Sudden infant death syndrome (SIDS) and child care centres (CCC)

A comparison of safe sleep violations in child care and family child care learning homes in Georgia

BACKGROUND

High rates of infant death associated with sleeping practices continue to persist in the United States. Infants spend a large portion of their day with child care and family child care learning home providers. Safe sleeping practices continue to be an area of need for care providers of young children.

METHOD

The current study examines data drawn from a publicly available database of child care licensing reports in Georgia (n = 3,501), which contained data on child care centres and family child care learning homes. Information in the database included characteristics of the centres, year of data collection and the specific violations by child care provider type.

RESULTS

Results indicated clear differences in the prevalence of violations between child care centres and family child care learning homes. Within the overall sample, 13.3% of centres and family child care learning homes were cited for safe sleeping practice violations with higher prevalence in licensed child care centres and unaccredited centres. Violations were consistent with those commonly found in child care environments and inconsistent with the American Academy of Pediatrics safe sleep recommendations.

CONCLUSIONS

Data from the current study suggest a continued need for professional learning on safe sleep practices.

Integrative literature review: sleep patterns in infants attending nurseries

OBJECTIVE

To identify evidence available in the literature about sleep patterns of infants attending nurseries.

METHOD

An integrative review of studies published in Portuguese, English or Spanish available in full text on LILACS, CINAHL, and PubMed databases. The following descriptors sono, lactente and creches or berçários (in Portuguese) and sleep, infant and childcare or nurseries were used for LILACS, CINAHL and Pubmed, respectively. Nine studies were selected and analyzed.

RESULTS

The main component explored in the studies about sleep pattern is the sleep position of the infants, due to its association with sudden infant death syndrome. The results pointed to the need to promote and develop written guidelines regarding behavioral practices to reduce the risk of this phenomenon.

CONCLUSION

Evidence has identified sleep issues, mainly regarding the sleep position of the infant and the environment where the infant sleeps, showing that it is critical to set routines and interventions to improve the quality of sleep care of infants attending nurseries.

Cardiac ion channelopathies and the sudden infant death syndrome

The sudden infant death syndrome (SIDS) causes the sudden death of an apparently healthy infant, which remains unexplained despite a thorough investigation, including the performance of a complete autopsy. The triple risk model for the pathogenesis of SIDS points to the coincidence of a vulnerable infant, a critical developmental period, and an exogenous stressor. Primary electrical diseases of the heart, which may cause lethal arrhythmias as a result of dysfunctioning cardiac ion channels (“cardiac ion channelopathies”) and are not detectable during a standard postmortem examination, may create the vulnerable infant and thus contribute to SIDS. Evidence comes from clinical correlations between the long QT syndrome and SIDS as well as genetic analyses in cohorts of SIDS victims (“molecular autopsy”), which have revealed a large number of mutations in ion channel-related genes linked to inheritable arrhythmogenic syndromes, in particular the long QT syndrome, the short QT syndrome, the Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia. Combining data from population-based cohort studies, it can be concluded that at least one out of five SIDS victims carries a mutation in a cardiac ion channel-related gene and that the majority of these mutations are of a known malignant phenotype.

Influence of swaddling experience on spontaneous arousal patterns and autonomic control in sleeping infants

OBJECTIVE

To investigate the effects of swaddling experience on infant sleep, spontaneous arousal patterns and autonomic control.

STUDY DESIGN

Twenty-seven healthy term infants, who were routinely swaddled at home (n=15) or "naïve" to swaddling (n=12), were monitored with daytime polysomnography in swaddled and unswaddled conditions at 3 to 4 weeks and at 3 months after birth.

RESULTS

Swaddling did not alter sleep time, spontaneous arousability, or heart rate variability in routinely swaddled infants at either age. During active sleep at 3 months, cortical arousal frequency was decreased, and total sleep time was increased by swaddling in infants who were naïve to swaddling. Heart rate variability when swaddled was also highest in the naïve group.

CONCLUSIONS

The effects of infant swaddling on sleep time, arousability, and autonomic control are influenced by previous swaddling experience. Infants in the naïve to swaddling group exhibited decreased spontaneous cortical arousal, similar to responses observed in future victims of sudden infant death syndrome. Infants in unfamiliar sleeping conditions may therefore be more susceptible to cardiorespiratory challenges that fail to stimulate arousal and may lead to sudden infant death syndrome.