The effect of positioning on infant cries: implications for sudden infant death syndrome

National SIDS Trends in the United States From 2000 to 2019: A Population-Based Study on 80 Million Live Births

Sudden infant death syndrome (SIDS) is the most common cause of death for infants between 1 month and 1 year of age in the United States. The objective was to examine recent trends in SIDS in the United States, over time and by sex and race. A population-based cross-sectional study was conducted on 80 710 348 live births using data from the Center for Disease Control and Prevention's (CDC) "Birth Data" and "Mortality Multiple Cause" files from 2000 to 2019. Logistic regression examined the effects of sex and race on the risk of SIDS and examined temporal changes in risk across sex and race over the study period. Incidence of SIDS decreased from 6.3 to 3.4/10 000 births from 2000 to 2019, with an overall incidence of 4.9/10 000 births (95% confidence interval [CI] = 4.4-5.3). Male infants were at the greatest risk of SIDS as were black and American Indian infants. Although SIDS incidence decreased by sex and race over time, the decline was smaller among Hispanic and American Indian infants.

Long-Term Averaged Spectrum Descriptors of Dysarthria in Patients With Parkinson's Disease Treated With Subthalamic Nucleus Deep Brain Stimulation

PURPOSE

This study aimed to evaluate whether long-term averaged spectrum (LTAS) descriptors for reading and monologue are suitable to detect worsening of dysarthria in patients with Parkinson's disease (PD) treated with subthalamic nucleus deep brain stimulation (STN-DBS) with potential effect of ON and OFF stimulation conditions and types of connected speech.

METHOD

Four spectral moments based on LTAS were computed for monologue and reading passage collected from 23 individuals with PD treated with bilateral STN-DBS and 23 age- and gender-matched healthy controls. Speech performance of patients with PD was compared in ON and OFF STN-DBS conditions.

RESULTS

All LTAS spectral moments including mean, standard deviation, skewness, and kurtosis across both monologue and reading passage were able to significantly distinguish between patients with PD in both stimulation conditions and control speakers. The spectral mean was the only LTAS measure sensitive to capture better speech performance in STN-DBS ON, as compared to the STN-DBS OFF stimulation condition (p < .05). Standardized reading passage was more sensitive compared to monologue in detecting dysarthria severity via LTAS descriptors with an area under the curve of up to 0.92 obtained between PD and control groups.

CONCLUSIONS

Our findings confirmed that LTAS is a suitable approach to objectively describe changes in speech impairment severity due to STN-DBS therapy in patients with PD. We envisage these results as an important step toward a continuum development of technological solutions for the automated assessment of stimulation-induced dysarthria.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21644798.

Associations Between Neonatal Cry Acoustics and Visual Attention During the First Year

It has been suggested that early cry parameters are connected to later cognitive abilities. The present study is the first to investigate whether the acoustic features of infant cry are associated with cognitive development already during the first year, as measured by oculomotor orienting and attention disengagement. Cry sounds for acoustic analyses (fundamental frequency; F0) were recorded in two neonatal cohorts at the age of 0–8 days (Tampere, Finland) or at 6 weeks (Cape Town, South Africa). Eye tracking was used to measure oculomotor orienting to peripheral visual stimuli and attention disengagement from central stimuli at 8 months (Tampere) or at 6 months (Cape Town) of age. Only a marginal positive correlation between fundamental frequency of cry (F0) and visual attention disengagement was observed in the Tampere cohort, but not in the Cape Town cohort. This correlation indicated that infants from the Tampere cohort with a higher neonatal F0 were marginally slower to shift their gaze away from the central stimulus to the peripheral stimulus. No associations between F0 and oculomotor orienting were observed in either cohort. We discuss possible factors influencing the current pattern of results suggesting a lack of replicable associations between neonatal cry and visual attention and suggest directions for future research investigating the potential of early cry analysis in predicting later cognitive development.

Are Cry Studies Replicable? An Analysis of Participants, Procedures, and Methods Adopted and Reported in Studies of Infant Cries

Infant cry is evolutionarily, psychologically, and clinically significant. Over the last half century, several researchers and clinicians have investigated acoustical properties of infant cry for medical purposes. However, this literature suffers a lack of standardization in conducting and reporting cry-based studies. In this work, methodologies and procedures employed to analyze infant cry are reviewed and best practices for reporting studies are provided. First, available literatures on vocal and audio acoustic analysis are examined to identify critical aspects of participant information, data collection, methods, and data analysis. Then, 180 peer-reviewed research articles have been assessed to certify the presence of critical information. Results show a general lack of critical description. Researchers in the field of infant cry need to develop a consensual standard set of criteria to report experimental studies to ensure the validity of their methods and results.

Targeted educational program improves infant positioning practice in the NICU

Quality problem or issue

Infant positioning may interfere with neuromotor development. Bedside education and Infant Positioning Assessment Tool (IPAT) improve nurses' and doctors' proficiency in applying proper infant positioning.

Initial assessment

Nursing compliance with proper positioning is suboptimal due to many factors. One factor was the inadequate knowledge and practice of infant positioning, since the baseline mean IPAT score was 3.4.

Choice of solution

Three experienced neonatal intensive care unit (NICU) nurses were chosen as position champions to help other NICU nurses apply proper positioning and monitor IPAT scores. Education and hands-on demonstration sessions were developed based on the observed baseline practice.

Implementation

Periodic education with hands-on demonstration was given to NICU nurses and residents. Infants' positions were objectively scored using IPAT. Two Plan, Do, Study and Act cycles were completed and adjustments were made based on each cycle's achieved results.

Evaluation

Mean IPAT scores increased from 3.4 at baseline and 6.3 in the second cycle to 7.3 in the third cycle of intervention.

Lessons learned

A systematic approach targeting infants' positioning succeeded in improving nurses' and residents' clinical performance. Not reaching significant change until after 18 months highlights the difficulty and complexity in changing behaviors.

Risky Behaviors of Mothers with Infants on Sudden Infant Death Syndrome in Turkey

PURPOSE

Sudden infant death syndrome is the most common cause of death during the post-neonatal period. Factors such as sleeping position, bed sharing, pillow use, smoking during pregnancy and the breastfeeding period constitute risk factors for sudden infant death syndrome. This study aims to identify the risky behaviors of mothers with infants that may put their children at risk for sudden infant death syndrome.

DESIGN AND METHODS

This is a cross-sectional, descriptive study. Data were collected using a questionnaire that was developed by the researchers. The questionnaire was filled out by 456 mothers who applied to the family health center between October 2014 and January 2015.

RESULTS

The greatest risk factor is the infant's sleeping position. A total of 77.9% of the mothers put their babies in bed in a non-supine position; 65.8% used a pillow when they put their babies in bed, 52.9% used a soft mattress, and 28.5% shared their beds with their babies. Prone sleeping was more likely to occur when smoke was present in the home or a pillow was used.

CONCLUSION

Nurses should notify families of the risky behaviors that can cause sudden infant death syndrome and plan appropriate nursing care.

Simultaneous Sudden Infant Death Syndrome: Case Report

Simultaneous sudden infant death syndrome (SSIDS) is death of both twins within 24 hours which is compatible with the sudden infant death syndrome criteria and death is independent of each other. A pair of twin babies, approximately two months old, was found dead in the supine position in bed by their mother. After scene, autopsy, toxicological and histopathological investigations, specific cause of death could not be found. There were 41 pairs of twin babies with SSIDS reported in the literature between 1900 and 1998. This is the second case report from Turkey.

Comparative Survey of Holding Positions for Reducing Vaccination Pain in Young Infants

Background. Infant holding position may reduce vaccination pain. However, the optimal position for young infants remains controversial. Objectives. To compare the effectiveness of holding infants in the supine position and the effectiveness of holding infants in upright position for relieving acute pain from vaccine injection. Methods. This prospective cohort study enrolled 6-12-week-old healthy infants. We examined infant pain responses by evaluating the following three categories: (1) crying, (2) irritability, and (3) facial expression. Results. In total, 282 infants were enrolled, with 103 and 179 held in the supine and upright positions, respectively. At 30 s after vaccination, the infants in the supine position showed a larger decrease in crying (p < 0.001), irritability (p = 0.002), and pained facial expression (p = 0.001) than did those in the upright position. However, there was no significant difference in pain response between two groups at 180 s after intervention. Conclusion. In 2-month-old infants, the supine position may reduce acute pain more effectively than does the upright position. Our findings provide a clinical strategy for relieving vaccination pain in young infants.

Acoustic estimates of respiration in the pain cries of newborns

OBJECTIVE

The purpose of the present study was to examine the temporal features of pain-elicited crying demonstrated by healthy full term infants to estimate (1) the respiratory rate during cry and (2) the inspiratory and expiratory phase composition of the cry respiratory cycle.

PATIENTS AND METHODS

The pain-elicited cries of 12 newborn infants were recorded within the first 2 weeks following birth. A complete crying episode was analyzed for each infant and acoustically measured for the number and duration of inspiratory and expiratory cry components. These components were then used to estimate the respiratory rate of infant crying, as well as the inspiratory and expiratory phase composition of the cry respiratory cycles.

RESULTS

Acoustic analysis revealed that the average rate of crying was 57 breaths min⁻¹ with the inspiratory phase contributing 27% to the overall respiratory cycle. However, considerable variability was found across infants with distinct patterns of respiration associated with high versus low respiratory rates.

CONCLUSIONS

The respiratory patterns associated with pain cries is highly variable and may be associated with variations in stress-arousal, strength of emotional expression, and overall fitness. This study supports the notion that the respiratory activity surrounding newborn infant crying is unique to the type of cry sampled.