1
|
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.
Collapse
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
| | | |
Collapse
|
2
|
Abstract
Sleep-Disordered Breathing in Childhood Abstract. One out of ten healthy children is a habitual snorer, and one fourth of snoring children suffer from obstructive sleep apnea syndrome (OSAS). While OSAS is widely recognized as a relevant social and health problem due to its negative impact on behavior and neurocognitive development, the medical significance of habitual snoring remains debated. Sleep-disordered breathing remains underestimated and underdiagnosed in childhood, in part due to the variability of clinical manifestations. This is particularly true for children with an underlying syndromal morbidity such as Down syndrome or Prader-Willi syndrome. This review summarizes the essential key points of Sleep-Disordered Breathing (SDB) in childhood.
Collapse
Affiliation(s)
- Daniel Trachsel
- 1 Zentrum für Schlafmedizin der Basler Universitätskliniken USB, UKBB, UPK, Basel
- 2 Abteilung für pädiatrische Pneumologie und Intensivmedizin, Universitäts-Kinderspital beider Basel, Universität Basel
| | - Alexandre N Datta
- 1 Zentrum für Schlafmedizin der Basler Universitätskliniken USB, UKBB, UPK, Basel
- 3 Abteilung für Neuro- und Entwicklungspädiatrie, Universitäts-Kinderspital beider Basel, Universität Basel
| |
Collapse
|
3
|
Abstract
Few studies to date have investigated the relationship between pacifier use or finger sucking and infant sleep. One hundred and four mothers of infants (ages 0-11 months) completed the Brief Infant Sleep Questionnaire (BISQ). Infants who engaged in finger sucking had fewer night wakings and longer stretches of nighttime sleep, although less daytime sleep. There were no significant differences in sleep patterns between pacifier users and infants who did not engage in nonnutritive sucking. Furthermore, no significant differences were found across groups for sleep ecology, including parental involvement at bedtime and following night wakings. Finally, infants were consistently able to retrieve their pacifiers independently by 7 months of age, although this did not appear to be associated with sleep outcomes. Results suggest that when parents are deciding whether to give their infant a pacifier, sleep may not be a critical factor. In contrast, parents of finger and thumb suckers should be reassured that this nonnutritive sucking is beneficial to sleep, at least in the first year of life.
Collapse
Affiliation(s)
- Rachel Butler
- a Saint Joseph's University , Philadelphia , Pennsylvania
| | - Melisa Moore
- b Children's Hospital of Philadelphia , Pennsylvania
| | - Jodi A Mindell
- a Saint Joseph's University , Philadelphia , Pennsylvania.,b Children's Hospital of Philadelphia , Pennsylvania
| |
Collapse
|
4
|
Moon RY. SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment. Pediatrics 2016; 138:peds.2016-2940. [PMID: 27940805 DOI: 10.1542/peds.2016-2940] [Citation(s) in RCA: 350] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS), ill-defined deaths, and accidental suffocation and strangulation in bed. After an initial decrease in the 1990s, the overall sleep-related infant death rate has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, use of a firm sleep surface, room-sharing without bed-sharing, and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence and rationale for recommendations are presented for skin-to-skin care for newborn infants, bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. In addition, expanded recommendations for infant sleep location are included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment," which is included in this issue.
Collapse
|
5
|
Horne RSC, Fyfe KL, Odoi A, Athukoralage A, Yiallourou SR, Wong FY. Dummy/pacifier use in preterm infants increases blood pressure and improves heart rate control. Pediatr Res 2016; 79:325-32. [PMID: 26488553 DOI: 10.1038/pr.2015.212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/04/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Preterm infants are at increased risk of sudden infant death syndrome (SIDS). Use of a dummy/pacifier is thought to be protective against SIDS; accordingly, we assessed the effects of dummy/pacifier use on blood pressure, cerebral oxygenation, and heart rate control over the first 6 mo of life after term corrected age (CA) when SIDS risk is greatest. METHODS Thirty-five preterm infants were studied longitudinally at 2-4 wk, 2-3 mo, and 5-6 mo CA. Cardiac control was assessed from spectral indices of heart rate variability (HRV) in the low frequency (LF) and the high frequency (HF) range, and the ratio of HF/LF indicating sympathovagal balance was calculated. RESULTS Overall, at 2-3 mo, mean arterial pressure was significantly higher in the supine position in dummy/pacifier users in both quiet sleep (70 ± 2 vs. 60 ± 2 mm Hg; P < 0.05) and active sleep (74 ± 3 vs. 69 ± 2 mm Hg; P < 0.05). Dummy/pacifier users had higher LF HRV and LF/HF ratio and lower HF HRV. CONCLUSION Dummy/pacifier use increased blood pressure during sleep, at the age of greatest SIDS risk. Overall, LF HRV was elevated and HF HRV reduced in dummy/pacifier users, suggesting that dummy use alters cardiac control in preterm infants.
Collapse
Affiliation(s)
- Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Karinna L Fyfe
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Alexsandria Odoi
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia
| | - Anjalee Athukoralage
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia
| | - Stephanie R Yiallourou
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Flora Y Wong
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia.,Monash Newborn, Monash Medical Centre, Melbourne, Australia
| |
Collapse
|
6
|
Wennergren G, Nordstrand K, Alm B, Möllborg P, Öhman A, Berlin A, Katz‐Salamon M, Lagercrantz H. Updated Swedish advice on reducing the risk of sudden infant death syndrome. Acta Paediatr 2015; 104:444-8. [PMID: 25656219 PMCID: PMC6680202 DOI: 10.1111/apa.12966] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 01/25/2015] [Accepted: 02/02/2015] [Indexed: 12/27/2022]
Abstract
This article reviews updated advice and factual material from the Swedish National Board of Health and Welfare on reducing the risk of sudden infant death syndrome. Issues covered by the guidance for parents and healthcare professionals include sleeping positions, smoking, breastfeeding, bed sharing and using pacifiers. Conclusion The guidelines conclude that infants under three months of age are safest sleeping in their own cot and that a pacifier can be used when they are going to sleep.
Collapse
Affiliation(s)
- Göran Wennergren
- 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
| | - Per Möllborg
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Anna Öhman
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Anita Berlin
- Centre for Family and Community Medicine Department of Neurobiology, Care Sciences and Society Karolinska Institute Stockholm Sweden
| | - Miriam Katz‐Salamon
- Department of Women's and Children's Health Karolinska Institute Stockholm Sweden
| | - Hugo Lagercrantz
- Department of Women's and Children's Health Karolinska Institute Stockholm Sweden
| |
Collapse
|
7
|
Odoi A, Andrew S, Wong FY, Yiallourou SR, Horne RSC. Pacifier use does not alter sleep and spontaneous arousal patterns in healthy term-born infants. Acta Paediatr 2014; 103:1244-50. [PMID: 25169652 DOI: 10.1111/apa.12790] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/28/2014] [Accepted: 08/25/2014] [Indexed: 12/01/2022]
Abstract
AIM Impaired arousal from sleep has been implicated in sudden infant death syndrome (SIDS). Sleeping in the prone position is a major risk factor for SIDS. Epidemiological studies have shown that pacifier use decreases the risk of SIDS, even when infants sleep prone. We examined spontaneous arousability in infants slept prone and supine over the first 6 months of life and hypothesised that spontaneous arousals would be increased in pacifier users, particularly in the prone position. METHODS Healthy term infants (n = 30) were studied on three occasions over the first 6 months after birth. Spontaneous cortical arousals and subcortical activations were scored and converted into frequency per hour of sleep. RESULTS There was no effect of pacifier use on total time spent sleeping or awake or the number of spontaneous awakenings at any age. There was also no effect of pacifier use on the frequency or duration of the total number of spontaneous arousals or on cortical arousals and subcortical activations. CONCLUSION Pacifier use did not alter infant spontaneous arousability at any of the three ages studied, in either the prone or supine sleeping position. Any preventative effect of pacifiers for SIDS may be through physiological mechanisms other than increased arousability.
Collapse
Affiliation(s)
- Alexsandria Odoi
- The Ritchie Centre; Monash Institute of Medical Research and Prince Henry's Institute and Monash University; Melbourne Victoria Australia
| | - Shanelle Andrew
- The Ritchie Centre; Monash Institute of Medical Research and Prince Henry's Institute and Monash University; Melbourne Victoria Australia
| | - Flora Y Wong
- The Ritchie Centre; Monash Institute of Medical Research and Prince Henry's Institute and Monash University; Melbourne Victoria Australia
- Monash Newborn; Monash Health; Melbourne Victoria Australia
- Department of Paediatrics; Monash University; Melbourne Victoria Australia
| | - Stephanie R Yiallourou
- The Ritchie Centre; Monash Institute of Medical Research and Prince Henry's Institute and Monash University; Melbourne Victoria Australia
- Department of Paediatrics; Monash University; Melbourne Victoria Australia
| | - Rosemary S C Horne
- The Ritchie Centre; Monash Institute of Medical Research and Prince Henry's Institute and Monash University; Melbourne Victoria Australia
- Department of Paediatrics; Monash University; Melbourne Victoria Australia
| |
Collapse
|
8
|
Yiallourou SR, Poole H, Prathivadi P, Odoi A, Wong FY, Horne RS. The effects of dummy/pacifier use on infant blood pressure and autonomic activity during sleep. Sleep Med 2014; 15:1508-16. [DOI: 10.1016/j.sleep.2014.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 07/07/2014] [Accepted: 07/13/2014] [Indexed: 10/24/2022]
|
9
|
Horne RSC, Hauck FR, Moon RY, L'hoir MP, Blair PS. Dummy (pacifier) use and sudden infant death syndrome: potential advantages and disadvantages. J Paediatr Child Health 2014; 50:170-4. [PMID: 24674245 DOI: 10.1111/jpc.12402] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2013] [Indexed: 12/01/2022]
Abstract
The large decline in deaths due to the sudden infant death syndrome (SIDS) in the last 20 years in many countries is largely due to risk-reduction advice resulting from observational studies that examined the relationship between infant care practices and SIDS. Most of this advice remains largely uncontroversial and educators and researchers in this field are in agreement as to the specific recommendations that should be given to parents and health professionals. However, advice surrounding the apparent protective effect of dummies (also known as pacifiers) has been controversial. Several systematic reviews have demonstrated a strong association between the lack of a pacifier being used by the infant for the final sleep and SIDS, but it is not clear how pacifiers confer protection or if this is a marker for something as yet unmeasured. The Epidemiology and Physiology Working Groups of the International Society for the Study and Prevention of Perinatal and Infant Death (ISPID) are comprised of leading SIDS researchers with an objective to provide evidence-based position statements surrounding the factors associated with SIDS (http://www.ispid.org/) and risk-reduction strategies. The evidence, discussion and conclusions from these working groups regarding dummies (pacifiers) are described below to help inform this debate and describe the future evidence required so that we might find a common recommendation about dummies (pacifiers) and SIDS.
Collapse
Affiliation(s)
- Rosemary S C Horne
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia
| | | | | | | | | | | |
Collapse
|
10
|
Liaw JJ, Yang L, Lo C, Yuh YS, Fan HC, Chang YC, Chao SC. Caregiving and positioning effects on preterm infant states over 24 hours in a neonatal unit in Taiwan. Res Nurs Health 2011; 35:132-45. [DOI: 10.1002/nur.21458] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2011] [Indexed: 11/07/2022]
|
11
|
Franco P, Kato I, Richardson HL, Yang JSC, Montemitro E, Horne RSC. Arousal from sleep mechanisms in infants. Sleep Med 2010; 11:603-14. [PMID: 20630799 DOI: 10.1016/j.sleep.2009.12.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 12/14/2009] [Accepted: 12/17/2009] [Indexed: 11/19/2022]
Abstract
Arousals from sleep allow sleep to continue in the face of stimuli that normally elicit responses during wakefulness and also permit awakening. Such an adaptive mechanism implies that any malfunction may have clinical importance. Inadequate control of arousal in infants and children is associated with a variety of sleep-related problems. An excessive propensity to arouse from sleep favors the development of repeated sleep disruptions and insomnia, with impairment of daytime alertness and performance. A lack of an adequate arousal response to a noxious nocturnal stimulus reduces an infant's chances of autoresuscitation, and thus survival, increasing the risk for Sudden Infant Death Syndrome (SIDS). The study of arousability is complicated by many factors including the definition of an arousal; the scoring methodology; the techniques used (spontaneous arousability versus arousal responses to endogenous or exogenous stimuli); and the confounding factors that complicate the determination of arousal thresholds by changing the sleeper's responses to a given stimulus such as prenatal drug, alcohol, or cigarette use. Infant age and previous sleep deprivation also modify thresholds. Other confounding factors include time of night, sleep stages, the sleeper's body position, and sleeping conditions. In this paper, we will review these different aspects for the study of arousals in infants and also report the importance of these studies for the understanding of the pathophysiology of some clinical conditions, particularly SIDS.
Collapse
Affiliation(s)
- Patricia Franco
- Pediatric Sleep Unit, HFME & INSERM U 628, University Lyon 1, Lyon, France.
| | | | | | | | | | | |
Collapse
|