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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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2
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Garstang JJ, Menka M. Infant death from accidental suffocation and strangulation in bed in England and Wales: rare or unrecognised events? BMJ Paediatr Open 2024; 8:e002419. [PMID: 38316470 PMCID: PMC10860092 DOI: 10.1136/bmjpo-2023-002419] [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: 11/26/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Mandatory joint police and healthcare investigations of sudden unexpected death in infancy (SUDI) have been in place since 2008 in England. These include death scene examination with cause of death determined at multiprofessional case conference. Detailed evidence on sleep arrangements is available for most cases potentially leading to more being identified as due to accidental suffocation. SUDI remaining unexplained following investigation are classified as SIDS (sudden infant death syndrome) or unspecified deaths.Our objective was to determine whether detailed SUDI investigation has led to an increase in deaths classified as accidental suffocation or strangulation in bed (ASSB)? METHODS We obtained official mortality data for England and Wales for infants dying aged 0-364 days for International Statistical Classification of Diseases and Related Health Problems, 10th revision codes R95 (SIDS), R96, R98, R99 (unspecified causes of mortality) and W75 (ASSB) for the years 2000-2019.We calculated the mortality rate for ASSB, SIDS and unspecified causes based on total live births each year. RESULTS Unexplained SUDI decreased from 353 in 2000 to 175 in 2019, with the mortality rate falling from 0.58 to 0.29 per 1000 live births. The total postneonatal mortality rate fell during this time from 1.9 to 0.9 per 1000 live births suggesting this is a genuine fall. SIDS accounted for 70% of unexplained SUDI in 2000 falling to 49% in 2020 with a corresponding increase in R99 unspecified deaths.Few deaths were recorded as ASSB (W75), ranging between 4 in 2010 and 24 in 2001. The rate for ASSB ranged from 0.6 to 4.0 per 100000 live births. CONCLUSIONS There is a shift away from SIDS (R95) towards unspecified causes of death (R96, R98, R99). Improved investigation of deaths has not led to increased numbers of death identified as due to ASSB. There needs to be clear guidelines on accurate classification of deaths from ASSB to facilitate learning from deaths and inform prevention efforts.
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Affiliation(s)
- Joanna Jane Garstang
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Children and Family Services, Birmingham Community Healthcare NHS Trust, Aston, UK
| | - Marivjena Menka
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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3
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Hitchcock SC. What More Can We Do to Prevent Infants From Dying While They Sleep? Nurs Womens Health 2023; 27:448-456. [PMID: 37918814 DOI: 10.1016/j.nwh.2023.07.004] [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: 05/23/2023] [Revised: 07/04/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023]
Abstract
Sleep-related infant deaths, now called sudden unexpected infant deaths, are not declining, and the United States continues to have greater rates than most other developed nations. Health disparities are significant, with death rates greater in certain vulnerable groups, including non-Hispanic Black infants. Nurses play a crucial role in educating, role-modeling, and problem-solving with parents. Thus, it is critical for nurses to stay current with the science, prevention recommendations, and societal decisions and debates surrounding this topic. This article provides a summary of the updated safe sleep recommendations released by the American Academy of Pediatrics in 2022 as well as discussions on current trends, thoughts, and controversies related to how safe sleep education is provided to parents.
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4
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Byard RW. The diminishing role of the pathologist in sudden infant death syndrome. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00741-z. [PMID: 37878165 DOI: 10.1007/s12024-023-00741-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 10/26/2023]
Abstract
All major definitions of sudden infant death syndrome (SIDS) specify that a careful pathological examination must be conducted which includes performance of a "complete" autopsy. Unfortunately, there is an increasing trend for cases to be classified as SIDS without fulfilling the required criteria, even including cases where an autopsy has not been performed. Failure to have an experienced pathologist with an understanding of SIDS involved in every step of the investigation and follow-up, with or without subsequent studies, may severely undermine the veracity of the diagnosis and the reliability of subsequent research conclusions.
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Affiliation(s)
- Roger W Byard
- Forensic Science SA and the School of Biomedicine, The University of Adelaide, Level 2, Room N237, Helen Mayo North, Frome Road, Adelaide, SA, 5000, Australia.
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5
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Haynes RL, Trachtenberg F, Darnall R, Haas EA, Goldstein RD, Mena OJ, Krous HF, Kinney HC. Altered 5-HT2A/C receptor binding in the medulla oblongata in the sudden infant death syndrome (SIDS): Part I. Tissue-based evidence for serotonin receptor signaling abnormalities in cardiorespiratory- and arousal-related circuits. J Neuropathol Exp Neurol 2023; 82:467-482. [PMID: 37226597 PMCID: PMC10209647 DOI: 10.1093/jnen/nlad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
The sudden infant death syndrome (SIDS), the leading cause of postneonatal infant mortality in the United States, is typically associated with a sleep period. Previously, we showed evidence of serotonergic abnormalities in the medulla (e.g. altered serotonin (5-HT)1A receptor binding), in SIDS cases. In rodents, 5-HT2A/C receptor signaling contributes to arousal and autoresuscitation, protecting brain oxygen status during sleep. Nonetheless, the role of 5-HT2A/C receptors in the pathophysiology of SIDS is unclear. We hypothesize that in SIDS, 5-HT2A/C receptor binding is altered in medullary nuclei that are key for arousal and autoresuscitation. Here, we report altered 5-HT2A/C binding in several key medullary nuclei in SIDS cases (n = 58) compared to controls (n = 12). In some nuclei the reduced 5-HT2A/C and 5-HT1A binding overlapped, suggesting abnormal 5-HT receptor interactions. The data presented here (Part 1) suggest that a subset of SIDS is due in part to abnormal 5-HT2A/C and 5-HT1A signaling across multiple medullary nuclei vital for arousal and autoresuscitation. In Part II to follow, we highlight 8 medullary subnetworks with altered 5-HT receptor binding in SIDS. We propose the existence of an integrative brainstem network that fails to facilitate arousal and/or autoresuscitation in SIDS cases.
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Affiliation(s)
- Robin L Haynes
- CJ Murphy Laboratory for SIDS Research, Department of Pathology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Robert’s Program on Sudden Unexpected Death in Pediatrics, Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
| | | | - Ryan Darnall
- CJ Murphy Laboratory for SIDS Research, Department of Pathology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elisabeth A Haas
- Department of Research, Rady Children’s Hospital, San Diego, California, USA
| | - Richard D Goldstein
- Robert’s Program on Sudden Unexpected Death in Pediatrics, Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Othon J Mena
- San Diego County Medical Examiner Office, San Diego, California, USA
| | - Henry F Krous
- University of California, San Diego, San Diego, California, USA
- Rady Children’s Hospital, San Diego, California, USA
| | - Hannah C Kinney
- CJ Murphy Laboratory for SIDS Research, Department of Pathology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Robert’s Program on Sudden Unexpected Death in Pediatrics, Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
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6
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Blair PS, Ball HL, Pease A, Fleming PJ. Bed-sharing and SIDS: an evidence-based approach. Arch Dis Child 2023; 108:e6. [PMID: 35256354 DOI: 10.1136/archdischild-2021-323469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/21/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Peter S Blair
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | | | - Anna Pease
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Peter J Fleming
- Centre for Academic Child Health, University of Bristol, Bristol, UK
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7
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Tappin D, Mitchell EA, Carpenter J, Hauck F, Allan L. Bed-sharing is a risk for sudden unexpected death in infancy. Arch Dis Child 2023; 108:79-80. [PMID: 34674991 PMCID: PMC9887357 DOI: 10.1136/archdischild-2021-322480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/08/2021] [Indexed: 02/03/2023]
Affiliation(s)
- David Tappin
- Child Health, University of Glasgow, Glasgow, UK
| | | | - James Carpenter
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Fern Hauck
- Family Medicine and Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
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8
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Menéndez M. Wrong Assignment of Strength of Recommendations in AAP Policy Statement. Pediatrics 2022; 150:189799. [PMID: 36305232 DOI: 10.1542/peds.2022-059507a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 02/25/2023] Open
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9
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Weiss S. Protecting Infants from Sudden Unexpected Infant Death: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives. J Midwifery Womens Health 2022; 67 Suppl 1:S83-S92. [PMID: 36480671 DOI: 10.1111/jmwh.13430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
With 300-400 annual deaths in France, sudden unexpected infant death (SUID) is the leading cause of mortality in France among infants from the end of their first through their 12th month of life. These clinical practice guidelines aim to identify strategies for (future) parents to prevent avoidable SUIDs. They are based on a narrative literature review and an analysis of the existing reports and guidelines available on the topic in 2019-2020. In summary, it is recommended that parents ensure that their infants sleep on their back on a firm, empty surface in a sufficiently ventilated environment, share the parental bedroom, and be breastfed and vaccinated. All of these actions create protective factors against SUID. Conversely, parents should know that several factors increase the risk of SUID: unsafe sleep, maternal smoking, passive smoking after birth, exposure to alcohol or other psychoactive substances, and excessive heat. Precis: Sudden Unexpected Infant Death prevention includes infants being breastfed and vaccinated, sleeping on their back, on a firm, empty surface, near parents, and that they are not overheated.
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Affiliation(s)
- Stephanie Weiss
- Savoie Metropolitan Area Hospital Center, Place Lucien Biset, Chambéry
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10
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Moon RY, Abu Jawdeh EG, Carlin RF, Colvin J, Goodstein MH, Hand I, Hauck FR, Hwang SS. Author Response: Reply to: Wrong Assignment of Strength of Recommendations in AAP Policy Statement. Pediatrics 2022; 150:189801. [PMID: 36316273 DOI: 10.1542/peds.2022-059507b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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11
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Mitchell EA, Zhang D, Thompson JMD, Liu C, Leversha A, Milne BJ. Maternal mental health and substance use disorders in sudden unexpected death in infancy using routinely collected health data in New Zealand, 2000-2016. Arch Dis Child 2022; 107:917-921. [PMID: 35676082 DOI: 10.1136/archdischild-2021-323006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 05/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Mortality from sudden unexpected death in infancy (SUDI) has declined dramatically since the 'Back to Sleep' campaign. Deaths now are more prevalent in those with socioeconomic disadvantage. The investigation of SUDI frequently identifies parents that have mental health or drug, alcohol and addiction problems. AIMS To estimate the prevalence of maternal mental health and substance use disorders and assess the magnitude of their risk for SUDI. METHODS We conducted a population-based cohort study using data from the Integrated Data Infrastructure (IDI), a large research database containing linked data from a range of government agencies. The study population was all live births and their mothers in New Zealand from 2000 to 2016. The exposures of interest were maternal mental health problems and maternal substance use disorders in the year prior to the birth. The outcome was deaths from SUDI. RESULTS The total population was 1086 504 live births and of these 1078 811 (99.3%) were able to be linked to other data sets within the IDI. The prevalence of maternal mental health problems in the total population was 5.2% and substance use disorder was 0.7%. There were 42 deaths from SUDI (0.75/1000) that were exposed to maternal mental illness and 864 deaths (0.84/1000) that were not exposed (adjusted relative risk (aRR)=1.23, 95% CI 0.90 to 1.68). There were 21 deaths from SUDI (2.67/1000) that were exposed to maternal substance use disorders and 885 (0.83/1000) that were not exposed (aRR=1.82, 95% CI 1.17 to 2.83). CONCLUSIONS Maternal substance use disorders, but not maternal mental health problems, in the year prior to the child's birth was associated with an increased risk of SUDI. However, the numbers that are affected are small and the effect size moderate. This group of women should receive additional SUDI prevention services and Safe Sleep advice.
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Affiliation(s)
- Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Doney Zhang
- Centre of Methods and Policy Application in the Social Sciences, Faculty of Arts, The University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Chris Liu
- Centre of Methods and Policy Application in the Social Sciences, Faculty of Arts, The University of Auckland, Auckland, New Zealand
| | - Alison Leversha
- Community Paediatrics, Auckland District Health Board, Auckland, New Zealand
| | - Barry J Milne
- Centre of Methods and Policy Application in the Social Sciences, Faculty of Arts, The University of Auckland, Auckland, New Zealand
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12
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Zanetti N, D'Souza L, Tchernegovski P, Blunden S. Parents' perceptions of the quality of infant sleep behaviours and practices: A qualitative systematic review. INFANT AND CHILD DEVELOPMENT 2022. [DOI: 10.1002/icd.2369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nina Zanetti
- Faculty of Education Monash University Clayton Victoria Australia
| | - Levita D'Souza
- Faculty of Education Monash University Clayton Victoria Australia
| | | | - Sarah Blunden
- Appleton Institute of Behavioural Science, School of Health, Medical and Applied Sciences Central Queensland University Rockhampton Queensland Australia
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13
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The Impact of Breastfeeding and Safe Sleep Mobile Health Messaging on Breastfeeding and Bedsharing. Acad Pediatr 2022; 22:927-934. [PMID: 35124281 PMCID: PMC9349472 DOI: 10.1016/j.acap.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Mobile health (mHealth) safe sleep messaging increases rates of safe sleep. Bedsharing is more common among breastfeeders. Advice to not bedshare may negatively impact breastfeeding. We compared the impact of safe sleep or breastfeeding mHealth messaging on bedsharing and breastfeeding at 2 to 5 months. METHODS This is a secondary analysis of mothers who initiated breastfeeding from a cluster randomized clinical trial of mHealth messaging for safe sleep or breastfeeding. A multi-ethnic sample of 1600 mothers was recruited from 16 US birth hospitals and surveyed at 2 to 5 months regarding the previous 2 weeks' breastfeeding and bedsharing practices. Data on 997 mothers who initiated breastfeeding were analyzed with multivariable generalized estimating logistic regression models to examine the association of mHealth messaging with infant care practices. RESULTS Overall, exposure to breastfeeding versus safe sleep messaging was not associated with a difference in any breastfeeding at 2 to 5 months (69.3% vs 65.5%, respectively; adjusted odds ratio [aOR] = 1.33 [95% confidence interval, 0.91, 1.94]). Women with shorter planned duration of breastfeeding who received breastfeeding messaging had increased odds of breastfeeding at 2 to 5 months (50% vs 31%; aOR 3.13 [95% CI, 1.47, 6.65]). Mothers who received safe sleep messaging had lower rates of bedsharing overall when compared to breastfeeding messaging (24.8% vs 35.2%; aOR = 0.58 [95% CI, 0.44, 0.78]). CONCLUSIONS In this large multi-ethnic US sample, receipt of safe sleep mHealth messaging was associated with lower rates of bedsharing without negatively impacting breastfeeding rates. Future research should focus on continued development of interventions to improve adherence to both safe sleep and breastfeeding recommendations.
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14
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Priyadarshi M, Balachander B, Sankar MJ. Effect of sleep position in term healthy newborns on sudden infant death syndrome and other infant outcomes: A systematic review. J Glob Health 2022; 12:12001. [PMID: 35838069 PMCID: PMC9284601 DOI: 10.7189/jogh.12.12001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Though recommended by numerous guidelines, adherence to supine sleep position during the first year of life is variable across the globe. Methods This systematic review of randomized trials and observational studies assessed the effect of the supine compared to non-supine (prone or side) sleep position on healthy newborns. Key outcomes were neonatal mortality, sudden infant death syndrome (SIDS), sudden unexpected death in infancy (SUDI), acute life-threatening event (ALTE), neurodevelopment, and positional plagiocephaly. We searched MEDLINE via PubMed, Cochrane CENTRAL, EMBASE, and CINAHL (updated till November 2021). Two authors separately evaluated the risk of bias, extracted data, and synthesised effect estimates using relative risk (RR) or odds ratio (OR). The GRADE approach was used to assess the certainty of evidence. Results We included 54 studies (43 observational studies and 11 intervention trials) involving 474 672 participants. A single study meeting the inclusion criteria suggested that the supine sleep position might reduce the risk of SUDI (0-1 year; OR = 0.39, 95% confidence interval (CI) = 0.23-0.65; 384 infants), compared to non-supine position. Supine sleep position might reduce the risk of SIDS (0-1 year; OR = 0.51, 95% CI = 0.42-0.61; 26 studies, 59332 infants) and unexplained SIDS/severe ALTE (neonatal period; OR = 0.16, 95% CI = 0.03-0.82; 1 study, 119 newborns), but the evidence was very uncertain. Supine sleep position probably increased the odds of being 0.5 standard deviation (SD) below mean on Gross Motor Scale at 6 months (OR = 1.67, 95% CI = 1.22-2.27; 1 study, 2097 participants), but might have little to no effect at 18 months of age (OR = 1.16, 95% CI = 0.96, 1.43; 1 study, 1919 participants). An increase in positional plagiocephaly at 2-7 months of age with supine sleep position is possible (OR = 2.77, 95% CI = 2.06-3.72; 6 studies, 1774 participants). Conclusions Low- to very low-certainty evidence suggests that supine sleep position may reduce the risk of SUDI (0-1 year) and SIDS (0-1 year). Limited evidence suggests that supine sleeping probably delays short-term ‘gross motor’ development at 6 months, but the effect on long-term neurodevelopment at 18 months may be negligible.
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Affiliation(s)
- Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bharathi Balachander
- Department of Neonatology, St. Johns Medical College Hospital, Bangalore, Karnataka, India
| | - Mari J Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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15
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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: 19] [Impact Index Per Article: 9.5] [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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16
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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: 41] [Impact Index Per Article: 20.5] [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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MacFarlane ME, Thompson JMD, Wilson J, Lawton B, Taylor B, Elder DE, Baker N, McDonald GK, Zuccollo J, Schlaud M, Fleming P, Mitchell EA. Infant Sleep Hazards and the Risk of Sudden Unexpected Death in Infancy. J Pediatr 2022; 245:56-64. [PMID: 35120985 DOI: 10.1016/j.jpeds.2022.01.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the effects of infant sofa-sleeping, recent use by caregivers of alcohol, cannabis, and/or other drugs, and bed type and pillows, on the risk of sudden unexpected death in infancy (SUDI) in New Zealand. STUDY DESIGN A nationwide prospective case-control study was implemented between March 2012 and February 2015. Data were collected during interviews with parents/caregivers. "Hazards" were defined as infant exposure to 1 or more of sofa-sleeping and recent use by caregivers of alcohol, cannabis, and other drugs. The interaction of hazards with tobacco smoking in pregnancy and bed sharing, including for very young infants, and the difference in risk for Māori and non-Māori infants, also were assessed. RESULTS The study enrolled 132 cases and 258 controls. SUDI risk increased with infant sofa-sleeping (imputed aOR [IaOR] 24.22, 95% CI 1.65-356.40) and with hazards (IaOR 3.35, 95% CI 1.40-8.01). The SUDI risk from the combination of tobacco smoking in pregnancy and bed sharing (IaOR 29.0, 95% CI 10.10-83.33) increased with the addition of 1 or more hazards (IaOR 148.24, 95% CI 15.72-1398), and infants younger than 3 months appeared to be at greater risk (IaOR 450.61, 95% CI 26.84-7593.14). CONCLUSIONS Tobacco smoking in pregnancy and bed sharing remain the greatest SUDI risks for infants and risk increases further in the presence of sofa-sleeping or recent caregiver use of alcohol and/or cannabis and other drugs. Continued implementation of effective, appropriate programs for smoking cessation, safe sleep, and supplying safe sleep beds is required to reduce New Zealand SUDI rates and SUDI disparity among Māori.
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Affiliation(s)
| | - John M D Thompson
- Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Jessica Wilson
- Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Beverley Lawton
- Centre for Women's Health Research, Victoria University of Wellington, Wellington, New Zealand
| | - Barry Taylor
- Women's and Children's Health, University of Otago, Otago, New Zealand
| | - Dawn E Elder
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Nick Baker
- Department of Paediatrics, Nelson-Marlborough Hospital, Nelson, New Zealand
| | | | - Jane Zuccollo
- National Perinatal Pathology Service (NPPS), Auckland City Hospital, Auckland, New Zealand
| | - Martin Schlaud
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Peter Fleming
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, United Kingdom
| | - Edwin A Mitchell
- Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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18
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Godoy M, Maher M. A ten-year retrospective case review of risk factors associated with sleep-related infant deaths. Acta Paediatr 2022; 111:1176-1185. [PMID: 35124846 DOI: 10.1111/apa.16281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 11/30/2022]
Abstract
AIM The study aimed to identify risk factors associated with sleep-related deaths of infants (0-24 months) in the province of Manitoba, Canada, between January 2009 and December 2018. METHODS A systematic retrospective case review of autopsies and administrative records in Manitoba between 2009 and 2018. RESULTS A total of 145 infants died in cases where unsafe sleep environments were known to have contributed to or resulted in their death and where no explained medical causes were identified. Where data complete, all infants had at least one known risk factor for sleep-related deaths, and 96% had multiple. The most common risk factors increased over time and included objects in the sleeping environment (90% of cases), not approved sleep surfaces (77%) and bedsharing (50%). Indigenous infants, infants of young mothers and infants in low-income neighbourhoods are overrepresented. Risk factors for Indigenous infants differed from cases involving non-Indigenous infants. CONCLUSION A high proportion of sleep-related infant deaths were associated with not approved sleep surfaces and bedsharing, especially for infants under one year. Families in low-income neighbourhoods, Indigenous families and families with young mothers were disproportionately affected by sleep-related infant deaths. There is a need to enhance messaging and smoking cessation messaging in Indigenous communities to prevent sleep-related deaths.
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Affiliation(s)
- Maria Godoy
- Office of the Manitoba Advocate for Children and Youth Winnipeg Canada
| | - Matthew Maher
- Office of the Manitoba Advocate for Children and Youth Winnipeg Canada
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19
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Development and validation of the Safe Sleep Calculator to assess risk of sudden unexpected death in infancy. Sci Rep 2022; 12:6133. [PMID: 35414652 PMCID: PMC9005526 DOI: 10.1038/s41598-022-10201-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
We describe the development and validation of a Sudden Unexpected Death in Infancy (SUDI) risk assessment clinical tool. An initial SUDI risk assessment algorithm was developed from an individual participant data meta-analysis of five international SIDS/SUDI case–control studies. The algorithm was translated into a clinical web tool called the Safe Sleep Calculator, which was tested at the routine infant 6-week check-up in primary care clinics in New Zealand. Evidence was gathered through mixed-methods research to inform the revision of the algorithm and the clinical tool. The revised algorithm performance was validated on a new contemporary New Zealand SUDI case–control study dataset and the pilot population data set. The area under the Receiver Operator Characteristic (ROC) curve is 0.89, with a sensitivity of 83.0% and a specificity of 80.9% in the NZ infant population when 0.3 per 1000 live births or more risk is used to define ‘at higher risk’. The Safe Sleep Calculator SUDI risk assessment tool provides individualized evidence-based specific SUDI prevention advice for every infant and enables the concentration of additional SUDI prevention efforts and resource for infants at higher risk.
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20
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Affiliation(s)
- Philip O Anderson
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, USA
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21
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Landa-Rivera JL, Pérez-Pérez J, González-Núñez MDP, Gil-Miralles RA, Jover-Escolano Y, Fernández-Pan Astacio V. Population-Based Survey Showing That Breastfed Babies Have a Lower Frequency of Risk Factors for Sudden Infant Death Syndrome Than Nonbreastfed Babies. Breastfeed Med 2022; 17:182-188. [PMID: 34919408 PMCID: PMC8867097 DOI: 10.1089/bfm.2021.0113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Justification: Breastfeeding provides the best infant food, and closeness to the mother is crucial for successful breastfeeding. However, sharing parents' beds and sleeping on the stomach poses a high risk for sudden infant death syndrome (SIDS). There is little information on these practices regarding the Spanish population. Objective: To explore breastfeeding and bed-sharing practices in the study population Materials and Methods: A cross sectional observational study was conducted through an anonymous telephone survey with a representative random sample of babies born in the Health Area of La Marina Baixa, Alicante, between 2018 and 2019. A previous-day strategy was implemented to determine the feeding and bed-sharing variables. Results: The total breastfeeding and formula-feeding rates were 47.0% and 52.9%, respectively. The overall bed-sharing rate was 66.5%. The breastfeeding rate was 86.4% with bed-sharing and 13.6% without bed-sharing. The rate of prone sleeping position in children younger than 6 months of age was 9.3-3.5% with breastfeeding and 5.8% with formula feeding. Lower frequencies of tobacco, alcohol, and nonsupine sleeping positions were observed among mothers who practiced breastfeeding and bed-sharing. Conclusions: We found a close relationship between breastfeeding and bed-sharing and a lower frequency of SIDS risk factors associated with both practices. Families should be informed about the risk factors associated with SIDS to encourage safe bed-sharing while avoiding recommendations that discourage breastfeeding.
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Affiliation(s)
- José Leonardo Landa-Rivera
- Marina Baixa Hospital, Association for the Promotion of and Scientific and Cultural Research into Breastfeeding (APILAM), Alicante, Spain
| | - Juan Pérez-Pérez
- Pediatric Service, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
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22
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Bilgin A, Wolke D. Bed-Sharing in the First 6 Months: Associations with Infant-Mother Attachment, Infant Attention, Maternal Bonding, and Sensitivity at 18 Months. J Dev Behav Pediatr 2022; 43:e9-e19. [PMID: 34117203 DOI: 10.1097/dbp.0000000000000966] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to investigate whether bed-sharing during the first 6 months of life is associated with infant's attachment and behavioral outcomes and mother's bonding and sensitive parenting at 18 months of age. METHODS The sample with complete longitudinal data comprised 178 infants and their caretakers. Bed-sharing was assessed with maternal report at term, 3, 6, and 18 months. Infant attachment was measured at 18 months using the strange situation procedure. Infant behavioral outcomes (i.e., poor attention/hyperactivity and task persistence) were assessed with 2 observational measures at 18 months. Maternal sensitivity was observed at 3 and 18 months, and mothers reported on bonding to their infant at term, 3, and 18 months. RESULTS Bed-sharing was common at term (41.2%), which decreased at 3 months (22.6%) followed by a slight increase at 6 (27.5%) and 18 months of age (31.3%). No associations between bed-sharing during the first 6 months and infant-mother attachment and infant behavioral outcomes at 18 months were found. Similarly, there were no associations between bed-sharing during the first 6 months and maternal bonding and sensitivity at consequent assessment points (i.e., 3 and 18 months). CONCLUSION Bed-sharing during the first 6 months is not associated with positive or negative outcomes about infant-mother attachment, infant behavior, maternal bonding, or sensitive parenting.
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Affiliation(s)
- Ayten Bilgin
- School of Psychology, University of Kent, Canterbury, United Kingdom
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, United Kingdom
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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23
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Bartick M, Young M, Louis-Jacques A, McKenna JJ, Ball HL. Bedsharing may partially explain the reduced risk of sleep-related death in breastfed infants. Front Pediatr 2022; 10:1081028. [PMID: 36582509 PMCID: PMC9792691 DOI: 10.3389/fped.2022.1081028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Melissa Bartick
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Michal Young
- Department of Pediatrics and Child Health, Howard University College of Medicine, Washington, DC, United States
| | - Adetola Louis-Jacques
- Department of Obstetrics and Gynecology, University of Florida Health, Gainesville, FL, United States
| | - James J McKenna
- Department of Anthropology, Santa Clara University, Santa Clara, CA, United States.,Department of Anthropology, University of Notre Dame, South Bend, IN, United States
| | - Helen L Ball
- Department of Anthropology, Durham Infancy & Sleep Centre, Durham University, Durham, United Kingdom
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Algwaiz AF, Almutairi AM, Alnatheer AM, Alrubaysh MA, Alolaiwi O, Alqahtani M. Knowledge Assessment of Correct Infant Sleep Practices and Sudden Infant Death Syndrome Among Mothers. Cureus 2021; 13:e20510. [PMID: 35070547 PMCID: PMC8764877 DOI: 10.7759/cureus.20510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Sudden infant death syndrome (SIDS) is characterized as the sudden unexpected death of a healthy infant below the age of 12 months with an unknown cause even after careful death scene assessment. The aim of this study is to estimate the percentage of proper sleep practices among infants and assess the knowledge and awareness of SIDS and its associated risk factors among Saudi and non-Saudi mothers. METHODS This cross-sectional study was done in Riyadh, Saudi Arabia. The data were collected using an anonymous, self-administered questionnaire that consisted of 36 items that were divided into demographic data of the parents and child, observations of the child's sleep practice, and knowledge and awareness of SIDS and its associated risk factors. RESULTS A total of 667 participants completed the questionnaire. The mean age of the mothers was 31.44 + 7.55. As for the nationality, 527 (79%) were Saudi and 140 (21%) were non-Saudi. The majority had bachelors' degrees 407 (61%). Sleep practices assessment demonstrated that 391 (58.6%) of infants were sleeping in the supine position. A total of 329 (49.3%) participants reported hearing about SIDS from social media and websites as being the major source of information. SIDS acknowledgment was higher in non-Saudi mothers compared to Saudis. CONCLUSION The results provide informative descriptive data on childcare practices in Saudi Arabia. Considerable variation was noted and the results from this study are intended to have a better understanding of the prevalence of childcare practices and knowledge of SIDS risk factors in Saudi and non-Saudi mothers.
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Affiliation(s)
- Abdulrahman F Algwaiz
- Ophthalmology, Imam Mohammed Ibn Saud Islamic University, Riyadh, SAU
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh, SAU
| | | | | | | | - Osama Alolaiwi
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh, SAU
| | - Mohammed Alqahtani
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh, SAU
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25
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Kanits F, L'Hoir MP, Boere-Boonekamp MM, Engelberts AC, Feskens EJM. Risk and Preventive Factors for SUDI: Need We Adjust the Current Prevention Advice in a Low-Incidence Country. Front Pediatr 2021; 9:758048. [PMID: 34869115 PMCID: PMC8635138 DOI: 10.3389/fped.2021.758048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/21/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The incidence of Sudden Unexpected Death in Infancy (SUDI) is low in the Netherlands, with an incidence rate of 0.18 per 1,000 live births. Therefore, prevention advice may receive less attention, potentially leading to increasing incidence rates. It is currently unknown whether the risks for SUDI changed in the Netherlands, and if other risk factors might be present. The aim of this study was to examine the current risks and preventive factors for SUDI in Dutch infants, in order to determine if it is necessary to adapt the prevention advice toward the current needs. Methods: A case-control study was conducted comparing SUDI cases aged <12 months from 2014-2020 in the Netherlands (n = 47), to a Dutch national survey control group from 2017 including infants <12 months of age (n = 1,192). Results: Elevated risks for several well-known factors were observed, namely: duvet use (aOR = 8.6), mother smoked during pregnancy (aOR = 9.7), or after pregnancy (aOR = 5.4) and the prone sleeping position (aOR = 4.6). Reduced risks were observed for the well-known factors: room-sharing (aOR = 0.3), sleep sack use (aOR = 0.3), breastfeeding (aOR = 0.3), and the use of a pacifier (aOR = 0.4). For infants <4 months, the risk for SUDI was higher when bed-sharing (aOR = 3.3), and lower when room-sharing (aOR = 0.2) compared to older infants. For older infants, the sleep sack was found to be more protective (aOR = 0.2). A high risk for SUDI when bed-sharing was found when mother smoked, smoked during pregnancy, or if the infant did not receive any breastfeeding (respectively aOR = 17.7, aOR = 10.8, aOR = 9.2). Conclusions: Internationally known factors related to the sudden unexpected death of infants were also found in this study. Relatively new findings are related to specific groups of infants, in which the strengths of these risk factors differed. In a low-incidence country like the Netherlands, renewed attention to the current prevention advice is needed. Furthermore, additional attention for prevention measures in low educated groups, and additional advice specifically targeting high-risk groups is recommended.
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Affiliation(s)
- Floortje Kanits
- Department of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Monique P. L'Hoir
- Department of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
- Community Health Center, GGD Noord-Oost-Gelderland, Warnsveld, Netherlands
| | - Magda M. Boere-Boonekamp
- Department of Health Technology & Services Research, University of Twente, Enschede, Netherlands
| | - Adèle C. Engelberts
- Department of Pediatrics, Zuyderland Medical Center, Sittard-Geleen, Netherlands
| | - Edith J. M. Feskens
- Department of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
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26
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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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27
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Sunekær K, Hansen SH, Banner J. Trends in infant mortality: an evaluation of forensic autopsied infants in Eastern Denmark over 39 years. Int J Legal Med 2021; 136:169-178. [PMID: 34350495 DOI: 10.1007/s00414-021-02663-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND SIDS is a diagnosis of exclusion applied to the death of an infant < 1 year of age after an extensive post-mortem investigation. From 1980 to 2018, a total of 870 infants have been autopsied at the Section of Forensic Pathology, Department of Forensic Medicine, UCPH, covering East Denmark. In the same period, Danish national guidelines for infant care have been revised to avoid infants dying of SIDS. OBJECTIVE This study aimed to describe trends in infant autopsies regarding cause and manner of death, gender, age, month of death, sleeping position, and bed-sharing. The trends were compared to the change in national SIDS guidelines during the period of this study. DESIGN Information from autopsy reports from 1980 to 2018 were collected into 55 categories designed specifically for this study. Data from 7 of these categories were chosen and processed in Excel for basic epidemiological comparison. RESULTS The trends show that most infants in the study die of natural manner and most predominant causes of death are SIDS, infection, and congenital malformations. A change in national guidelines in 1991 recommending supine- or side sleeping position coincided with a reduction in the overall infant mortality and cases of SIDS. The peak age in the cohort is 90 days, but stratification in decades shows the infants dying younger each decade. Through the study period, the number of infants found dead sleeping in the prone position has declined. Relatively more infants in this cohort have been found dead while bed-sharing, even though the prevalence of these cases has remained largely the same for four decades.
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Affiliation(s)
- Katharina Sunekær
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Frederik V's Vej 11, 2100, Copenhagen East, Denmark.
| | - Steen Holger Hansen
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Frederik V's Vej 11, 2100, Copenhagen East, Denmark
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Frederik V's Vej 11, 2100, Copenhagen East, Denmark
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Kellams A, Feldman-Winter L. Sudden Unexpected Infant Death: Keeping the Newborn Safe in Hospital and at Home. Clin Perinatol 2021; 48:619-630. [PMID: 34353583 DOI: 10.1016/j.clp.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sudden unexpected infant death is a leading cause of death in infancy. Both safe sleep practices and breastfeeding can help decrease the risk, although the current practice of educating parents about the recommendations has not resulted in universal adherence. Prenatal counseling provides opportunities to discuss recommendations as well as troubleshoot common barriers to breastfeeding and safe infant sleep with goals to gradually change attitudes, address social norms, and prepare new parents. A conversational, motivational approach to discussions about the importance of safe sleep and continued breastfeeding, with explanations as to the reasoning behind these recommendations, can help parents incorporate optimal practices into their lifestyles in a way that is sustainable for adherence.
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Affiliation(s)
- Ann Kellams
- Department of Pediatrics, University of Virginia, PO Box 800386, Charlottesville, VA 22908, USA.
| | - Lori Feldman-Winter
- Children's Regional Hospital at Cooper University Healthcare, Cooper Medical School of Rowan University, Three Cooper Plaza Suite 200, Camden, NJ 08103, USA
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29
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Gustafsson S, Jacobzon A, Lindberg B, Engström Å. Parents' strategies and advice for creating a positive sleep situation in the family. Scand J Caring Sci 2021; 36:830-838. [PMID: 34291480 DOI: 10.1111/scs.13020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/27/2021] [Accepted: 07/11/2021] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to describe the experience-based knowledge of parents of children aged 0-3 years for creating a positive sleep situation in the family. DESIGN This study has a qualitative design. Data were collected using an online survey and analysed using the critical incident technique. METHODS The study participants were recruited through an announcement posted in parenting groups on a social media platform in September 2018. A total of 93 parents answered the questionnaire; 76 of the parents matched the study's selection criteria, and their responses were included in the analysis. RESULTS The results are presented from the two main questions in the survey: "Strategies for creating a positive sleep situation" and "Advice to new parents regarding sleep". Having routines and reading the child's signals were important strategies, as were creating good conditions for sleep and making sure the child was well-fed and content at bedtime. Winding down and giving the child closeness and touch was described as important, and some parents would co-sleep to soothe the child quickly and create a sense of security and belonging. Parents' most frequent advice to other parents was to accept the situation and to let go of the idea that the child should sleep without waking up in a separate bed or room. CONCLUSION Personal preferences and needs are likely to vary among individuals, and it is important that nurses tailor sleep advice in accordance with families' preferences and needs, taking individual variations and views into account.
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Affiliation(s)
- Silje Gustafsson
- Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology, Luleå, SE-97187, Sweden
| | - Anna Jacobzon
- Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology, Luleå, SE-97187, Sweden
| | - Birgitta Lindberg
- Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology, Luleå, SE-97187, Sweden
| | - Åsa Engström
- Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology, Luleå, SE-97187, Sweden
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30
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Osberg S, Kalstad TG, Stray‐Pedersen A. Norwegian parents avoid placing infants in prone sleeping positions but frequently share beds in hazardous ways. Acta Paediatr 2021; 110:2119-2125. [PMID: 33544951 DOI: 10.1111/apa.15797] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/28/2022]
Abstract
AIM Campaigns to prevent prone sleeping and other modifiable risk factors have greatly reduced the incidence of sudden infant death syndrome in Norway. Sleep-related infant deaths still occur sporadically and may be preventable. We studied infants' sleeping environments and whether parents followed safe sleep recommendations. METHODS Parents with infants up to 12 months of age were invited to complete an online questionnaire from May to December 2018. It was publicised by health centres and on websites and social media. RESULTS We received 4886 responses and 4150 met the age criteria and were included. Just under two-thirds (62.7%) reported routine bed-sharing, and this practice was associated with increased nocturnal breastfeeding, single parents and having more than one child. A small number of infants under six months were occasionally placed prone when they were laid down to sleep (2.1%) and 29.7% were placed on their side. Nearly three-quarters (72.6%) of the 2330 parents with infants under six months of age reported previous high-risk behaviour, such as sleeping together on a sofa or bed-sharing after smoking or drinking. CONCLUSION Norwegian parents rarely used prone sleeping positions for infants. However, bed-sharing was common, including high-risk scenarios such as smoking, alcohol use and sofas.
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Affiliation(s)
- Silje Osberg
- Department of Forensic Sciences Oslo University Hospital Oslo Norway
| | - Trine Giving Kalstad
- Institute of Clinical Medicine University of Oslo Oslo Norway
- The Norwegian SIDS and Stillbirth Society Oslo Norway
| | - Arne Stray‐Pedersen
- Department of Forensic Sciences Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
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31
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Wennergren G, Strömberg Celind F, Goksör E, Alm B. Swedish survey of infant sleep practices showed increased bed-sharing and positive associations with breastfeeding. Acta Paediatr 2021; 110:1835-1841. [PMID: 33314307 PMCID: PMC8246951 DOI: 10.1111/apa.15719] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 12/11/2022]
Abstract
AIM Many countries lack monitoring of infant sleep practices, despite associations with sudden infant death. We studied sleep positions, bed-sharing and breastfeeding in a new birth cohort. METHODS Data were obtained from a prospective, population-based cohort study of children born in western Sweden in 2018. The parents of 9,465 six-month-old infants, via postal questionnaires, were asked about their infants' sleeping positions at three and six months, including where they slept and any bed-sharing arrangements. The data were compared with our earlier 2003-2004 birth cohort. RESULTS Questionnaires were completed by the parents of 3,590 (38%) infants. At three months, 54% of the infants slept in a separate cot in their parents' room. A further 43% slept in their parents' bed: 42% in baby nests and 42% in close contact with their parents. At six months, 33% bed-shared, compared with 20% in 2003-2004 (p < 0.001). Bed-sharing was positively associated with breastfeeding (odds ratio at three months: 1.5-2.8, 95% confidence interval: 1.1-4.5). CONCLUSION Most infants slept in separate cots during the first three months. However, bed-sharing showed an increasing trend and baby nests were popular. Bed-sharing was positively associated with breastfeeding, but the association may not be causal.
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Affiliation(s)
- Göran Wennergren
- Department of Paediatrics University of Gothenburg Queen Silvia Children’s Hospital Gothenburg Sweden
| | - Frida Strömberg Celind
- Department of Paediatrics University of Gothenburg Queen Silvia Children’s Hospital Gothenburg Sweden
| | - Emma Goksör
- Department of Paediatrics University of Gothenburg Queen Silvia Children’s Hospital Gothenburg Sweden
| | - Bernt Alm
- Department of Paediatrics University of Gothenburg Queen Silvia Children’s Hospital Gothenburg Sweden
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Carpenter JR, Smuk M. Missing data: A statistical framework for practice. Biom J 2021; 63:915-947. [PMID: 33624862 PMCID: PMC7615108 DOI: 10.1002/bimj.202000196] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 12/19/2022]
Abstract
Missing data are ubiquitous in medical research, yet there is still uncertainty over when restricting to the complete records is likely to be acceptable, when more complex methods (e.g. maximum likelihood, multiple imputation and Bayesian methods) should be used, how they relate to each other and the role of sensitivity analysis. This article seeks to address both applied practitioners and researchers interested in a more formal explanation of some of the results. For practitioners, the framework, illustrative examples and code should equip them with a practical approach to address the issues raised by missing data (particularly using multiple imputation), alongside an overview of how the various approaches in the literature relate. In particular, we describe how multiple imputation can be readily used for sensitivity analyses, which are still infrequently performed. For those interested in more formal derivations, we give outline arguments for key results, use simple examples to show how methods relate, and references for full details. The ideas are illustrated with a cohort study, a multi-centre case control study and a randomised clinical trial.
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Affiliation(s)
- James R. Carpenter
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
- MRC Clinical Trials Unit at UCL, London, UK
| | - Melanie Smuk
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
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Parks SE, Erck Lambert AB, Hauck FR, Cottengim CR, Faulkner M, Shapiro-Mendoza CK. Explaining Sudden Unexpected Infant Deaths, 2011-2017. Pediatrics 2021; 147:e2020035873. [PMID: 33906930 PMCID: PMC8132195 DOI: 10.1542/peds.2020-035873] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Sudden unexpected infant death (SUID) represents a broad group of explained and unexplained infant deaths (<1 year old). Explaining why SUID occurs is critical to understanding etiology and prevention. Death certificate data cannot differentiate explained from unexplained SUID cases nor describe the surrounding circumstances. We report SUID rates by explained and unexplained categories and describe demographics and history of recent injury or illness using the Centers for Disease Control and Prevention SUID Case Registry. METHODS The registry is a population-based surveillance system built on Child Death Review programs. Data are derived from multiple sources, including death certificates, scene investigations, and autopsy reports. Cases included SUIDs reported by states or jurisdictions participating in the registry during 2011-2017. Cases were classified into explained and unexplained categories by using the registry's classification system. Frequencies, percentages, and mortality rates per 100 000 live births were calculated. RESULTS Of the 4929 SUID cases, 82% were categorized as unexplained. Among all cases, 73% had complete case information. Most SUIDs (72%) occurred in an unsafe sleep environment. The SUID mortality rate was 97.3 per 100 000 live births. Among explained and possible suffocation deaths, ∼75% resulted from airway obstruction attributed to soft bedding. CONCLUSIONS Unsafe sleep factors were common in explained and unexplained SUID cases, but deaths could only be classified as explained suffocation for ∼20% of cases. Further analysis of unexplained deaths, including continued improvements to death scene investigation and documentation, may generate hypotheses for physiologic and genetic research, advance our understanding of gaps in SUID investigation, and enhance our understanding of infants at highest risk.
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Affiliation(s)
- Sharyn E Parks
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia;
| | | | - Fern R Hauck
- Department of Family Medicine, University of Virginia, Charlottesville, Virginia; and
| | - Carri R Cottengim
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meghan Faulkner
- Center for National Prevention Initiatives, Michigan Public Health Institute, Okemos, Michigan
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Abstract
BACKGROUND There is great global variation in the sleeping arrangements for healthy newborn infants. Bed sharing is a type of sleeping practice in which the sleeping surface (e.g. bed, couch or armchair, or some other sleeping surface) is shared between the infant and another person. The possible physiological benefits include better oxygen and cardiopulmonary stability, fewer crying episodes, less risk of hypothermia, and a longer duration of breastfeeding. On the other hand, the most important harmful effect of bed sharing is that it may increase the risk of sudden infant death syndrome (SIDS). Studies have found conflicting evidence regarding the safety and efficacy of bed sharing during infancy. OBJECTIVES To evaluate the efficacy and safety of bed sharing, started during the neonatal period, on breastfeeding status (exclusive and total duration of breastfeeding), incidence of SIDS, rates of hypothermia, neonatal and infant mortality, and long-term neurodevelopmental outcomes. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 7) in the Cochrane Library; MEDLINE via PubMed (1966 to 23 July 2020), CINAHL (1982 to 23 July 2020), and LILACS (1980 to 23 July 2020). We also searched clinical trials databases, and the reference lists of retrieved articles, for randomised controlled trials (RCTs) and quasi-RCTS. SELECTION CRITERIA We planned to include RCTs or quasi-RCTs (including cluster-randomised trials) that included term neonates initiated on bed sharing within 24 hours of birth (and continuing to bed share with the mother in the first four weeks of life, followed by a variable time period thereafter), and compared them to a 'no bed sharing' group. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as recommended by Cochrane. We planned to use the GRADE approach to assess the certainty of evidence. MAIN RESULTS Our search strategy yielded 6231 records. After removal of duplicate records, we screened 2745 records by title and abstract. We excluded 2739 records that did not match our inclusion criteria. We obtained six full-text studies for assessment. These six studies did not meet the eligibility criteria and were excluded. AUTHORS' CONCLUSIONS We did not find any studies that met our inclusion criteria. There is a need for RCTs on bed sharing in healthy term neonates that directly assess efficacy (i.e. studies in a controlled setting, like hospital) or effectiveness (i.e. studies conducted in community or home settings) and safety. Future studies should assess outcomes such as breastfeeding status and risk of SIDS. They should also include neonates from high-income countries and low- and middle-income countries, especially those countries where bed sharing is more prevalent because of cultural practices (e.g. Asian countries).
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Affiliation(s)
- Rashmi R Das
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Mari Jeeva Sankar
- Newborn Health Knowledge Centre, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
| | - Ramesh Agarwal
- Newborn Health Knowledge Centre, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
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Stahn D, Leinweber J. [Does Bed-Sharing Increase the Risk for Sudden Infant Death Syndrome? - A Review of the Literature and Official Guidelines of Selected EU Countries]. Z Geburtshilfe Neonatol 2021; 225:397-405. [PMID: 33752248 DOI: 10.1055/a-1392-1324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION In Europe in 2015, 726 infants died of sudden infant death syndrome (SIDS). Bed-sharing is often discussed as a risk factor for SIDS. This paper examines the evidence on the impact of bed-sharing on the risk of SIDS and considers the official recommendations of individual EU countries on safe infant sleep. METHOD An integrative literature review was conducted. The Cochrane Library, Pubmed, CINAHL, and MIDRIS databases were searched using the keywords "Sudden Infant Death Syndrome", "SIDS", bed sharing", "breastfeeding" and "baby sleep" for articles in the German or English language that were published between 2012 and February 2019. In a second step, official recommendations for safe baby sleep from 6 EU countries were analyzed. RESULTS The risk for SIDS in bed-sharing three months postpartum is not higher in the absence of risk factors. Not all EU country recommendations on bed-sharing and SIDS differentiate between bed-sharing in the first 3 months of the baby's life and bed-sharing with babies 3 months or older. CONCLUSION Parents and health care professionals need evidence-based information to optimize the newborn baby's sleeping environment. Official recommendations on safe baby sleep should be assessed in regards to their congruence with current research findings on bed-sharing and SIDS.
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Affiliation(s)
- Dörthe Stahn
- Evangelische Hochschule Berlin, Midwifery, Berlin, Deutschland
| | - Julia Leinweber
- Evangelische Hochschule Berlin, Midwifery, Berlin, Deutschland
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Garstang J, Cohen M, Mitchell EA, Sidebotham P. Classification of sleep-related sudden unexpected death in infancy: A national survey. Acta Paediatr 2021; 110:869-874. [PMID: 32654334 DOI: 10.1111/apa.15472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022]
Abstract
AIM To identify how British Child Death Overview Panels (CDOPs) and paediatric pathologists classify cause of death for sleep-related Sudden Unexpected Death in Infancy (SUDI). To determine compliance with national requirements for SUDI investigation. METHODS Electronic survey of CDOPs and pathologists using three vignettes of SUDI cases illustrating: accidental asphyxia, typical Sudden Infant Death Syndrome (SIDS) and SIDS with co-sleeping. RESULTS Thirty-eight (41%) of 92 CDOPs returned questionnaires, and 32 were complete. Thirteen (14%) of 90 pathologists returned complete questionnaires. Thirty-one (97%) CDOPs and 7 (53%) pathologists agreed with the cause of death in the accidental asphyxia case; 24 (75%) CDOPs and 9 (69%) pathologists in the typical SIDS case; and 11 (34%) CDOPs and 1 (8%) pathologist in the co-sleeping SIDS case. Pathologists used the terms SUDI or unascertained as the cause of death for the accidental asphyxia case (46%) and the co-sleeping SIDS case (77%). These terms were used by CDOPs for the typical SIDS case (25%) and the co-sleeping SIDS case (41%). Seventeen (46%) CDOPs reported compliance with guidelines for investigation in more than 75% of cases. CONCLUSION There is wide variation in classification of deaths, with only limited agreement between CDOPs and pathologists. The terms SIDS and accidental asphyxia are underused, even in typical cases.
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Affiliation(s)
- Joanna Garstang
- Allens Croft Children's Centre Birmingham Community Healthcare NHS Trust University of Birmingham Birmingham UK
| | - Marta Cohen
- Sheffield Children's Hospital NHS Trust Sheffield UK
| | - Edwin A. Mitchell
- Department of Paediatrics: Child and Youth Health The University of Auckland Auckland New Zealand
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de Beer C, Ayele BT, Dempers J. Immune biomarkers as an adjunct diagnostic modality of infection in cases of sudden and unexpected death in infancy (SUDI) at Tygerberg Medico-legal Mortuary, Cape Town, South Africa. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Allen K, Anderson TM, Chajewska U, Ramirez J, Mitchell EA. Factors associated with age of death in sudden unexpected infant death. Acta Paediatr 2021; 110:174-183. [PMID: 32304589 PMCID: PMC7574313 DOI: 10.1111/apa.15308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 12/28/2022]
Abstract
Aim This study aimed to systematically analyse the pregnancy, birth and demographic‐related factors associated with age of death in sudden unexpected infant death (SUID). Methods Data were analysed from the Centers for Disease Control and Prevention's Cohort Linked Birth/Infant Death data set (2011‐2013; 11 737 930 live births). SUID was defined as deaths from sudden infant death syndrome, ill‐defined causes, or accidental suffocation and strangulation in bed. There were 9668 SUID cases (7‐364 days; gestation >28 weeks; 0.82/1000 live births). The odds of death at different ages were compared to determine which variables significantly affect the SUID age of death. Results Forty‐three features indicated a significant change in age of death with two main patterns: (a) younger chronologic age at death was associated with maternal smoking and factors associated with lower socio‐economic status, and (b) older age was associated with low birthweight, prematurity and admission to the neonatal intensive care unit. However, when age was corrected for gestation, these factors were associated with younger age. Conclusion Factors that varied with age of death are well‐documented risk factors for SUID. The majority of these risk factors were associated with younger age at death after allowing for gestational age at birth.
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Affiliation(s)
| | | | | | - Jan‐Marino Ramirez
- Seattle Children’s Research Institute Seattle WA USA
- Departments of Neurological Surgery and Pediatrics University of Washington School of Medicine Seattle WA USA
| | - Edwin A. Mitchell
- Department of Paediatrics: Child and Youth Health University of Auckland Auckland New Zealand
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O’ Brien N, McGarvey C, Hamilton K, Hayes B. Maternal intentions towards infant sleeping practices in Ireland. Acta Paediatr 2021; 110:184-193. [PMID: 32415996 DOI: 10.1111/apa.15352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/23/2022]
Abstract
AIM Mortality from Sudden Infant Death Syndrome (SIDS) has reduced by 50%-85% globally. Despite improvements from 1990 to 2009, the Irish SIDS rate has plateaued. Reasons for this are unclear, but may be related to a reduced parental SIDS awareness. Our study aimed to assess intentions regarding infant sleeping practices in mothers in Ireland. METHODS A cross-sectional survey of post-partum mothers was performed in the Rotunda Hospital over a four month period. Mothers with a history of SIDS, miscarriage or neonatal admissions were excluded. RESULTS Of 451 participants, unsafe sleeping positions were intended by 15.4%, reduced by Irish ethnicity [AOR = 0.52, 95% CI = 0.277-0.959, P = .036]. Safe sleep locations were intended by 66%, increased by Irish ethnicity [AOR = 2.6, 95% CI = 1.617-4.191, P < .001], and reduced by young maternal age [AOR = 0.15, 95% CI = 0.03-0.713, P = .02]. Maternal smoking was more likely in mothers with lower educational level [AOR = 3.51, 95% CI = 1.169-10.56, P = .03]. Soft bedding use was intended by 34.8%, increased in younger mothers [AOR = 2.28, 95% CI = 1.04-4.98, P = .04]. Breastfeeding was intended by 72.2%, decreased by Irish ethnicity [AOR = 0.14, 95% CI = 0.067-0.271, P < .001], and low maternal education [AOR = 0.22, 95% CI = 0.117-0.406, P < .001]. CONCLUSION Educational campaigns on safe sleep for infants in Ireland need to address modifiable SIDS risks factors, focusing on younger, non-Irish mothers, with lower educational attainment.
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Affiliation(s)
- Niamh O’ Brien
- Department of Neonatology Rotunda Hospital Dublin 1 Ireland
| | - Cliona McGarvey
- Children’s Health Ireland (CHI) at Temple St National Paediatric Mortality Register Dublin 1 Ireland
| | - Karina Hamilton
- Children’s Health Ireland (CHI) at Temple St National Paediatric Mortality Register Dublin 1 Ireland
| | - Breda Hayes
- Department of Neonatology Rotunda Hospital Dublin 1 Ireland
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Bøylestad L, Stray‐Pedersen A, Vege Å, Osberg S, Rognum T. Death-scene investigations contribute to legal protection in unexpected child deaths in Norway. Acta Paediatr 2020; 109:2627-2635. [PMID: 32248546 DOI: 10.1111/apa.15284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022]
Abstract
AIM This study reviewed cases of sudden unexpected child deaths in Norway to determine the significance of death-scene investigations (DSIs) in establishing cause and manner of death, and thereby it is relevance to legal protection. METHODS Data from forensic autopsy reports and DSIs were collected and analysed for cases of unexpected deaths in children below 4 years of age in Norway during 2010-2016. RESULTS Out of 141 cases, the death scene was investigated as a voluntary procedure in 75 cases and by the police in 41 cases. The cause of death remained unexplained in 81/141 (57%) of the cases, of which 46/141 (33%) met the criteria for sudden infant death syndrome (SIDS) or sudden unexplained death in early childhood (SUDC). The manner of death was determined in 102/141 (72%). Voluntary DSI increased the ability to rule out accidental suffocation, facilitated evaluations of environmental risk factors and enabled detection of possible neglect. CONCLUSION Death-scene investigations illuminate uncertainty about the cause of death, especially in grey-area cases where accidental suffocation, neglect or abuse is suspected. Knowledge about the course of events and the cause of death enhances both the child's and the caregiver's legal protection. Death-scene investigations should therefore be mandatory.
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Affiliation(s)
- Lillian Bøylestad
- Department of Forensic Sciences Oslo University Hospital Oslo Norway
| | - Arne Stray‐Pedersen
- Department of Forensic Sciences Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Åshild Vege
- Department of Forensic Sciences Oslo University Hospital Oslo Norway
| | - Silje Osberg
- Department of Forensic Sciences Oslo University Hospital Oslo Norway
| | - Torleiv Rognum
- Department of Forensic Sciences Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
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Brashears KA, Erdlitz K. Screening and Support for Infant Safe Sleep: A Quality Improvement Project. J Pediatr Health Care 2020; 34:591-600. [PMID: 33097170 DOI: 10.1016/j.pedhc.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/01/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
Infant sleep is an anticipatory guidance topic that is discussed frequently at well child checks, starting with the newborn visit. It is challenging to cover a large amount of information in a short visit. This article describes a quality improvement project implemented at a pediatric primary care practice to improve screening for infant safe sleep. The screening form was updated to include questions from the Pregnancy Risk Assessment Monitoring System (PRAMS). This updated screening better captured actual sleeping practices, allowing for more targeted education.
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A Nursing Perspective on Infant Bed-Sharing Using Multidisciplinary Theory Integration. ANS Adv Nurs Sci 2020; 43:338-348. [PMID: 32956089 DOI: 10.1097/ans.0000000000000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The American Academy of Pediatrics recommends against bed-sharing between infants and caregivers due to an association with suffocation. Caregivers continue to share a bed with their infant despite these recommendations for a multitude of reasons. A close examination of the bed-sharing literature reveals that the debate is fundamentally about theoretical differences. The major theories used to frame this problem include the triple risk model of bed-sharing and evolutionary theories. Nurses are masters of multidisciplinary collaboration and are well positioned to unify the triple risk and evolutionary views of infant bed-sharing to guide future innovations in health care practice and research.
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Waynforth D. Mother-Infant Co-Sleeping and Maternally Reported Infant Breathing Distress in the UK Millennium Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17092985. [PMID: 32344849 PMCID: PMC7246529 DOI: 10.3390/ijerph17092985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 12/11/2022]
Abstract
Mother-infant co-sleeping or bed sharing is discouraged by health organisations due to evidence that it is associated with unexplained sudden infant death. On the other hand, there is evidence that it should theoretically be beneficial for infants. One line of this evidence concerns breathing regulation, which at night is influenced by the rocking movement of the mother's chest as she breathes. Here, the hypothesis that mother-infant co-sleeping will be associated with a lower probability of infant breathing distress is tested in the UK Millennium Cohort Study (n = 18,552 infants). Maternal, infant, family, and socio-economic covariates were included in logistic regression analysis, and in a machine learning algorithm (Random Forest) to make full use of the number of variables available in the birth cohort study data. Results from logistic regression analysis showed that co-sleeping was associated with a reduced risk of breathing difficulties (OR = 0.69, p = 0.027). The Random Forest algorithm placed high importance on socio-economic aspects of infant environment, and indicated that a number of maternal, child, and environmental variables predicted breathing distress. Co-sleeping by itself was not high in the Random Forest variable importance ranking. Together, the results suggest that co-sleeping may be associated with a modest reduction in risk of infant breathing difficulties.
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Affiliation(s)
- David Waynforth
- School of Medicine, Bond University, Gold Coast 4229, Australia
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44
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Sudden infant death syndrome: Do the parents follow the recommendations? ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ruiz Botia I, Cassanello Peñarroya P, Díez Izquierdo A, Martínez Sánchez JM, Balaguer Santamaria A. [Sudden infant death syndrome: Do the parents follow the recommendations?]. An Pediatr (Barc) 2020; 92:222-228. [PMID: 31353309 DOI: 10.1016/j.anpedi.2019.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Prone sleeping position is the main known modifiable risk factor for sudden infant death syndrome (SIDS). There are other SIDS recommendations although with less impact. The objective of this study is to describe the prevalence of prone position during sleep as well as other risk factors associated with SIDS in a sample of Spanish babies and infants. METHODS Cross-sectional study carried out on 640 families with children from 0 months to 11 months. In addition to the sleep position, the adherence to four other recommendations regarding SIDS was analysed: place where infant sleeps, breastfeeding, use of non-nutritive suction, and maternal smoking. RESULTS A total of 41.3% of infants under 6 months and 59.7% of infants aged 6 to 11 months slept in a non-recommended position. Only 6.4% of families analysed followed all five recommendations. DISCUSSION There is a high prevalence of modifiable risk factors for SIDS among the studied population. Personalized education should be promoted, along with other campaigns to raise awareness and prevent SIDS.
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Affiliation(s)
- Irene Ruiz Botia
- Servicio de Pediatría, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España.
| | - Pía Cassanello Peñarroya
- Servicio de Pediatría, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España; Universitat Internacional de Catalunya, Barcelona, España
| | - Ana Díez Izquierdo
- Servicio de Pediatría, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España; Universitat Internacional de Catalunya, Barcelona, España
| | | | - Albert Balaguer Santamaria
- Servicio de Pediatría, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España; Universitat Internacional de Catalunya, Barcelona, España
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Abstract
The human need for sleep is universal and unquestioned; however, humans vary in their sleep needs according to age, individual differences, as well as cultural and social norms and practices. Therefore, what is “normal” in infant sleep and the development of sleep architecture in humans is highly dependent on biological and sociocultural variables as well as socially constructed assumptions about what infant sleep “should” look like. This paper uses a multidisciplinary approach to review papers from fields including pediatrics, anthropology, psychology, medicine, and sociology to understand “normal” infant sleep. Because human culture and behavioral practice changes much more quickly than evolved human biology, and because human evolutionary history occurred in the context of breastfeeding and cosleeping, new work in the field of infant sleep architecture development would benefit from a multidisciplinary approach. To come to a consensus about what is “normal” infant sleep, researchers must agree on underlying basic assumptions of infant sleep from which to ask question and interpret findings.
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Affiliation(s)
- Elaine S. Barry
- Human Development and Family Studies, Penn State Fayette, The Eberly Campus, Lemont Furnace, PA, USA
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47
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Byard RW. Infant suffocation while breastfeeding. Forensic Sci Med Pathol 2020; 16:569-570. [PMID: 32125631 DOI: 10.1007/s12024-020-00229-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Roger W Byard
- Forensic Science SA, 21 Divett Place, Adelaide, 5000, Australia. .,Discipline of Anatomy and Pathology, The University of Adelaide, Frome Road, Level 2 Helen Mayo Building North, Adelaide, SA, 5005, Australia. .,Adelaide Medical School, The University of Adelaide, Frome Road, Level 3 Medical School North Building, Adelaide, SA, 5005, Australia.
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Kellams A, Hauck FR, Moon RY, Kerr SM, Heeren T, Corwin MJ, Colson E. Factors Associated With Choice of Infant Sleep Location. Pediatrics 2020; 145:peds.2019-1523. [PMID: 32034081 PMCID: PMC7049941 DOI: 10.1542/peds.2019-1523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the prevalence of and factors associated with actual recent practice and near-future intention for infant sleep location in a national sample. METHODS There were 3260 mothers from 32 US hospitals who responded to a survey at infant age 2 to 6 months regarding care practices, including usual and all infant sleep locations in the previous 2 weeks and intended location for the next 2 weeks. Mothers were categorized as (1) having practiced and/or intending to practice exclusive room-sharing without bed-sharing, (2) having practiced anything other than exclusive room-sharing but intending to practice exclusive room-sharing, (3) intending to have the infant sleep in another room; and (4) intending to practice bed-sharing all night or part of the night. Multivariable multinomial logistic regression examined associations between sleep-location category, demographics, feeding method, doctor advice, and theory of planned behavior domains (attitudes, social norms, and perceived control). RESULTS Fewer than half (45.4%) of the mothers practiced and also intended to practice room-sharing without bed-sharing, and 24.2% intended to practice some bed-sharing. Factors associated with intended bed-sharing included African American race and exclusive breastfeeding; however, the highest likelihood of bed-sharing intent was associated with perceived social norms favoring bed-sharing (adjusted odds ratio [aOR] 5.84; 95% confidence interval [CI] 4.14-8.22) and positive attitudes toward bed-sharing (aOR 190.1; 95% CI 62.4-579.0). Women with a doctor's advice to room-share without bed-sharing intended to practice bed-sharing less (aOR 0.56; 95% CI 0.36-0.85). CONCLUSIONS Sleep-location practices do not always align with the recommendation to room-share without bed-sharing, and intention does not always correspond with previous practice. Attitudes, perceived social norms, and doctor advice are factors that are amenable to change and should be considered in educational interventions.
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Affiliation(s)
| | - Fern R. Hauck
- Family Medicine, University of Virginia,
Charlottesville, Virginia
| | | | - Stephen M. Kerr
- Slone Epidemiology Center, Boston University, Boston,
Massachusetts; and
| | - Timothy Heeren
- Department of Biostatistics, School of Public Health
and
| | - Michael J. Corwin
- Slone Epidemiology Center, Boston University, Boston,
Massachusetts; and
| | - Eve Colson
- Department of Pediatrics, School of Medicine,
Washington University in St Louis, St Louis, Missouri
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49
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Chang CT, Shunmugam P, Abdul Aziz NA, Abdul Razak NS, Johari N, Mohamad N, Ghazali R, Rajagam H, Hss AS. Exploring Malaysian mothers' plans on sleeping arrangement with their newborn. J Paediatr Child Health 2020; 56:426-431. [PMID: 31654469 DOI: 10.1111/jpc.14646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/02/2019] [Accepted: 09/10/2019] [Indexed: 11/26/2022]
Abstract
AIM Bed sharing is defined as a newborn sleeping in the same bed with an adult. Bed sharing may put the newborn at risk of suffocation due to accidental smothering. METHODS This was a quasi-experimental study conducted in a tertiary referral hospital. Healthy post-delivery Malaysian mothers were randomly selected and enrolled into the control or the intervention group. On the day of discharge, mothers in the intervention group were interviewed face-to-face in the post-natal ward on their plans for sleeping arrangement with their newborn. After the interview, mothers were advised not to bed share with their newborn and were given an educational leaflet on safe sleeping practices. One week after discharge, mothers in both groups were interviewed over the telephone regarding their actual sleeping arrangements with their newborn using the same questionnaire. Logistic regression was performed to determine factors associated with reduced bed sharing. RESULTS A total of 94 mothers and 95 mothers were recruited to the control and intervention group, respectively. The baseline bed-sharing prevalence was similar between groups: 60.6% in the control group and 61.1% in the interventional group. The proportion of mothers who bed shared with their newborn reduced from 61.1 to 37.9% after the intervention (P < 0.001). Most mothers in the control group opted for bed sharing to ease breastfeeding (68.4%). Mothers in the control group had a 5.9 times higher odds of bed sharing. CONCLUSIONS In this study, the majority of mothers practiced bed sharing at baseline. A significant proportion of mothers changed their sleeping practices after receiving the intervention in the form of an information leaflet.
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Affiliation(s)
- Chee-Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Pavithrah Shunmugam
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | | | - Noor Shahizan Abdul Razak
- Allied Health Science College Sultan Azlan Shah, Ministry of Health Malaysia, Tanjung Rambutan, Malaysia
| | - Nurhidayatun Johari
- Allied Health Science College Sultan Azlan Shah, Ministry of Health Malaysia, Tanjung Rambutan, Malaysia
| | - Norazra Mohamad
- Allied Health Science College Sultan Azlan Shah, Ministry of Health Malaysia, Tanjung Rambutan, Malaysia
| | - Roswati Ghazali
- Allied Health Science College Sultan Azlan Shah, Ministry of Health Malaysia, Tanjung Rambutan, Malaysia
| | - Haymalatha Rajagam
- Allied Health Science College Sultan Azlan Shah, Ministry of Health Malaysia, Tanjung Rambutan, Malaysia
| | - Amar-Singh Hss
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
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50
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Aitken ME, Miller BK, Bai S, Mullins SH, Walton-Buford S, Whiteside-Mansell L. Generations in Families Talking Safe Sleep (GIFTSS): Randomized Controlled Trial of a Safe Sleep Educational Intervention for Young Pregnant Women. SOCIAL SCIENCE PROTOCOLS 2020; 3:10.7565/ssp.2020.2804. [PMID: 36776783 PMCID: PMC9910824 DOI: 10.7565/ssp.2020.2804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sudden Infant Death Syndrome (SIDS) and suffocation account for more than half of all Sudden Unexpected Infant Deaths (SUID) and are leading causes of post-neonatal deaths. Risk reduction strategies, including supine sleep position and safe sleep environment, are critical for prevention. Teen mothers, especially those in rural, poor, southern states, are at higher risk due to low compliance with recommendations. We will conduct a randomized trial to test a tailored educational intervention on the sleep-related safety behaviors of teen mothers. In one study arm, the intervention will include not only the teen mothers but also senior caregivers (SCGs) to assess the influence they have in the decision-making of young mothers regarding infant health and safety. Our hypotheses are H1) teen mothers exposed to intervention will be more likely than controls to adopt safe sleep practices, and H2) teen mothers will be more likely to use those practices when they and their mothers or other significant female senior caregivers also participate in safe sleep education. Better understanding of the mediating role of female SCGs in the health decision of young mothers for their children may have implications for interventions addressing important health problems.
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Affiliation(s)
- Mary E Aitken
- Department of Pediatrics, McGovern Medical School at UTHealth, Houston Texas 77030,Correspondence to Mary E Aitken, Department of Pediatrics, McGovern Medical School at UT Health, Houston Texas 77030.
| | - Beverly K Miller
- Center for Applied Research and Evaluation, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, 72202, USA.,Arkansas Children’s Research Institute, Little Rock, AR, 72202, USA.,Injury Prevention Center, Arkansas Children’s Hospital, Little Rock, AR, 72202, USA
| | - Shasha Bai
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, Ohio 43210, USA. and Biostatistics Resources at Nationwide Children’s Hospital, Columbus, Ohio 43205, USA
| | - Samantha H Mullins
- Center for Applied Research and Evaluation, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, 72202, USA.,Arkansas Children’s Research Institute, Little Rock, AR, 72202, USA.,Injury Prevention Center, Arkansas Children’s Hospital, Little Rock, AR, 72202, USA
| | - S. Walton-Buford
- Center for Applied Research and Evaluation, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, 72202, USA.,Arkansas Children’s Research Institute, Little Rock, AR, 72202, USA.,Injury Prevention Center, Arkansas Children’s Hospital, Little Rock, AR, 72202, USA
| | - Leanne Whiteside-Mansell
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72202, USA
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