The uptake of safe infant sleep practices by Brazilian pediatricians: a nationwide cross-sectional survey

Brazilian Mother’s Practice on Infant Body Position From Birth to 6 Months Old

There is a gap in the understanding of what has been recommended by health professionals to Brazilian mothers regarding infant body positioning whereas the description of this parenting practice can provide criteria for guidance programs already in the maternity ward. This study aimed to record the time (hours/day) Brazilian mothers reported that their infants spent awake or sleeping in 1 of the four body postures: Prone, supine, lateral positions and sitting. The second aim of this study was to verify whether this reported time was associated with birth weight, gestational age, infant chronological age and maternal age. A cross sectional study assessed 92 mothers divided into six groups according to the age of their full-term infant, in months (Mth): 1 Mth (n= 15), 2 Mth (n= 15), 3 Mth (n= 15), 4 Mth (n= 15), 5 Mth (n= 17), and 6 Mth (n= 15). Mothers registered in a 24-hour schedule the most frequent positioning of each infant in 1 day based on the week prior to the assessment day. Infant chronological age was associated with time spent in positions reported by mothers (p< .05). 47.8% of mothers stated not placing infants in prone position anytime in the awake period. Some mothers reported that the infant slept in the prone position. Brazilian caregivers still need to be alerted that the practice of not placing infants to lay in prone might hinder developmental opportunities for them, as well as, on the risks of SIDS and the importance of supine position for infants to sleep.

Longitudinal study of sleep behavior and motor development in low-birth-weight preterm children from infancy to preschool years

OBJECTIVE

To verify the relationship between sleep characteristics and motor development in low-birth-weight preterm infants during infancy and preschool years.

METHOD

Forty-one healthy preterm infants (<37 weeks' gestation) with low birth weight (≤1500 g) were assessed longitudinally at three different time points: at 6 months of corrected age, at 12 months of corrected age, and at 4-5 years of chronological age. At 6 and 12 months, motor development was assessed using the Denver Developmental Screening Test II and Alberta Infant Motor Scale, while sleep-related habits and disturbances were assessed using the Brief Infant Sleep Questionnaire. At 4-5 years, motor development was reassessed using the Pediatric Evaluation of Disability Inventory and sleep was reassessed using the Sleep Disturbance Scale for Children. Correlations were performed using sleep quality as the predictor variable and motor development as the outcome variable.

RESULTS

Most infants had suspected delay/atypical development at 6 and 12 months, with no difference between the scales (p = 1.000). Suspected delay/atypical development were associated with lateral sleep position (p = 0.004), greater number of nighttime awakenings (p = 0.008), and longer awake periods (p = 0.014) only at 6 months. At 4-5 years, the suspected delay/atypical development observed at 6 and 12 months disappeared.

CONCLUSIONS

Sleep quality correlated with delayed/atypical motor development in healthy preterm infants with low birth weight only at 6 months of corrected age, which did not appear to affect later development of motor skills.

Implementation of Safe Sleep Practice Recommendations for Infants in Inpatient Wards

Background

Sudden infant death syndrome (SIDS) is defined as the sudden unexpected death of an infant, even after conducting thorough investigations and autopsy. SIDS is related to several factors, such as baby’s position and presence of pillows, blankets and objects in the crib. The implementation of safe sleep recommendations in the inpatient setting is unknown and there is a scarcity of available data.

Methods

This was an observational, cross-sectional study that was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. All infants less than one year of age were considered after fulfilling the inclusion criteria. A checklist was developed in alignment with the latest American Association of Pediatrics (AAP) recommendations and an an independent observer was trained on how to evaluate and record the various components of the checklist.

Results

One hundred and two patients were enrolled in this study. The mean age of participants was 18.85 weeks. Asleep infants were found to be mostly placed in their cribs (71.4%), on their back (81%). Among the sleeping infants, 46% of them were swaddled at the time of data collection. Blankets were present in 79.4% of the cases, and loose sheets in more than half of the cases. Pillows were seen in 42.2% of the beds. No bumper pads were present in any of the beds.

Conclusion

This observational study highlights the importance of increasing awareness about safe sleep practices. Not only is it important for ensuring patient safety during admissions but also to send an important message to caregivers through role-modeling. Further studies are required to examine the barriers to implementing recommended safe sleep practices both within institutions that care for infants as well as among parents and caregivers.

Sleep characteristics in Brazilian children and adolescents: a population-based study

Objective/background

To evaluate sleep characteristics in Brazilian children and adolescents aged 0–19 years and determine the prevalence of sleep disturbances (SDs) and their association with regional differences and socioeconomic status (SES).

Patients/methods

The target population was divided into three age groups: 0–3 years, 4–12 years, and 13–19 years. An online questionnaire based on Brazilian versions of instruments for sleep assessment was made available to participants from 2014 to 2017. Sleep habits were characterized following the recommendations of the instruments and of the National Sleep Foundation. Data were evaluated by bivariate analyses and logistic regression analyses (p ≤ 0.05).

Results

A total of 1180 respondents were included, representative of all Brazilian regions and SES levels. Inadequate bedtime habits and total sleep time below the recommended levels were observed in all age groups. Overall SD prevalence was 25.5%. Increased risk of SDs was associated with a current health problem in children aged 0–3 years, with hospitalization after birth and sleeping in parents' bed in children aged 4–12 years, and with medication use and playing video games/using the cell phone before sleep in adolescents. There was no significant difference in SD rates between the regions. There was an increased risk of SDs in children with low SES (0–3 years), lower middle SES (4–12 years), and high SES (13–19 years).

Conclusions

Brazilian children and adolescents overall present inadequate sleep habits and sleep duration lower than recommended. SDs increased with age, reaching a peak in adolescence, with an influence of SES on these disturbances.

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Brazilian children and adolescents overall present inadequate sleep habits.

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Sleep duration is lower than recommended in children and adolescents.

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Low socioeconomic status increased the risk of sleep disturbances in children.

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High socioeconomic status increased the risk of sleep disturbances in adolescents.

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Co-sleeping was found in 38.8% and inadequate sleep position in 68.8% of infants.

Sudden Arrhythmic Death During Exercise: A Post-Mortem Genetic Analysis

BACKGROUND

Sudden cardiac death is a natural and unexpected death that occurs within 1 h of the first symptom. Most sudden cardiac deaths occur during exercise, mostly as a result of myocardial infarction. After autopsy, some cases, especially in the young, are diagnosed as cardiomyopathies or remain without a conclusive cause of death. In both situations, genetic alterations may explain the arrhythmia.

OBJECTIVE

Our aim was to identify a genetic predisposition to sudden cardiac death in a cohort of post-mortem cases of individuals who died during exercise, with a structurally normal heart, and were classified as arrhythmogenic death.

METHODS

We analyzed a cohort of 52 post-mortem samples from individuals <50 years old who had a negative autopsy. Next-generation sequencing technology was used to screen genes associated with sudden cardiac death.

RESULTS

Our cohort showed a male prevalence (12:1). Half of the deaths occurred in individuals 41-50 years of age. Running was the most common exercise activity during the fatal event, accounting for 46.15% of cases. Genetic analysis identified 83 rare variants in 37 samples (71.15% of all samples). Of all rare variants, 36.14% were classified as deleterious, being present in 53.84% of all cases.

CONCLUSIONS

A comprehensive analysis of sudden cardiac death-related genes in individuals who died suddenly while exercising enabled the identification of potentially causative variants. However, many genetic variants remain of indeterminate significance, thus further work is needed before clinical translation. Nonetheless, comprehensive genetic analysis of individuals who died during exercise enables the detection of potentially causative variants and helps to identify at-risk relatives.

Mother-child bed-sharing trajectories and psychiatric disorders at the age of 6 years

BACKGROUND

Little is known about the effect of bed-sharing with the mother over the child mental health.

METHODS

Population-based birth cohort conducted in Pelotas, Brazil. Children were enrolled at birth (n=4231) and followed-up at 3 months and at 1, 2, 4, and 6 years of age. Bed-sharing was defined as "habitual sharing of the bed between the child and the mother, for sleeping, for part of the night or the whole night". Trajectories of bed sharing between 3 months and 6 years of age were calculated. Mental health was assessed at the age of 6 years using the Development and Well-Being Assessment instrument that generates psychiatric diagnosis according to ICD-10 and DSM-IV criteria. Odds ratios (OR) with 95% confidence intervals were obtained by multivariate logistic regression.

RESULTS

3583 children were analyzed. Four trajectories were identified: non bed-sharers (44.4%), early-only (36.2%), late-onset (12.0%), and persistent bed-sharers (7.4%). In the adjusted analyses persistent bed-sharers were at increased odds of presenting any psychiatric disorder (OR=1.7; 1.2-2.5) and internalizing problems (OR=2.1; 1.4-3.1), as compared to non bed-sharers. Among the early-only bed-sharers OR for any psychiatric disorder was 1.4 (1.1-1.8) and for internalizing problems 1.6 (1.2-2.1).

LIMITATIONS

Although the effect of bed-sharing was adjusted for several covariates including the family socio-economic status, maternal mental health and excessive crying, there was no information on maternal personal reasons for bed-sharing. Mothers that bed-share intentionally and those that bed-share in reaction to a child sleep problem may have a different interpretation of their children behavior that may bias the study results.

CONCLUSION

Bed-sharing is a common practice in our setting and is associated with impaired child mental health at the age of six years.