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Current Topics
Use of a Fan During Sleep and the Risk of Sudden Infant Death Syndrome
"The results of this study suggest that using a fan may be an effective intervention for lowering the risk of SIDS [sudden infant death syndrome] in sleeping environments that facilitate rebreathing," state the authors of an article published in the October 2008 issue of Archives of Pediatrics and Adolescent Medicine. Despite a 50% decrease in the national incidence of SIDS, it remains the leading cause of postneonatal mortality in the United States. While other risk factors have been publicized by the Back to Sleep campaign, the relationship between room ventilation and SIDS has received little attention.
Rebreathing exhaled carbon dioxide trapped near an infant's airway by bedding has been suggested as a possible mechanism for SIDS in at-risk infants and may occur with the use of soft bedding, covering the head during sleep, and use of the prone sleeping position. The authors examined whether improved room ventilation by use of a fan or an open window affects the risk of SIDS.
The authors found that: After adjusting for matching variables, known risk factors, and other potential confounders, having a fan on in the room during last sleep was associated with a 72% reduction in the rate of SIDS.
The authors conclude that "although improving the methods used to convey the importance of the supine sleep position remains paramount, use of a fan in the room of a sleeping infant may be an easily available means of further reducing SIDS risk that can be readily accepted by care providers from a variety of social and cultural backgrounds."
Coleman-Phox K, Odouli R, De-Kun L. 2008. Use of a fan during sleep and the risk of sudden infant death syndrome. Archives of Pediatrics and Adolescent Medicine 162(10):963-968.
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American Academy of Pediatrics Revises Recommendations to Reduce the Incidence of Infant Death
The American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome recently released a revised policy statement providing evidence based best practices to reduce infant death. The major changes are the use of pacifiers, side sleep position, and bed sharing. The following is a summary of the recommendations
Place infants on their back to sleep for naps and nighttime, in a safe crib, never on a couch, chair or other soft surfaces.
Use a safety approved firm crib mattress covered by a fitted sheet. *
Keep all soft objects out of crib such as stuffed toys, comforters, pillows, and quilts.
No smoking around baby.
Do not share a bed with your baby. Baby can sleep in the same room as parents, but should have its own separate sleep surface.
Use a clean, dry pacifier when placing baby to sleep. Breastfed infants should not be offered a pacifier for the first month until breastfeeding has been established.
Avoid overheating baby by keeping baby’s room at a comfortable temperature and reducing covers.
Home monitors are not recommended as a method for reducing SIDS.
Do not use products designed to keep baby in a back sleep position, for example, foam wedges. They have not been sufficiently tested and are not recommended.
Give baby “tummy time” while awake to strengthen head and neck. It will also help reduce chances for a “flat head.” Place baby at alternate ends of the crib, with head to side, for sleep. Reducing excessive time in car seat carriers and bouncers, and upright cuddle time will also help.
Make sure everyone caring for baby knows about these recommendations.
The side is no longer considered a safe sleep position.
Source: American Academy of Pediatrics Policy Statement, “Changing Concept of Sudden Infant Death Syndrome” released Oct. 10, 2005.
*Car seats, swings or infants seats are not meant to be substitutes for cribs.
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Center Funds Research
The Center is pleased to have funded, in part, a study entitled "Forensic Investigation of Sudden Infant Deaths in the State of Maryland"
Ling Li, Xiang Zhang, Carolyn Fowler, Ron Zielke, David Fowler
Office of the Chief Medical Examiner, State of Maryland; Department of Pediatrics, University of Maryland U.S.A., Department of Pediatrics, University of Maryland, School of Medicine; Johns Hopkins University, School of Public Health
The Office of the Chief Medical Examiner (OCME) has witnessed a significant decline in the death of Sudden Infant Death Syndrome (SIDS) in the State of Maryland since 1994. As the SIDS rate in Maryland dropped sharply from 1.19 per 1000 live births in 1990 to only 0.27 per 1000 live births in 2003, the occurrence of related diagnosis, such a ”undetermined” cases has increased considerably. We present an investigation of 104 infant victims who died suddenly and unexpectedly in the state of Maryland in 2003. Of the 104 infants, only 20 cases were determined to be SIDS, 30 deaths were due to natural diseases, 14 were accidents, and 5 were homicides. The manner of death could not be determined after a thorough scene investigation, review of history and a complete postmortem examination in 34 cases, in which the cause of death was listed as Sudden Unexplained Death in Infancy (SUDI). The percentage of “undetermined” cases increased from 2.1% in 1990 to 32% in 2003. The most common “undetermined” cases in 2003 were co-sleeping infants because the possibility of asphyxia due to overlay could not be ruled out.
The study showed that only 24 (23%) infants were sleeping alone in a crib or bassinet and 46 (44%) were sleeping in bed with another person or persons (co-sleeping) at the time when they were found unresponsive. Co-sleeping contributed to 10 infants dying of asphyxia due to overlay by an adult or older sibling. Asphyxia due to overlay could not be completely excluded in an additional 28 infants while co-sleeping. Majority of co-sleeping infants were less than 4 months old and more than 50% of co-sleeping infants shared a bed with 2-3 people. The crib availability was also documented in all the co-sleeping cases. Twenty-eight (60.9%) co-sleeping infants had a crib at home and 9 out of 10 asphyxia victims had an available crib at the time of the incident.
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Research Briefs
Preterm Delivery and Age of SIDS Death
http://www.sciencedirect.com
Purpose: The aim of the study is to (1) reexamine risk factors for sudden infant death syndrome (SIDS).
Conclusions: Preterm birth continues to be a strong risk factor for SIDS after controlling for fetal growth. With increasing gestational age, mean age of SIDS death decreases considerably, with the postnatal age of death of very preterm infants, 6 weeks later than that of term infants.
Second-Trimester Maternal Serum Levels of Alpha-Fetoprotein and the Subsequent Risk of Sudden Infant Death Syndrome
http://www.obgynsurvey.com
This study investigates whether second-trimester maternal alpha-fetoprotein levels are associated with the future risk of sudden infant death syndrome (SIDS) and stillbirth. Researchers conducted this study in Scotland by linking a prenatal screening database for women with databases of maternity, perinatal death, and birth and death certifications of assess the association. The results of the study indicate that there is a direct association between second-trimester maternal serum alpha-fetoprotein levels and the risk of SIDS, which may be mediated in part through impaired fetal growth and preterm birth.
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