledge and/or advice to parents were included in a systematic review. The search was performed in PubMed and in MEDLINE, and 21 studies were identified. RESULTS The correctness of healthcare professionals' knowledge and parent advice about the supine sleeping position increased over the past 20 years. However, the percentage of those aware that parents should avoid putting their babies to sleep in a prone position is decreasing over time: from about 97% in the 1990s to about 90% at the end of the 2000s. CONCLUSIONS The effectiveness of the BTS campaigns in publicising the benefits of the supine position is confirmed by this paper. More and more healthcare professionals know that it is the best position to reduce the risk of sleep-related deaths and they recommend it exclusively. However, the decrease in the knowledge about non-prone positions suggests that the campaigns may not have focused enough on the dangers of the prone position.
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Affiliation(s)
- Federico de Luca
- School of Social Sciences: Social Statistics & Demography, University of Southampton, Southampton, UK
| | - Andrew Hinde
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
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McDonald FB, Chandrasekharan K, Wilson RJA, Hasan SU. Cardiorespiratory control and cytokine profile in response to heat stress, hypoxia, and lipopolysaccharide (LPS) exposure during early neonatal period. Physiol Rep 2016; 4:4/2/e12688. [PMID: 26811056 PMCID: PMC4760388 DOI: 10.14814/phy2.12688] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Sudden infant death syndrome (SIDS) is one of the most common causes of postneonatal infant mortality in the developed world. An insufficient cardiorespiratory response to multiple environmental stressors (such as prone sleeping positioning, overwrapping, and infection), during a critical period of development in a vulnerable infant, may result in SIDS. However, the effect of multiple risk factors on cardiorespiratory responses has rarely been tested experimentally. Therefore, this study aimed to quantify the independent and possible interactive effects of infection, hyperthermia, and hypoxia on cardiorespiratory control in rats during the neonatal period. We hypothesized that lipopolysaccharide (LPS) administration will negatively impact cardiorespiratory responses to increased ambient temperature and hypoxia in neonatal rats. Sprague-Dawley neonatal rat pups were studied at postnatal day 6-8. Rats were examined at an ambient temperature of 33°C or 38°C. Within each group, rats were allocated to control, saline, or LPS (200 μg/kg) treatments. Cardiorespiratory and thermal responses were recorded and analyzed before, during, and after a hypoxic exposure (10% O2). Serum samples were taken at the end of each experiment to measure cytokine concentrations. LPS significantly increased cytokine concentrations (such as TNFα, IL-1β, MCP-1, and IL-10) compared to control. Our results do not support a three-way interaction between experimental factors on cardiorespiratory control. However, independently, heat stress decreased minute ventilation during normoxia and increased the hypoxic ventilatory response. Furthermore, LPS decreased hypoxia-induced tachycardia. Herein, we provide an extensive serum cytokine profile under various experimental conditions and new evidence that neonatal cardiorespiratory responses are adversely affected by dual interactions of environmental stress factors.
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Affiliation(s)
- Fiona B McDonald
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kumaran Chandrasekharan
- Fetal and Neonatal Physiology, Department of Pediatrics, Faculty of Medicine B271, Health Sciences Center, University of Calgary, Calgary, Alberta, Canada
| | - Richard J A Wilson
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shabih U Hasan
- Fetal and Neonatal Physiology, Department of Pediatrics, Faculty of Medicine B271, Health Sciences Center, University of Calgary, Calgary, Alberta, Canada
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Mathews A, Joyner BL, Oden RP, He J, McCarter R, Moon RY. Messaging Affects the Behavior of African American Parents with Regards to Soft Bedding in the Infant Sleep Environment: A Randomized Controlled Trial. J Pediatr 2016; 175:79-85.e2. [PMID: 27263400 PMCID: PMC9528736 DOI: 10.1016/j.jpeds.2016.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/19/2016] [Accepted: 05/03/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the impact of specific health messages on the decisions of African American parents regarding soft bedding use, specifically related to the high degree of self-efficacy that African American parents have with regards to preventing infant suffocation vs low self-efficacy with regards to sudden infant death syndrome (SIDS) risk reduction. STUDY DESIGN We conducted a randomized, controlled clinical trial of African American mothers of infants. The control group received standard messaging emphasizing safe sleep practices recommended by the American Academy of Pediatrics for the purposes of SIDS risk reduction. The intervention group received enhanced messaging emphasizing safe sleep practices for both SIDS risk reduction and suffocation prevention. Participants completed interviews at 2-3 weeks, 2-3 months, and 5-6 months after the infant's birth. RESULTS Of 1194 mothers enrolled, 637 completed all interviews. The use of soft bedding both in the past week and last night declined with age (P < .001). Infants in the enhanced group had a lower rate of use of soft bedding in the past week (P = .006) and last night (P = .013). Mothers who received the enhanced message were more likely to state that they avoided soft bedding to protect their infant from suffocation. CONCLUSIONS African American mothers who receive an enhanced message about SIDS risk reduction and suffocation prevention are less likely to use soft bedding in their infant's sleep environment. TRIAL REGISTRATION ClinicalTrials.gov: NCT01361880.
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Affiliation(s)
- Anita Mathews
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC
| | - Brandi L Joyner
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC
| | - Rosalind P Oden
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC
| | - Jianping He
- Center for Translational Science, Children's National Medical Center, Washington, DC
| | - Robert McCarter
- Center for Translational Science, Children's National Medical Center, Washington, DC; Department of Pediatrics, George Washington University, Washington, DC
| | - Rachel Y Moon
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC; Center for Translational Science, Children's National Medical Center, Washington, DC; Department of Epidemiology and Biostatistics, Washington, DC.
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Pease AS, Fleming PJ, Hauck FR, Moon RY, Horne RSC, L'Hoir MP, Ponsonby AL, Blair PS. Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics 2016; 137:peds.2015-3275. [PMID: 27244847 DOI: 10.1542/peds.2015-3275] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Swaddling is a traditional practice of wrapping infants to promote calming and sleep. Although the benefits and risks of swaddling in general have been studied, the practice in relation to sudden infant death syndrome remains unclear. OBJECTIVE The goal of this study was to conduct an individual-level meta-analysis of sudden infant death syndrome risk for infants swaddled for sleep. DATA SOURCES Additional data on sleeping position and age were provided by authors of included studies. STUDY SELECTION Observational studies that measured swaddling for the last or reference sleep were included. DATA EXTRACTION Of 283 articles screened, 4 studies met the inclusion criteria. RESULTS There was significant heterogeneity among studies (I(2) = 65.5%; P = .03), and a random effects model was therefore used for analysis. The overall age-adjusted pooled odds ratio (OR) for swaddling in all 4 studies was 1.58 (95% confidence interval [CI], 0.97-2.58). Removing the most recent study conducted in the United Kingdom reduced the heterogeneity (I(2) = 28.2%; P = .25) and provided a pooled OR (using a fixed effects model) of 1.38 (95% CI, 1.05-1.80). Swaddling risk varied according to position placed for sleep; the risk was highest for prone sleeping (OR, 12.99 [95% CI, 4.14-40.77]), followed by side sleeping (OR, 3.16 [95% CI, 2.08-4.81]) and supine sleeping (OR, 1.93 [95% CI, 1.27-2.93]). Limited evidence suggested swaddling risk increased with infant age and was associated with a twofold risk for infants aged >6 months. LIMITATIONS Heterogeneity among the few studies available, imprecise definitions of swaddling, and difficulties controlling for further known risks make interpretation difficult. CONCLUSIONS Current advice to avoid front or side positions for sleep especially applies to infants who are swaddled. Consideration should be given to an age after which swaddling should be discouraged.
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Affiliation(s)
- Anna S Pease
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom;
| | - Peter J Fleming
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | | | - Rachel Y Moon
- Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Pediatrics, Monash University, Victoria, Australia
| | | | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute, Royal Children's Hospital, University of Melbourne, and Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Peter S Blair
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Raine R, Fitzpatrick R, Barratt H, Bevan G, Black N, Boaden R, Bower P, Campbell M, Denis JL, Devers K, Dixon-Woods M, Fallowfield L, Forder J, Foy R, Freemantle N, Fulop NJ, Gibbons E, Gillies C, Goulding L, Grieve R, Grimshaw J, Howarth E, Lilford RJ, McDonald R, Moore G, Moore L, Newhouse R, O’Cathain A, Or Z, Papoutsi C, Prady S, Rycroft-Malone J, Sekhon J, Turner S, Watson SI, Zwarenstein M. Challenges, solutions and future directions in the evaluation of service innovations in health care and public health. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04160] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
HeadlineEvaluating service innovations in health care and public health requires flexibility, collaboration and pragmatism; this collection identifies robust, innovative and mixed methods to inform such evaluations.
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Affiliation(s)
- Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Helen Barratt
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames, Department of Applied Health Research, University College London, London, UK
| | - Gywn Bevan
- Department of Management, London School of Economics and Political Science, London, UK
| | - Nick Black
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Boaden
- Alliance Manchester Business School, University of Manchester, Manchester, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Manchester, UK
| | - Peter Bower
- National Institute for Health Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jean-Louis Denis
- Canada Research Chair in Governance and Transformation of Health Organizations and Systems, École Nationale d’Administration Publique, Ville de Québec, QC, Canada
| | - Kelly Devers
- Health Policy Centre, Urban Institute, Washington, DC, USA
| | - Mary Dixon-Woods
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), University of Sussex, Brighton, UK
| | - Julien Forder
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
| | - Robbie Foy
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
| | - Elizabeth Gibbons
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Clare Gillies
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands and NIHR Research Design Service East Midlands, University of Leicester, Leicester, UK
| | - Lucy Goulding
- King’s Improvement Science, Centre for Implementation Science, King’s College London, London, UK
| | - Richard Grieve
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Emma Howarth
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, University of Cambridge, Cambridge, UK
| | | | - Ruth McDonald
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Graham Moore
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Laurence Moore
- Medical Research Council (MRC)/Chief Scientist Office (CSO) Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Robin Newhouse
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Zeynep Or
- Institut de Recherche et Documentation en Économie de la Santé, Paris, France
| | - Chrysanthi Papoutsi
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, Imperial College London, London, UK
| | | | | | - Jasjeet Sekhon
- Department of Political Science and Statistics, University of California Berkeley, Berkeley, CA, USA
| | - Simon Turner
- Department of Applied Health Research, University College London, London, UK
| | | | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Department of Family Medicine, Western University, London, ON, Canada
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Crane D, Ball HL. A qualitative study in parental perceptions and understanding of SIDS-reduction guidance in a UK bi-cultural urban community. BMC Pediatr 2016; 16:23. [PMID: 26830470 PMCID: PMC4736706 DOI: 10.1186/s12887-016-0560-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 01/27/2016] [Indexed: 12/02/2022] Open
Abstract
Background Differences in both Sudden Infant Death Syndrome (SIDS) rates and infant care practices between white British and South Asians in UK are well known, but research has not yet examined how these two groups understand and implement SIDS-reduction guidance. This study aimed to discover how white British and Pakistani mothers in Bradford recall, understand and interpret SIDS-reduction guidance, and to explore whether and how they implement this guidance in caring for their infants. Methods In-depth narrative interviews with 46 mothers (25 white British origin and 21 Pakistani origin) of 8–12 week old infants recruited from the pool of participants enrolled in the ‘Born in Bradford’ (BiB) cohort study. Results All mothers were aware of UK SIDS-reduction guidance from leaflets presented to them during antenatal or postnatal interactions with health care providers. Pakistani mothers tended to dismiss the guidance in toto as being irrelevant to their cultural practices; white British mothers dismissed, adapted and adopted aspects of the guidance to suit their preferred parenting decisions and personal circumstances. Many mothers misunderstood or misinterpreted the guidance given and explained their infant care behaviour according to their social and cultural circumstances. Conclusions Current SIDS reduction information in the UK does not meet the needs of immigrant families, and is easily misinterpreted or misunderstood by mothers from all sections of the community. Tailored information acknowledging cultural differences in infant care practices is vital, as is greater discussion with all mothers about the reasons for SIDS reduction guidance. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0560-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Denise Crane
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham, DH1 3LE, UK.
| | - Helen L Ball
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham, DH1 3LE, UK
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Hodkinson P, Argent A, Wallis L, Reid S, Perera R, Harrison S, Thompson M, English M, Maconochie I, Ward A. Pathways to Care for Critically Ill or Injured Children: A Cohort Study from First Presentation to Healthcare Services through to Admission to Intensive Care or Death. PLoS One 2016; 11:e0145473. [PMID: 26731245 PMCID: PMC4712128 DOI: 10.1371/journal.pone.0145473] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/04/2015] [Indexed: 11/21/2022] Open
Abstract
Purpose Critically ill or injured children require prompt identification, rapid referral and quality emergency management. We undertook a study to evaluate the care pathway of critically ill or injured children to identify preventable failures in the care provided. Methods A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation to healthcare services until paediatric intensive care unit (PICU) admission or emergency department death, using expert panel review of medical records and caregiver interview. Main outcomes were expert assessment of overall quality of care; avoidability of severity of illness and PICU admission or death and the identification of modifiable factors. Results The study enrolled 282 children, 252 emergency PICU admissions, and 30 deaths. Global quality of care was graded good in 10% of cases, with half having at least one major impact modifiable factor. Key modifiable factors related to access to care and identification of the critically ill, assessment of severity, inadequate resuscitation, and delays in decision making and referral. Children were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 185 (74%) of children, and death prior to PICU admission was avoidable in 17/30 (56.7%) of children. Conclusions The study presents a novel methodology, examining quality of care across an entire system, and highlighting the complexity of the pathway and the modifiable events amenable to interventions, that could reduce mortality and morbidity, and optimize utilization of scarce critical care resources; as well as demonstrating the importance of continuity and quality of care.
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Affiliation(s)
- Peter Hodkinson
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Andrew Argent
- Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Steve Reid
- Directorate of Primary Health Care, University of Cape Town, Cape Town, South Africa
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sian Harrison
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, United States of America
| | - Mike English
- Nuffield Department of Medicine, Oxford University, Oxford, UK and KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College, London, UK and NIHR BRC funded researcher Imperial College, London
| | - Alison Ward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Alm B, Wennergren G, Möllborg P, Lagercrantz H. Breastfeeding and dummy use have a protective effect on sudden infant death syndrome. Acta Paediatr 2016; 105:31-8. [PMID: 26175065 PMCID: PMC5049485 DOI: 10.1111/apa.13124] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/17/2015] [Accepted: 07/07/2015] [Indexed: 12/26/2022]
Abstract
We conducted a literature review on the effect of breastfeeding and dummy (pacifier) use on sudden infant death syndrome (SIDS). From 4343 abstracts, we identified 35 relevant studies on breastfeeding and SIDS, 27 on dummy use and SIDS and 59 on dummy use versus breastfeeding. Conclusion We found ample evidence that both breastfeeding and dummy use reduce the risk of SIDS. There has been a general reluctance to endorse dummy use in case it has a detrimental effect of breastfeeding. However, recent evidence suggests that dummy use might not be as harmful to breastfeeding as previously believed.
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Affiliation(s)
- Bernt Alm
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Göran Wennergren
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Per Möllborg
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Hugo Lagercrantz
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
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Scorza FA. Breaking bad news on the possible occurrence of sudden death in children with epilepsy sleeping on sofas. Epilepsy Behav 2015; 50:88-9. [PMID: 26149063 DOI: 10.1016/j.yebeh.2015.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/05/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Departamento de Neurologia/Neurocirurgia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
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Hesdorffer DC, Crandall LA, Friedman D, Devinsky O. Sudden unexplained death in childhood: A comparison of cases with and without a febrile seizure history. Epilepsia 2015; 56:1294-300. [DOI: 10.1111/epi.13066] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Dale C. Hesdorffer
- Gertrude H. Sergievsky Center and Department of Epidemiology; Columbia University; New York New York U.S.A
| | - Laura A. Crandall
- SUDC Foundation; Herndon Virginia U.S.A
- Department of Neurology; Com-prehensive Epilepsy Center; NYU Langone Medical Center; New York New York U.S.A
| | - Daniel Friedman
- Department of Neurology; Com-prehensive Epilepsy Center; NYU Langone Medical Center; New York New York U.S.A
| | - Orrin Devinsky
- Department of Neurology; Com-prehensive Epilepsy Center; NYU Langone Medical Center; New York New York U.S.A
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Gielen AC, McDonald EM, Shields W. Unintentional home injuries across the life span: problems and solutions. Annu Rev Public Health 2015; 36:231-53. [PMID: 25581150 DOI: 10.1146/annurev-publhealth-031914-122722] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Home injuries cause more than 30,000 deaths and 12 million nonfatal injuries annually in the United States. They generate an estimated $222 billion in lifetime costs annually. Despite some data limitations in documenting home as the location of an injury, much progress has been made in identifying effective prevention strategies that reduce injury or mitigate risk behaviors. The current interest in public health in the role of housing in health offers unparalleled opportunities for injury prevention professionals concerned with home injuries. Sharing the science of injury prevention with the wide array of professionals-such as architects, home builders, home visitors, and fire and emergency medical services providers-who create home environments and interact with residents could be a useful approach. A collaborative national effort to reduce the burden of home injuries is needed.
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Fleming P, Pease A, Blair P. Bed-sharing and unexpected infant deaths: what is the relationship? Paediatr Respir Rev 2015; 16:62-7. [PMID: 25464893 DOI: 10.1016/j.prrv.2014.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 10/29/2014] [Indexed: 11/16/2022]
Abstract
For much of human history infant survival has been largely predicated by close and continuous contact between the infant and the primary carer - almost always the mother. Many factors in post-industrial human society - notably tobacco smoking, alcohol intake and the use of recreational drugs- have been associated with increased risk to infants sleeping in close proximity to their mothers. This is particularly true for mothers who choose not to breastfeed. The question of the risks and possible benefits of bed-sharing for mothers who plan to breastfeed, do not smoke, do not drink alcohol or take recreational drugs, and are aware of how to ensure a safe infant sleep environment need to be quantified. In this paper we review the evidence from several epidemiological studies and identify the factors that make bedsharing more or less hazardous for the infant. This analysis is important in allowing us to give parents accurate and unbiased information on which to make their own choices about optimal night time care of their infants without demonising normal parental behaviour or practices.
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Affiliation(s)
- Peter Fleming
- University of Bristol, School of Social and Community Medicine, St Michael's Hospital, Southwell St, Bristol BS2 8EG.
| | - Anna Pease
- University of Bristol, School of Social and Community Medicine, St Michael's Hospital, Southwell St, Bristol BS2 8EG
| | - Peter Blair
- University of Bristol, School of Social and Community Medicine, St Michael's Hospital, Southwell St, Bristol BS2 8EG
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50
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Abstract
OBJECTIVE Sleeping on sofas increases the risk of sudden infant death syndrome and other sleep-related deaths. We sought to describe factors associated with infant deaths on sofas. METHODS We analyzed data for infant deaths on sofas from 24 states in 2004 to 2012 in the National Center for the Review and Prevention of Child Deaths Case Reporting System database. Demographic and environmental data for deaths on sofas were compared with data for sleep-related infant deaths in other locations, using bivariate and multivariable, multinomial logistic regression analyses. RESULTS A total of 1024 deaths on sofas made up 12.9% of sleep-related infant deaths. They were more likely than deaths in other locations to be classified as accidental suffocation or strangulation (adjusted odds ratio [aOR] 1.9; 95% confidence interval [CI], 1.6-2.3) or ill-defined cause of death (aOR 1.2; 95% CI, 1.0-1.5). Infants who died on sofas were less likely to be Hispanic (aOR 0.7; 95% CI, 0.6-0.9) compared with non-Hispanic white infants or to have objects in the environment (aOR 0.6; 95% CI, 0.5-0.7) and more likely to be sharing the surface with another person (aOR 2.4; 95% CI, 1.9-3.0), to be found on the side (aOR 1.9; 95% CI, 1.4-2.4), to be found in a new sleep location (aOR 6.5; 95% CI, 5.2-8.2), and to have had prenatal smoke exposure (aOR 1.4; 95% CI, 1.2-1.6). Data on recent parental alcohol and drug consumption were not available. CONCLUSIONS The sofa is an extremely hazardous sleep surface for infants. Deaths on sofas are associated with surface sharing, being found on the side, changing sleep location, and experiencing prenatal tobacco exposure, which are all risk factors for sudden infant death syndrome and sleep-related deaths.
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Affiliation(s)
- Lauren R Rechtman
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jeffrey D Colvin
- Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | | | - Rachel Y Moon
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, District of Columbia
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