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Ramos PV, Hoogerwerf PJ, Smith PK, Finley C, Okoro UE, Jennissen CA. Pre- and postnatal safe sleep knowledge and planned as compared to actual infant sleep practices. Inj Epidemiol 2023; 10:55. [PMID: 37885011 PMCID: PMC10601097 DOI: 10.1186/s40621-023-00467-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Our objectives were to compare safe sleep knowledge, attitudes and planned vs. actual infant sleep practices among expectant mothers before and after their infant's birth and to determine whether differences (if present) were associated with any demographic variables. METHODS Study participants were surveyed at their 28-week prenatal and 6-week postpartum obstetric clinic visits from November 2019-February 2021. Due to COVID-19 pandemic cancellation of in-person postpartum visits, many participants received text messaging encouraging them to take the follow-up survey online. Frequency and comparative analyses were performed. RESULTS 355 women (44%) completed both pre- and postnatal surveys. Many participants increased their safe sleep knowledge during the study. For example, of those who were unsure or thought it safe for a baby to sleep in a baby swing/bouncy seat, two-thirds (67/102, 66%) stated it was unsafe on the postnatal survey. In addition, many who were unsure or planned sleep practices considered unsafe prenatally reported utilizing safe sleep practices on their postnatal survey. For example, of those unsure or planning to use a crib bumper (17% of the total), almost all (88%) were not using one postnatally. Conversely, some participants who reported they would be following safe sleep practices prenatally were not doing so postpartum. For example, 13% of those stating they would place their child on their back reported using another sleep position on the postnatal survey. Certain demographics had higher proportions reporting this reversal for specific safe sleep practices. For example, non-Hispanic Whites (19%) as compared to other races/ethnicities (5%) and those with incomes ≥ $75,000 (21%) as compared with those with less income (9%) had higher proportions stating their infant would sleep in the same room but then reported postnatally they were sleeping in a different room, p = 0.0094 and p = 0.0138, respectively. CONCLUSIONS We observed increases in safe sleep knowledge and that some participants followed safer sleep practices than they had planned. However, there were also participants who planned to use safe sleep practices prenatally who were not doing so after their baby's birth. Our study identified demographics for which targeted safe sleep education and more effective interventions may be needed.
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Affiliation(s)
- Paula Valiño Ramos
- Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA USA
- Medical Scientist Training Program, Washington University in St. Louis, St. Louis, MO USA
| | - Pamela J. Hoogerwerf
- Injury Prevention and Community Outreach, University of Iowa Stead Family Children’s Hospital, University of Iowa, Iowa City, IA USA
| | - Penny K. Smith
- Iowa’s Statewide Perinatal Care Program, University of Iowa Stead Family Children’s Hospital, University of Iowa, Iowa City, IA USA
| | - Carolyn Finley
- University of Iowa Stead Family Children’s Hospital, University of Iowa, Iowa City, IA USA
| | - Uche E. Okoro
- Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA USA
| | - Charles A. Jennissen
- Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA USA
- Department of Pediatrics, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA USA
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Availability of death review of children using death certificates and forensic autopsy results. Leg Med (Tokyo) 2023; 60:102156. [PMID: 36270202 DOI: 10.1016/j.legalmed.2022.102156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/28/2022] [Accepted: 10/01/2022] [Indexed: 11/07/2022]
Abstract
The Model Project for Child Death Review (CDR) was initiated in Japan, but parental consent is required for detailed investigations. We proposed an alternative method to review child deaths using death certificates and forensic autopsy results when parental consent is not provided. We extracted and reviewed death certificates for the deceased younger than 18 years from among all certificates submitted in Shiga Prefecture between 2015 and 2017. In addition, we analyzed autopsy records in cases that underwent forensic autopsy. The prevalence of each cause of death was compared among age groups. The situation and circumstances of unnatural deaths were analyzed in detail. Of 131 certificates, unnatural deaths accounted for 29.7 %. The prevalence of each cause of death significantly differed among age groups. Malignant disease and suicide were most common in school-aged children and congenital disease was most common in infants. Suicide was the leading cause of unnatural death, followed by suffocation, which was most common in infants. Situations where suffocation was reported included co-sleeping with the mother and breastfeeding. Despite parental consent not being obtained, the trends of regional child deaths and the circumstances of accidental deaths were clarified by the present method. However, the results of detailed investigation were lacking. This study provided basic information for implementing detailed methods and procedures for CDR at the governmental level. To perform optimal CDR, legislation for collecting detailed information without parental consent is required.
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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.
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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
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Moon RY, Carlin RF, Hand I. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics 2022; 150:188304. [PMID: 35726558 DOI: 10.1542/peds.2022-057990] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Each year in the United States, ∼3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Classification of Diseases, 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 has 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. Additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is also included. The recommendations and strength of evidence for each recommendation are included in this policy statement. The rationale for these recommendations is discussed in detail in the accompanying technical report.
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Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Rebecca F Carlin
- Department of Pediatrics, Division of Pediatric Critical Care and Hospital Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, New York
| | - Ivan Hand
- Department of Pediatrics, SUNY-Downstate College of Medicine, NYC Health + Hospitals
- Kings County, Brooklyn, New York
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Al-shehri H, Almozaai R, Kariri M, Alhazmi Y, AlDakhel S, Alhunaishel R, Aladhadhi D. Factors Associated with Safe Infant Sleep Practices in Saudi Arabia. Pediatric Health Med Ther 2021; 12:533-541. [PMID: 34955665 PMCID: PMC8694400 DOI: 10.2147/phmt.s343535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose To assess mothers’ approaches to infant sleep practices. Patients and Methods A cross-sectional survey study was conducted on mothers with babies aged below five months who were attending paediatric clinics between November 1st, 2020, and January 5th, 2021, in Riyadh, Saudi Arabia. Results A total of 522 mothers participated in this study. A total of 38.9% practised exclusive formula feeding. A total of 61.9% of the participants practised the supine position. The majority (93.3%) of the mothers shared a room with their babies, while 34.7% shared a bed. Only 6.9% did not use any soft bedding. Age was a significant predictor associated with participant practices regarding sleeping and feeding positions (p < 0.05). Having two or more children was associated with improper sleeping practices (p < 0.05). Being non-Saudi and having a university degree or higher were associated with having a higher risk of unsafe practices regarding bed-sharing (p < 0.05). On the other hand, being contacted by a doctor, nurse, or other healthcare worker about safe sleep practices were an important factor that influenced safe practices regarding feeding (p < 0.05). Receiving care at a private hospital was associated with safer practices regarding sleeping position and bed-sharing (p < 0.05). Conclusion We observed high-risk sleeping practices among Saudi mothers. This includes using soft bedding and unsafe sleeping positions. The importance of this study lies in the future implementation of this result through public health measures aimed at at-risk populations.
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Affiliation(s)
- Hassan Al-shehri
- Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
- Correspondence: Hassan Al-shehri Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi ArabiaTel +966112582759 Email
| | - Rahaf Almozaai
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Marwh Kariri
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Yara Alhazmi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Shatha AlDakhel
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Reyouf Alhunaishel
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Dina Aladhadhi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Kanits F, L'Hoir MP, Boere-Boonekamp MM, Engelberts AC, Feskens EJM. Risk and Preventive Factors for SUDI: Need We Adjust the Current Prevention Advice in a Low-Incidence Country. Front Pediatr 2021; 9:758048. [PMID: 34869115 PMCID: PMC8635138 DOI: 10.3389/fped.2021.758048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/21/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The incidence of Sudden Unexpected Death in Infancy (SUDI) is low in the Netherlands, with an incidence rate of 0.18 per 1,000 live births. Therefore, prevention advice may receive less attention, potentially leading to increasing incidence rates. It is currently unknown whether the risks for SUDI changed in the Netherlands, and if other risk factors might be present. The aim of this study was to examine the current risks and preventive factors for SUDI in Dutch infants, in order to determine if it is necessary to adapt the prevention advice toward the current needs. Methods: A case-control study was conducted comparing SUDI cases aged <12 months from 2014-2020 in the Netherlands (n = 47), to a Dutch national survey control group from 2017 including infants <12 months of age (n = 1,192). Results: Elevated risks for several well-known factors were observed, namely: duvet use (aOR = 8.6), mother smoked during pregnancy (aOR = 9.7), or after pregnancy (aOR = 5.4) and the prone sleeping position (aOR = 4.6). Reduced risks were observed for the well-known factors: room-sharing (aOR = 0.3), sleep sack use (aOR = 0.3), breastfeeding (aOR = 0.3), and the use of a pacifier (aOR = 0.4). For infants <4 months, the risk for SUDI was higher when bed-sharing (aOR = 3.3), and lower when room-sharing (aOR = 0.2) compared to older infants. For older infants, the sleep sack was found to be more protective (aOR = 0.2). A high risk for SUDI when bed-sharing was found when mother smoked, smoked during pregnancy, or if the infant did not receive any breastfeeding (respectively aOR = 17.7, aOR = 10.8, aOR = 9.2). Conclusions: Internationally known factors related to the sudden unexpected death of infants were also found in this study. Relatively new findings are related to specific groups of infants, in which the strengths of these risk factors differed. In a low-incidence country like the Netherlands, renewed attention to the current prevention advice is needed. Furthermore, additional attention for prevention measures in low educated groups, and additional advice specifically targeting high-risk groups is recommended.
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Affiliation(s)
- Floortje Kanits
- Department of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Monique P. L'Hoir
- Department of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
- Community Health Center, GGD Noord-Oost-Gelderland, Warnsveld, Netherlands
| | - Magda M. Boere-Boonekamp
- Department of Health Technology & Services Research, University of Twente, Enschede, Netherlands
| | - Adèle C. Engelberts
- Department of Pediatrics, Zuyderland Medical Center, Sittard-Geleen, Netherlands
| | - Edith J. M. Feskens
- Department of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
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O’ Brien N, McGarvey C, Hamilton K, Hayes B. Maternal intentions towards infant sleeping practices in Ireland. Acta Paediatr 2021; 110:184-193. [PMID: 32415996 DOI: 10.1111/apa.15352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/23/2022]
Abstract
AIM Mortality from Sudden Infant Death Syndrome (SIDS) has reduced by 50%-85% globally. Despite improvements from 1990 to 2009, the Irish SIDS rate has plateaued. Reasons for this are unclear, but may be related to a reduced parental SIDS awareness. Our study aimed to assess intentions regarding infant sleeping practices in mothers in Ireland. METHODS A cross-sectional survey of post-partum mothers was performed in the Rotunda Hospital over a four month period. Mothers with a history of SIDS, miscarriage or neonatal admissions were excluded. RESULTS Of 451 participants, unsafe sleeping positions were intended by 15.4%, reduced by Irish ethnicity [AOR = 0.52, 95% CI = 0.277-0.959, P = .036]. Safe sleep locations were intended by 66%, increased by Irish ethnicity [AOR = 2.6, 95% CI = 1.617-4.191, P < .001], and reduced by young maternal age [AOR = 0.15, 95% CI = 0.03-0.713, P = .02]. Maternal smoking was more likely in mothers with lower educational level [AOR = 3.51, 95% CI = 1.169-10.56, P = .03]. Soft bedding use was intended by 34.8%, increased in younger mothers [AOR = 2.28, 95% CI = 1.04-4.98, P = .04]. Breastfeeding was intended by 72.2%, decreased by Irish ethnicity [AOR = 0.14, 95% CI = 0.067-0.271, P < .001], and low maternal education [AOR = 0.22, 95% CI = 0.117-0.406, P < .001]. CONCLUSION Educational campaigns on safe sleep for infants in Ireland need to address modifiable SIDS risks factors, focusing on younger, non-Irish mothers, with lower educational attainment.
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Affiliation(s)
- Niamh O’ Brien
- Department of Neonatology Rotunda Hospital Dublin 1 Ireland
| | - Cliona McGarvey
- Children’s Health Ireland (CHI) at Temple St National Paediatric Mortality Register Dublin 1 Ireland
| | - Karina Hamilton
- Children’s Health Ireland (CHI) at Temple St National Paediatric Mortality Register Dublin 1 Ireland
| | - Breda Hayes
- Department of Neonatology Rotunda Hospital Dublin 1 Ireland
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Goodstein MH, Lagon E, Bell T, Joyner BL, Moon RY. Stock Photographs Do Not Comply With Infant Safe Sleep Guidelines. Clin Pediatr (Phila) 2018; 57:403-409. [PMID: 28868896 DOI: 10.1177/0009922817728698] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated images in popular stock photography websites for adherence with American Academy of Pediatrics (AAP) guidelines for safe infant sleep practices. Three top stock photo websites were used to collect photographs generated from key phrases. All images depicting an infant sleep environment were analyzed for consistency with AAP guidelines. Descriptive statistics, chi-square and z test of proportions, were conducted. A total of 1233 of 1947 stock photographs showed sleeping infants on a flat surface. In all, 627 (50.8%) photographs showed the infant in the supine position and 79 (5%) of all infant sleep environments were adherent with AAP recommendations. Bedding inconsistent with safe sleep recommendations was identified in 1133 images (71.3%), with blankets noted in 49.5%. Images depicting sleeping infants on stock photography sites do not routinely adhere to AAP recommendations. Media messages inconsistent with health care messages create confusion and misinformation about infant sleep safety and may lead inadvertently to unsafe practices.
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Affiliation(s)
| | - Elena Lagon
- 2 University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Brandi L Joyner
- 3 Goldberg Center for Community Pediatric Health, Washington, DC, USA
| | - Rachel Y Moon
- 2 University of Virginia School of Medicine, Charlottesville, VA, USA
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Moon RY, Mathews A, Joyner BL, Oden RP, He J, McCarter R. Health Messaging and African-American Infant Sleep Location: A Randomized Controlled Trial. J Community Health 2018; 42:1-9. [PMID: 27470122 DOI: 10.1007/s10900-016-0227-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Infant-parent bedsharing increases the risk of SIDS and other sleep-related deaths. Despite AAP recommendations to avoid bedsharing, public health efforts have been unsuccessful in changing behaviors. African-American infants are more than twice as likely to die from SIDS and other sleep-related deaths, and are also twice as likely to bedshare with their parents. Further, African-American parents have a high degree of self-efficacy with regards to preventing infant suffocation, but low self-efficacy with regards to SIDS risk reduction. It is unclear whether messages emphasizing suffocation prevention will decrease bedsharing. To evaluate the impact of specific health messages on African-American parental decisions regarding infant sleep location. We conducted a randomized, controlled trial of African-American mothers of infants. The control group received standard messaging emphasizing AAP-recommended safe sleep practices, including avoidance of bedsharing, for the purposes of SIDS risk reduction. The intervention group received enhanced messaging emphasizing safe sleep practices, including avoidance of bedsharing, for both SIDS risk reduction and suffocation prevention. Participants completed interviews at 2-3 weeks, 2-3 months, and 5-6 months after the infant's birth. 1194 mothers were enrolled in the study, and 637 completed all interviews. Bedsharing, both usually (aOR 1.005 [95 % CI 1.003, 1.006]) and last night (aOR 1.004 [95 % CI 1.002, 1.007]) increased slightly but statistically significantly with infant age (p < 0.001). Receipt of the enhanced message did not impact on sleep location. Maternal belief that bedsharing increased the risk of SIDS or suffocation declined over 6 months (p < 0.001) and did not differ by group assignment. African-American mothers who received an enhanced message about SIDS risk reduction and suffocation prevention were no less likely to bedshare with their infants. CLINICAL TRIALS REGISTRATION Clinical Trials.gov identifier NCT01361880.
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Affiliation(s)
- Rachel Y Moon
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA.
- Center for Translational Science, Children's National Medical Center, Washington, DC, USA.
- Department of Pediatrics, George Washington University, Washington, DC, USA.
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.
- Division of General Pediatrics, University of Virginia, PO Box 800386, Charlottesville, VA, 22908, USA.
| | - Anita Mathews
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA
| | - Brandi L Joyner
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA
| | - Rosalind P Oden
- Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA
| | - Jianping He
- Center for Translational Science, Children's National Medical Center, Washington, DC, USA
| | - Robert McCarter
- Center for Translational Science, Children's National Medical Center, Washington, DC, USA
- Department of Pediatrics, George Washington University, Washington, DC, USA
- Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA
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Thompson JMD, Tanabe K, Moon RY, Mitchell EA, McGarvey C, Tappin D, Blair PS, Hauck FR. Duration of Breastfeeding and Risk of SIDS: An Individual Participant Data Meta-analysis. Pediatrics 2017; 140:peds.2017-1324. [PMID: 29084835 DOI: 10.1542/peds.2017-1324] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Sudden infant death syndrome (SIDS) is a leading cause of postneonatal infant mortality. Our previous meta-analyses showed that any breastfeeding is protective against SIDS with exclusive breastfeeding conferring a stronger effect.The duration of breastfeeding required to confer a protective effect is unknown. OBJECTIVE To assess the associations between breastfeeding duration and SIDS. DATA SOURCES Individual-level data from 8 case-control studies. STUDY SELECTION Case-control SIDS studies with breastfeeding data. DATA EXTRACTION Breastfeeding variables, demographic factors, and other potential confounders were identified. Individual-study and pooled analyses were performed. RESULTS A total of 2267 SIDS cases and 6837 control infants were included. In multivariable pooled analysis, breastfeeding for <2 months was not protective (adjusted odds ratio [aOR]: 0.91, 95% confidence interval [CI]: 0.68-1.22). Any breastfeeding ≥2 months was protective, with greater protection seen with increased duration (2-4 months: aOR: 0.60, 95% CI: 0.44-0.82; 4-6 months: aOR: 0.40, 95% CI: 0.26-0.63; and >6 months: aOR: 0.36, 95% CI: 0.22-0.61). Although exclusive breastfeeding for <2 months was not protective (aOR: 0.82, 95% CI: 0.59-1.14), longer periods were protective (2-4 months: aOR: 0.61, 95% CI: 0.42-0.87; 4-6 months: aOR: 0.46, 95% CI: 0.29-0.74). LIMITATIONS The variables collected in each study varied slightly, limiting our ability to include all studies in the analysis and control for all confounders. CONCLUSIONS Breastfeeding duration of at least 2 months was associated with half the risk of SIDS. Breastfeeding does not need to be exclusive to confer this protection.
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Affiliation(s)
- John M D Thompson
- Department of Paediatrics: Child and Youth Health and Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand;
| | | | - Rachel Y Moon
- Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health and Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Cliona McGarvey
- National Paediatric Mortality Register, Temple Street Children's University Hospital, Dublin, Ireland
| | - David Tappin
- Department of Child Health, School of Medicine, University of Glasgow, Glasgow, United Kingdom; and
| | - Peter S Blair
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Abstract
BACKGROUND Nonnutritive sucking using a finger or pacifier is a natural reflex for infants. We hypothesized that infants may overfeed if the bottle or breast is constantly offered. Our goal was to determine whether pacifier use in early infancy is associated with lower incidence of obesity at later age. METHODS Parents of 399 infants, 9 to 15 months old, were interviewed and asked whether a pacifier was used consistently for ≥9 months. Body mass indexes at birth, 6 months, and on the day of interview were calculated. RESULTS In all, 204 (51%) infants used a pacifier, and 195 (49%) were nonusers. More infants in the nonuser group were either overweight-40 (21%)-or obese-32 (16%)-than in the user group-22 (11%) and 22 (11%), respectively ( P = .003). CONCLUSIONS Pacifier use in infancy was associated with lower incidence of obesity at 9 to 15 months of age. Offering a pacifier can be protective against infantile obesity.
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Affiliation(s)
- Ahdi Amer
- 1 Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Xiaoming Li
- 3 University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Howard Fischer
- 1 Wayne State University School of Medicine, Detroit, MI, USA
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Psaila K, Foster JP, Pulbrook N, Jeffery HE. Infant pacifiers for reduction in risk of sudden infant death syndrome. Cochrane Database Syst Rev 2017; 4:CD011147. [PMID: 28378502 PMCID: PMC6478106 DOI: 10.1002/14651858.cd011147.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sudden infant death syndrome (SIDS) has been most recently defined as the sudden unexpected death of an infant less than one year of age, with onset of the fatal episode apparently occurring during sleep, that remains unexplained after a thorough investigation, including the performance of a complete autopsy and a review of the circumstances of death and clinical history. Despite the success of several prevention campaigns, SIDS remains a leading cause of infant mortality. In 1994, a 'triple risk model' for SIDS was proposed that described SIDS as an event that results from the intersection of three factors: a vulnerable infant; a critical development period in homeostatic control (age related); and an exogenous stressor. The association between pacifier (dummy) use and reduced incidence of SIDS has been shown in epidemiological studies since the early 1990s. Pacifier use, given its low cost, might be a cost-effective intervention for SIDS prevention if it is confirmed effective in randomised controlled trials. OBJECTIVES To determine whether the use of pacifiers during sleep versus no pacifier during sleep reduces the risk of SIDS. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 2), MEDLINE via PubMed, Embase, and CINAHL to 16 March 2016. We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Published and unpublished controlled trials using random and quasi-random allocations of infants born at term and at preterm (less than 37 weeks' gestation) or with low birth weight (< 2500 g). Infants must have been randomised by one month' postmenstrual age. We planned to include studies reported only by abstracts, and cluster and cross-over randomised trials. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed studies from searches. We found no eligible studies. MAIN RESULTS We identified no randomised controlled trials examining infant pacifiers for reduction in risk of SIDS. AUTHORS' CONCLUSIONS We found no randomised control trial evidence on which to support or refute the use of pacifiers for the prevention of SIDS.
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Affiliation(s)
- Kim Psaila
- Western Sydney UniversitySchool of Nursing and MidwiferyPenrithDCAustralia
| | - Jann P Foster
- Western Sydney UniversitySchool of Nursing and MidwiferyPenrith DCAustralia
- University of SydneySydney Nursing School/Central Clinical School, Discipline of Obstetrics, Gynaecology and NeonatologySydneyAustralia
- Ingham Research InstituteLiverpoolNSWAustralia
| | - Neil Pulbrook
- Liverpool HospitalNewborn CareElizabeth StreetLiverpoolAustralia2170
| | - Heather E Jeffery
- University of SydneySydney School of Public HealthSydneyNSWAustralia2050
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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.
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Joyner BL, Oden RP, Moon RY. Reasons for Pacifier Use and Non-Use in African-Americans: Does Knowledge of Reduced SIDS Risk Change Parents' Minds? J Immigr Minor Health 2016; 18:402-10. [PMID: 25864091 PMCID: PMC4601923 DOI: 10.1007/s10903-015-0206-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To investigate African-American parental reasons for pacifier use or non-use, and whether knowledge of the association with decreased SIDS risk changes decisions about pacifier use. We conducted focus groups and individual interviews with mothers. Grounded theory methodology was used. 83 mothers participated; 72.3 % of infants used pacifiers. Reasons for pacifier use included comfort/soothing, safety/SIDS, and preference over digit-sucking. Reasons for pacifier non-use included infant refusal, fear of attachment, nipple confusion, and germs. Many parents were unaware that pacifier use reduces SIDS risk; however, most parents of non-users did not think that this knowledge would have changed their decision. Reasons included skepticism about the pacifier-SIDS link. Many reasons underlie African-American parental decisions about pacifier use. Providers should provide information about the benefits of pacifiers. Establishing for parents any plausible link between the protective mechanism of pacifiers and SIDS pathophysiology may be important in promoting pacifier use.
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Affiliation(s)
- Brandi L Joyner
- Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC, USA
| | - Rosalind P Oden
- Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC, USA
| | - Rachel Y Moon
- Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC, USA.
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Division of General Pediatrics and Community Health, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC, 20010, USA.
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Alm B, Wennergren G, Möllborg P, Lagercrantz H. Breastfeeding and dummy use have a protective effect on sudden infant death syndrome. Acta Paediatr 2016; 105:31-8. [PMID: 26175065 PMCID: PMC5049485 DOI: 10.1111/apa.13124] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/17/2015] [Accepted: 07/07/2015] [Indexed: 12/26/2022]
Abstract
We conducted a literature review on the effect of breastfeeding and dummy (pacifier) use on sudden infant death syndrome (SIDS). From 4343 abstracts, we identified 35 relevant studies on breastfeeding and SIDS, 27 on dummy use and SIDS and 59 on dummy use versus breastfeeding. Conclusion We found ample evidence that both breastfeeding and dummy use reduce the risk of SIDS. There has been a general reluctance to endorse dummy use in case it has a detrimental effect of breastfeeding. However, recent evidence suggests that dummy use might not be as harmful to breastfeeding as previously believed.
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Affiliation(s)
- Bernt Alm
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Göran Wennergren
- 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
| | - Hugo Lagercrantz
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
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Scorza FA. Breaking bad news on the possible occurrence of sudden death in children with epilepsy sleeping on sofas. Epilepsy Behav 2015; 50:88-9. [PMID: 26149063 DOI: 10.1016/j.yebeh.2015.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/05/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Departamento de Neurologia/Neurocirurgia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
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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]
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Abstract
OBJECTIVE Sleeping on sofas increases the risk of sudden infant death syndrome and other sleep-related deaths. We sought to describe factors associated with infant deaths on sofas. METHODS We analyzed data for infant deaths on sofas from 24 states in 2004 to 2012 in the National Center for the Review and Prevention of Child Deaths Case Reporting System database. Demographic and environmental data for deaths on sofas were compared with data for sleep-related infant deaths in other locations, using bivariate and multivariable, multinomial logistic regression analyses. RESULTS A total of 1024 deaths on sofas made up 12.9% of sleep-related infant deaths. They were more likely than deaths in other locations to be classified as accidental suffocation or strangulation (adjusted odds ratio [aOR] 1.9; 95% confidence interval [CI], 1.6-2.3) or ill-defined cause of death (aOR 1.2; 95% CI, 1.0-1.5). Infants who died on sofas were less likely to be Hispanic (aOR 0.7; 95% CI, 0.6-0.9) compared with non-Hispanic white infants or to have objects in the environment (aOR 0.6; 95% CI, 0.5-0.7) and more likely to be sharing the surface with another person (aOR 2.4; 95% CI, 1.9-3.0), to be found on the side (aOR 1.9; 95% CI, 1.4-2.4), to be found in a new sleep location (aOR 6.5; 95% CI, 5.2-8.2), and to have had prenatal smoke exposure (aOR 1.4; 95% CI, 1.2-1.6). Data on recent parental alcohol and drug consumption were not available. CONCLUSIONS The sofa is an extremely hazardous sleep surface for infants. Deaths on sofas are associated with surface sharing, being found on the side, changing sleep location, and experiencing prenatal tobacco exposure, which are all risk factors for sudden infant death syndrome and sleep-related deaths.
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Affiliation(s)
- Lauren R Rechtman
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jeffrey D Colvin
- Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | | | - Rachel Y Moon
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, District of Columbia
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Abstract
This column describes the experience of the units practice council in developing an evidence-based practice teaching program focused on safe sleep for newborn infants.
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Blair PS, Sidebotham P, Pease A, Fleming PJ. Bed-sharing in the absence of hazardous circumstances: is there a risk of sudden infant death syndrome? An analysis from two case-control studies conducted in the UK. PLoS One 2014; 9:e107799. [PMID: 25238618 PMCID: PMC4169572 DOI: 10.1371/journal.pone.0107799] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/21/2014] [Indexed: 11/18/2022] Open
Abstract
Objective The risk of sudden infant death syndrome (SIDS) among infants who co-sleep in the absence of hazardous circumstances is unclear and needs to be quantified. Design Combined individual-analysis of two population-based case-control studies of SIDS infants and controls comparable for age and time of last sleep. Setting Parents of 400 SIDS infants and 1386 controls provided information from five English health regions between 1993–6 (population: 17.7 million) and one of these regions between 2003–6 (population:4.9 million). Results Over a third of SIDS infants (36%) were found co-sleeping with an adult at the time of death compared to 15% of control infants after the reference sleep (multivariate OR = 3.9 [95% CI: 2.7–5.6]). The multivariable risk associated with co-sleeping on a sofa (OR = 18.3 [95% CI: 7.1–47.4]) or next to a parent who drank more than two units of alcohol (OR = 18.3 [95% CI: 7.7–43.5]) was very high and significant for infants of all ages. The risk associated with co-sleeping next to someone who smoked was significant for infants under 3 months old (OR = 8.9 [95% CI: 5.3–15.1]) but not for older infants (OR = 1.4 [95% CI: 0.7–2.8]). The multivariable risk associated with bed-sharing in the absence of these hazards was not significant overall (OR = 1.1 [95% CI: 0.6–2.0]), for infants less than 3 months old (OR = 1.6 [95% CI: 0.96–2.7]), and was in the direction of protection for older infants (OR = 0.1 [95% CI: 0.01–0.5]). Dummy use was associated with a lower risk of SIDS only among co-sleepers and prone sleeping was a higher risk only among infants sleeping alone. Conclusion These findings support a public health strategy that underlines specific hazardous co-sleeping environments parents should avoid. Sofa-sharing is not a safe alternative to bed-sharing and bed-sharing should be avoided if parents consume alcohol, smoke or take drugs or if the infant is pre-term.
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Affiliation(s)
- Peter S. Blair
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | | | - Anna Pease
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Peter J. Fleming
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
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Gaydos LM, Blake SC, Gazmararian JA, Woodruff W, Thompson WW, Dalmida SG. Revisiting Safe Sleep Recommendations for African-American Infants: Why Current Counseling is Insufficient. Matern Child Health J 2014; 19:496-503. [DOI: 10.1007/s10995-014-1530-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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.
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Affiliation(s)
- Rosemary S C Horne
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia
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Carpenter R, McGarvey C, Mitchell EA, Tappin DM, Vennemann MM, Smuk M, Carpenter JR. Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case-control studies. BMJ Open 2013; 3:e002299. [PMID: 23793691 PMCID: PMC3657670 DOI: 10.1136/bmjopen-2012-002299] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 04/02/2013] [Accepted: 04/03/2013] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To resolve uncertainty as to the risk of Sudden Infant Death Syndrome (SIDS) associated with sleeping in bed with your baby if neither parent smokes and the baby is breastfed. DESIGN Bed sharing was defined as sleeping with a baby in the parents' bed; room sharing as baby sleeping in the parents' room. Frequency of bed sharing during last sleep was compared between babies who died of SIDS and living control infants. Five large SIDS case-control datasets were combined. Missing data were imputed. Random effects logistic regression controlled for confounding factors. SETTING Home sleeping arrangements of infants in 19 studies across the UK, Europe and Australasia. PARTICIPANTS 1472 SIDS cases, and 4679 controls. Each study effectively included all cases, by standard criteria. Controls were randomly selected normal infants of similar age, time and place. RESULTS In the combined dataset, 22.2% of cases and 9.6% of controls were bed sharing, adjusted OR (AOR) for all ages 2.7; 95% CI (1.4 to 5.3). Bed sharing risk decreased with increasing infant age. When neither parent smoked, and the baby was less than 3 months, breastfed and had no other risk factors, the AOR for bed sharing versus room sharing was 5.1 (2.3 to 11.4) and estimated absolute risk for these room sharing infants was very low (0.08 (0.05 to 0.14)/1000 live-births). This increased to 0.23 (0.11 to 0.43)/1000 when bed sharing. Smoking and alcohol use greatly increased bed sharing risk. CONCLUSIONS Bed sharing for sleep when the parents do not smoke or take alcohol or drugs increases the risk of SIDS. Risks associated with bed sharing are greatly increased when combined with parental smoking, maternal alcohol consumption and/or drug use. A substantial reduction of SIDS rates could be achieved if parents avoided bed sharing.
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Affiliation(s)
- Robert Carpenter
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
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Ball HL, Volpe LE. Sudden Infant Death Syndrome (SIDS) risk reduction and infant sleep location – Moving the discussion forward. Soc Sci Med 2013; 79:84-91. [DOI: 10.1016/j.socscimed.2012.03.025] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 03/13/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
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Öhman A. A specially designed pillow may be used as treatment for young infants with developmental plagiocephaly. Health (London) 2013. [DOI: 10.4236/health.2013.512280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mitchell EA, Freemantle J, Young J, Byard RW. Scientific consensus forum to review the evidence underpinning the recommendations of the Australian SIDS and Kids Safe Sleeping Health Promotion Programme--October 2010. J Paediatr Child Health 2012; 48:626-33. [PMID: 22050484 DOI: 10.1111/j.1440-1754.2011.02215.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper summarises a 1-day scientific consensus forum that reviewed the evidence underpinning the Australian SIDS and Kids Safe Sleeping Health Promotion Programme. The focus was on each of the potentially modifiable risk factors for sudden unexpected deaths in infancy, including sudden infant death syndrome (SIDS) and fatal sleeping accidents. In particular infant sleeping position, covering of the face, exposure to cigarette smoke, room sharing, unsafe sleeping environments, bed sharing, immunisation, breastfeeding, pacifier use and Indigenous issues were discussed in depth. The participants recommended that future 'Reducing the Risk' campaign messages should focus on back to sleep, face uncovered, avoidance of cigarette smoke before and after birth, safe sleeping environment, room sharing and sleeping baby in own cot.
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Affiliation(s)
- Edwin A Mitchell
- Department of Paediatrics, University of Auckland, Auckland, New Zealand.
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Balaban R, Aguiar CM, da Silva Araújo AC, Dias Filho EBR. Knowledge of paediatricians regarding child oral health. Int J Paediatr Dent 2012; 22:286-91. [PMID: 22092596 DOI: 10.1111/j.1365-263x.2011.01196.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In dentistry, clinical practice is directed towards attitudes that promote oral health and the paediatricians occupy a privileged position in this process. AIM To assess the knowledge and attitudes of paediatricians in relation to the oral health of their patients. DESIGN A cross-sectional study was carried out at the Institute of Integrative Medicine Professor Fernando Figueira, Recife, Brazil. A total of 182 paediatricians participated by filling out a questionnaire. RESULTS A total of 63.9% believed the first visit to the dentist should occur before the child completes 1 year of life. Moreover, 67.8% considered their knowledge on oral health to be insufficient. Approximately 78% of the paediatricians diagnosed caries through an analysis of cavities. Only 29.9% always recommended fluoride dentifrice. The term 'fluorosis' was unknown by 48.3% of the respondents. Concerning pacifiers, 32.6% did not allow it and 66.9% did not either recommend it or restrict it. A total of 83.4% classified the oral health content in their medical education as either nonexistent or deficient; this figure remained high (72.4%) in relation to residency. CONCLUSIONS It is important to develop oral health information programmes to paediatricians. Information on oral health should be included in medical curricula and residency.
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Affiliation(s)
- Raquel Balaban
- Federal University of Pernambuco, Recife, Pernambuco, Brazil.
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Trachtenberg FL, Haas EA, Kinney HC, Stanley C, Krous HF. Risk factor changes for sudden infant death syndrome after initiation of Back-to-Sleep campaign. Pediatrics 2012; 129:630-8. [PMID: 22451703 PMCID: PMC3356149 DOI: 10.1542/peds.2011-1419] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To test the hypothesis that the profile of sudden infant death syndrome (SIDS) changed after the Back-to-Sleep (BTS) campaign initiation, document prevalence and patterns of multiple risks, and determine the age profile of risk factors. METHODS The San Diego SIDS/Sudden Unexplained Death in Childhood Research Project recorded risk factors for 568 SIDS deaths from 1991 to 2008 based upon standardized death scene investigations and autopsies. Risks were divided into intrinsic (eg, male gender) and extrinsic (eg, prone sleep). RESULTS Between 1991-1993 and 1996-2008, the percentage of SIDS infants found prone decreased from 84.0% to 48.5% (P < .001), bed-sharing increased from 19.2% to 37.9% (P < .001), especially among infants <2 months (29.0% vs 63.8%), prematurity rate increased from 20.0% to 29.0% (P = .05), whereas symptoms of upper respiratory tract infection decreased from 46.6% to 24.8% (P < .001). Ninety-nine percent of SIDS infants had at least 1 risk factor, 57% had at least 2 extrinsic and 1 intrinsic risk factor, and only 5% had no extrinsic risk. The average number of risks per SIDS infant did not change after initiation of the BTS campaign. CONCLUSIONS SIDS infants in the BTS era show more variation in risk factors. There was a consistently high prevalence of both intrinsic and especially extrinsic risks both before and during the Back-to-Sleep era. Risk reduction campaigns emphasizing the importance of avoiding multiple and simultaneous SIDS risks are essential to prevent SIDS, including among infants who may already be vulnerable.
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Affiliation(s)
| | | | - Hannah C. Kinney
- Children’s Hospital Boston and Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Christina Stanley
- San Diego County Medical Examiner’s Office, San Diego, California; and
| | - Henry F. Krous
- Rady Children’s Hospital, San Diego, California;,Departments of Pediatrics and Pathology, UCSD School of Medicine, La Jolla, California
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Broussard DL, Sappenfield WM, Goodman DA. The Black and White of infant back sleeping and infant bed sharing in Florida, 2004-2005. Matern Child Health J 2012; 16:713-24. [PMID: 21416390 DOI: 10.1007/s10995-011-0768-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Not using the infant back sleep position is an established risk factor for sudden unexpected infant death (SUID). Infant bed sharing may also increase SUID risk, particularly under certain circumstances. Both of these infant sleeping behaviors are disproportionately higher among Black mothers. We explored the relationship between not using the infant back sleeping and infant bed sharing, developed separate risk factor profiles for these behaviors, and identified maternal characteristics contributing to racial differences in their practice. Merged 2004-2005 birth certificate and Pregnancy Risk Assessment Monitoring System data for 2,791 non-Hispanic Black and White Florida women were evaluated using univariable and multivariable analyses to develop risk factor profiles for infrequent back sleeping and frequent bed sharing. Cross-product interaction terms were introduced to identify factors contributing to racial differences. Infrequent back sleeping and frequent bed sharing were reported by two-thirds of Black women and one-third of White women. There was no association between the infant sleeping behaviors when adjusted for race (adjusted odds ratio [aOR], 1.04; 95% CI, 0.83-1.31). The infant sleeping behaviors shared no common independent maternal characteristics. Father acknowledgement on the birth certificate was a strong contributor to racial differences in infrequent back sleeping while breastfeeding, trimester of entry to prenatal care, and maternal depression revealed notable racial differences for bed sharing. Behavior-specific and race-specific public health messages may be an important public health strategy for reducing risky infant sleeping behaviors and decreasing SUIDs.
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Affiliation(s)
- Danielle L Broussard
- Maternal and Child Health Practice and Analysis Unit, Bureau of Family and Community Health, Division of Family Health Services, Florida Department of Health, Tallahassee, FL, USA.
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Bed sharing and the risk of sudden infant death syndrome: can we resolve the debate? J Pediatr 2012; 160:44-8.e2. [PMID: 21868032 DOI: 10.1016/j.jpeds.2011.06.052] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 06/09/2011] [Accepted: 06/28/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To conduct a meta-analysis on the relationship between bed sharing and sudden infant death syndrome (SIDS) risk. STUDY DESIGN Data from PubMed and Medline were searched for studies published after Jan 1, 1970. The search strategy included articles with the terms "sudden infant death syndrome," "sudden unexpected death," and "cot death" with "bed sharing" or "co-sleeping." To further specify the potential risk of bed sharing and SIDS, subgroup analyses were performed. RESULTS Eleven studies met inclusion criteria and were included in the final meta-analysis. The combined OR for SIDS in all bed sharing versus non-bed sharing infants was 2.89 (95% CI, 1.99-4.18). The risk was highest for infants of smoking mothers (OR, 6.27; 95% CI, 3.94-9.99), and infants <12 weeks old (OR, 10.37; 95% CI, 4.44-24.21). CONCLUSIONS Bed sharing is a risk factor for SIDS and is especially enhanced in smoking parents and in very young infants.
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Moon RY. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 2011; 128:e1341-67. [PMID: 22007003 DOI: 10.1542/peds.2011-2285] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death occurring during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from being only SIDS-focused to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths including SIDS. The recommendations described in this report include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunization, consideration of a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in this technical report. The recommendations are published in the accompanying "Policy Statement--Sudden Infant Death Syndrome and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment," which is included in this issue (www.pediatrics.org/cgi/doi/10.1542/peds.2011-2220).
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Moon RY. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 2011; 128:1030-9. [PMID: 22007004 DOI: 10.1542/peds.2011-2284] [Citation(s) in RCA: 363] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death that occur during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from focusing only on SIDS to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths, including SIDS. The recommendations described in this policy statement include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunizations, consideration of using a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in the accompanying "Technical Report--SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment," which is included in this issue of Pediatrics (www.pediatrics.org/cgi/content/full/128/5/e1341).
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Hutchison BL, Rea C, Stewart AW, Koelmeyer TD, Tipene-Leach DC, Mitchell EA. Sudden unexpected infant death in Auckland: a retrospective case review. Acta Paediatr 2011; 100:1108-12. [PMID: 21332785 DOI: 10.1111/j.1651-2227.2011.02221.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To review autopsy reports of all SUDI deaths in the Auckland region, New Zealand, from October 2000 to December 2009. METHODS Information on all SUDI cases from 2000 to 2009 was extracted from autopsy and police reports from the National Forensic Pathology Service at Auckland Hospital. RESULTS Of the 332 post-mortems in this period, 221 were classified as SUDI. Of these, 83% were Māori or Pacific infants. The median age at death was 11 weeks and 11% occurred in 7- to 28-day-olds. At the time of death, 64% overall were bedsharing; this was more common in 7-28 day olds (92%). Bedsharing infants were significantly younger at death than non-bedsharing infants (p=0.008). Where sleep position was known, 57% were placed in non-supine at the last sleep. There was no evidence of diagnostic shift and the prevalence of bedsharing did not change over the decade. CONCLUSIONS Bedsharing was associated with a high proportion of SUDI cases, especially in the youngest infants, and non-supine sleep positions were common. There is a need to enhance SUDI prevention messages and consider innovative ways of promoting safe sleeping environment and supine sleep position in Māori and Pacific communities.
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Affiliation(s)
- B Lynne Hutchison
- Department of Paediatrics, The University of Auckland, Auckland, New Zealand
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Moon RY, Tanabe KO, Yang DC, Young HA, Hauck FR. Pacifier Use and Sids: Evidence for a Consistently Reduced Risk. Matern Child Health J 2011; 16:609-14. [DOI: 10.1007/s10995-011-0793-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Joyner BL, Oden RP, Ajao TI, Moon RY. Where should my baby sleep: a qualitative study of African American infant sleep location decisions. J Natl Med Assoc 2010; 102:881-9. [PMID: 21053702 DOI: 10.1016/s0027-9684(15)30706-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND African American infants are of higher risk for sudden infant death syndrome (SIDS) and accidental suffocation than other infants and are up to 4 times more likely to bedshare with their parents. OBJECTIVE To investigate, using qualitative methods, factors influencing African American parents' decisions regarding infant sleep location (room location and sleep surface). METHODS Eighty-three mothers participated in focus groups or individual interviews. Questions probed reasons for infant sleep location decisions and influences on decision making. RESULTS Most of the mothers in this study slept in the same room as their infant. Reasons for roomsharing included space, convenience, and safety. Mothers largely decided on infant sleep surface because of space for/availability of crib, comfort, convenience, and safety. Both roomsharing and bedsharing were often chosen to make feeding and checking on the infant more convenient. Mothers who chose not to bedshare cited privacy, concern that the infant would become attached to the parents' bed, and fears about suffocation. Mothers who chose to bedshare often cited the ability to maintain vigilance while asleep. Low-income mothers also used bedsharing as a defense against environmental dangers. CONCLUSION African American mothers in this study viewed both roomsharing and bedsharing as strategies to keep their infants safe. Efforts to encourage roomsharing without bed-sharing must address parental concerns about space for/ availability of a crib, convenience, infant and parent comfort, and infant safety.
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Affiliation(s)
- Brandi L Joyner
- Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC, USA
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Blair PS, Heron J, Fleming PJ. Relationship between bed sharing and breastfeeding: longitudinal, population-based analysis. Pediatrics 2010; 126:e1119-26. [PMID: 20956410 DOI: 10.1542/peds.2010-1277] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This is an investigation into the longitudinal patterns of bed sharing, the characteristics associated with those patterns, and the relationship with breastfeeding. METHODS The study used prospective, population-based data from the United Kingdom to investigate nocturnal bed sharing at 5 time points from birth to 4 years of age. Of 14 062 live births, 7447 (53%) had data available for all time points. RESULTS Latent class analysis identified 4 mutually exclusive groups, broadly described as nonsharers (66%), early bed sharers (only in infancy) (13%), late bed sharers (after the first year) (15%), and constant bed sharers (throughout the 4 years) (6%). The boy/girl ratio and the proportion of families of nonwhite ethnicity were slightly higher in all 3 bed-sharing groups, compared with the non-bed-sharing group. Higher maternal educational achievement and higher social class were positively associated with early bed sharing, negatively associated with late bed sharing, and not associated with constant bed sharing. The 3 bed-sharing patterns were related significantly to breastfeeding at 12 months (P < .001), whether the families shared beds late (odds ratio: 1.72 [95% confidence interval: 1.36-2.18]), early (odds ratio: 2.36 [95% confidence interval: 1.87-2.97]), or for the whole period (odds ratio: 5.29 [95% confidence interval: 4.05-6.91]). The prevalence of breastfeeding was significantly higher among the groups that shared beds constantly or early for each of the first 15 months after birth. CONCLUSIONS Advice on whether bed sharing should be discouraged needs to take into account the important relationship with breastfeeding.
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Affiliation(s)
- Peter S Blair
- Department of Community-Based Medicine, University of Bristol, Bristol, United Kingdom.
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Fu LY, Moon RY, Hauck FR. Bed sharing among black infants and sudden infant death syndrome: interactions with other known risk factors. Acad Pediatr 2010; 10:376-82. [PMID: 21075317 DOI: 10.1016/j.acap.2010.09.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 09/07/2010] [Accepted: 09/09/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Bed sharing has been associated with sudden infant death syndrome (SIDS) and may contribute to the racial disparity seen in infant mortality. It is unclear how bed sharing interacts with other factors to impact SIDS risk. We aimed to measure the effects of bed sharing on risk of SIDS in blacks and to determine whether the risk is modified by other characteristics of the sleep environment. METHODS Characteristics of 195 black infants who died of SIDS were compared with matched controls. The moderating influence of known SIDS risk factors on the effect of bed sharing on risk of SIDS was examined using logistic regression. RESULTS Almost half (47.4%) of the study population bed shared during the last/reference sleep (58% cases and 37% controls). Bed sharing was associated with 2 times greater risk of SIDS compared with not bed sharing. The deleterious effect of bed sharing was more pronounced with a soft sleep surface, pillow use, maternal smoking, and younger infant age. However, bed sharing was still associated with an increased risk of SIDS, even when the infant was not using a pillow or sleeping on a firm surface. The strongest predictors of SIDS among bed-sharing infants were soft sleep surface, nonuse of a pacifier, and maternal smoking during pregnancy. CONCLUSIONS Bed sharing is a common practice among black infants. It is associated with a clear and strong increased risk of SIDS, which is even greater when combined with other known risk factors for SIDS. This practice likely contributes to the excess incidence of SIDS among blacks, and culturally competent education methods must be developed to target this high-risk group.
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Affiliation(s)
- Linda Y Fu
- Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC 20010, USA.
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Abstract
UNLABELLED Despite the large reduction in SIDS mortality, which occurred in the early 1990s following the 'Back to Sleep' campaigns, SIDS remains the leading cause of death in the postneonatal age group. This paper describes the position in the 1980s, the contribution of the New Zealand Cot Death Study, what should be recommended and the current research priorities. CONCLUSION SIDS is preventable. Application of what we currently know could eliminate SIDS. The challenge is to find ways of implementing our knowledge.
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Affiliation(s)
- Edwin A Mitchell
- Department of Paediatrics, University of Auckland, Auckland, New Zealand.
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Blair PS, Sidebotham P, Evason-Coombe C, Edmonds M, Heckstall-Smith EMA, Fleming P. Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. BMJ 2009; 339:b3666. [PMID: 19826174 PMCID: PMC2762037 DOI: 10.1136/bmj.b3666] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate the factors associated with sudden infant death syndrome (SIDS) from birth to age 2 years, whether recent advice has been followed, whether any new risk factors have emerged, and the specific circumstances in which SIDS occurs while cosleeping (infant sharing the same bed or sofa with an adult or child). DESIGN Four year population based case-control study. Parents were interviewed shortly after the death or after the reference sleep (within 24 hours) of the two control groups. SETTING South west region of England (population 4.9 million, 184 800 births). PARTICIPANTS 80 SIDS infants and two control groups weighted for age and time of reference sleep: 87 randomly selected controls and 82 controls at high risk of SIDS (young, socially deprived, multiparous mothers who smoked). RESULTS The median age at death (66 days) was more than three weeks less than in a study in the same region a decade earlier. Of the SIDS infants, 54% died while cosleeping compared with 20% among both control groups. Much of this excess may be explained by a significant multivariable interaction between cosleeping and recent parental use of alcohol or drugs (31% v 3% random controls) and the increased proportion of SIDS infants who had coslept on a sofa (17% v 1%). One fifth of SIDS infants used a pillow for the last sleep (21% v 3%) and one quarter were swaddled (24% v 6%). More mothers of SIDS infants than random control infants smoked during pregnancy (60% v 14%), whereas one quarter of the SIDS infants were preterm (26% v 5%) or were in fair or poor health for the last sleep (28% v 6%). All of these differences were significant in the multivariable analysis regardless of which control group was used for comparison. The significance of covering the infant's head, postnatal exposure to tobacco smoke, dummy use, and sleeping in the side position has diminished although a significant proportion of SIDS infants were still found prone (29% v 10%). CONCLUSIONS Many of the SIDS infants had coslept in a hazardous environment. The major influences on risk, regardless of markers for socioeconomic deprivation, are amenable to change and specific advice needs to be given, particularly on use of alcohol or drugs before cosleeping and cosleeping on a sofa.
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Affiliation(s)
- Peter S Blair
- Department of Community Based Medicine, University of Bristol
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Abstract
The cause of sudden infant death syndrome (SIDS) is unknown. Many mechanisms have been postulated, although thermal stress, rebreathing of expired gases and infection/inflammation seem the most viable hypotheses for the causation of SIDS. Deaths from SIDS have reduced dramatically following the recommendation not to place infants to sleep prone. Epidemiological data have shown that prone sleeping position is more risky in winter, colder latitudes, higher altitudes, if the infant is unwell or has excessive bedding or clothing. This suggests prone sleeping position involves either directly or indirectly a thermal mechanism. SIDS caused by an infective/inflammatory mechanism might be associated with deaths occurring during the night. Rebreathing of expired gases, airway obstruction, long QT syndrome and other genetic conditions may explain a small number of sudden unexpected deaths in infancy.
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Affiliation(s)
- Edwin A Mitchell
- Department of Paediatrics, University of Auckland, Private Bag 92019, Auckland, New Zealand.
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Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Sauerland C, Mitchell EA. Sleep environment risk factors for sudden infant death syndrome: the German Sudden Infant Death Syndrome Study. Pediatrics 2009; 123:1162-70. [PMID: 19336376 DOI: 10.1542/peds.2008-0505] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our goal was to investigate the risk factors for sudden infant death syndrome in the infants' sleep environment for a population in which few infants sleep prone as a result of education campaigns. METHODS This was a population-based sudden infant death syndrome case-control study over 3 years (1998-2001) in Germany. RESULTS There were 333 sudden infant death syndrome cases and 998 matched controls. Although only 4.1% of the infants were placed prone to sleep, those infants were at a high risk of sudden infant death syndrome. Those who were unaccustomed to sleeping prone were at very high risk, as were those who turned to prone. Bed sharing (especially for infants younger than 13 weeks); duvets; sleeping prone on a sheepskin; sleeping in the house of a friend or a relative (compared with sleeping in the parental home); and sleeping in the living room (compared with sleeping in the parental bedroom) increased the risk for sudden infant death syndrome; pacifier use during the last sleep was associated with a significantly reduced risk of sudden infant death syndrome. CONCLUSIONS This study has clarified the risk factors for sudden infant death syndrome in a population where few infants sleep prone. This study supports the current recommendations of the American Academy of Pediatrics. This study has identified several novel risk factors for sudden infant death syndrome: an increased risk if the infants sleeps outside the parental home, death in the living room, and the high risk when sleeping prone on a sheepskin; however, because the numbers of cases in these groups are small, additional studies are needed to confirm these findings.
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Affiliation(s)
- Mechtild M Vennemann
- Institute of Legal Medicine, University of Münster, Röntgenstrasse 23, D-48149 Münster, Germany.
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Schlaud M, Dreier M, Debertin AS, Jachau K, Heide S, Giebe B, Sperhake JP, Poets CF, Kleemann WJ. The German case-control scene investigation study on SIDS: epidemiological approach and main results. Int J Legal Med 2009; 124:19-26. [PMID: 19159943 DOI: 10.1007/s00414-009-0317-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 11/25/2008] [Indexed: 12/18/2022]
Abstract
The present study, which was part of the German SIDS Study (GeSID), enrolled sudden infant death syndrome (SIDS) cases and population controls and obtained objective scene data via specifically trained observers shortly after discovery of each dead infant. Infants who had died suddenly and unexpectedly at ages between 8 and 365 days were enrolled in five regions of Germany between November 1998 and October 2001. Shortly after discovery of each dead infant, a specially trained doctor of legal medicine visited the bereaved family at home. Data were obtained by measurements and observations. Dead infants underwent a standardised autopsy, additional information being obtained by standardised parent interviews. Investigation of the sleep environment and wake-up scene in matched controls followed the same protocol. A total of 52 SIDS cases and 154 controls were enrolled, 58% were boys, and median age of cases vs. controls was 126 vs. 129 days. Risk factors in the sleeping environment were pillow use (adjusted OR 4.3; 95%CI 1.6-11.6), heavy duvets (OR 4.4; 1.5-13.3), soft underlay (OR 3.0; 1.1-8.7), face covered by bedding (OR 15.8; 2.5-102.1) and entire body covered by bedding (OR 35.5; 5.5-228.3). Using a standardised protocol, including objective measurements of the sleep environment and a case-control design, this study was able to confirm many risk factors for SIDS.
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Affiliation(s)
- Martin Schlaud
- Department of Epidemiology, Social Medicine, and Health System Research, Hannover Medical School, Hannover, Germany.
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Infant sleep location: associated maternal and infant characteristics with sudden infant death syndrome prevention recommendations. J Pediatr 2008; 153:503-8. [PMID: 18582898 PMCID: PMC3903790 DOI: 10.1016/j.jpeds.2008.05.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 04/09/2008] [Accepted: 05/01/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify factors associated with infant sleep location. STUDY DESIGN Demographic information and infant care practices were assessed for 708 mothers of infants ages 0 to 8 months at Women, Infants and Children centers. Generalized linear latent mixed models were constructed for the outcome, sleeping arrangement last night (room-sharing without bed-sharing versus bed-sharing, and room-sharing without bed-sharing versus sleeping in separate rooms). RESULTS Two-thirds of the mothers were African-American. A total of 48.6% mothers room-shared without bed-sharing, 32.5% bed-shared, and 18.9% slept in separate rooms. Compared with infants who slept in separate rooms, infants who room-shared without bed-sharing were more likely to be Hispanic (odds ratio [OR], 2.58, 95% CI 1.11-5.98) and younger (3.66- and 1.74-times more likely for infants 0-1 month old and 2-3 months old, respectively, as compared with older infants). Compared with infants who bed-shared, infants who room-shared without bed-sharing were more likely to be 0 to 1 month old (OR, 1.57; 95% CI, 1.05-2.35) and less likely to be African-American (OR, 0.43; 95% CI, 0.26-0.70) or have a teenage mother (OR, 0.37; 95% CI, 0.23-0.58). CONCLUSIONS Approximately one-third of mothers and infants bed-share, despite increased risk of sudden infant death syndrome (SIDS). The factors associated with bed-sharing are also associated with SIDS, likely rendering infants with these characteristics at high risk for SIDS.
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Hanzer M, Zotter H, Sauseng W, Pfurtscheller K, Müller W, Kerbl R. Pacifier use does not alter the frequency or duration of spontaneous arousals in sleeping infants. Sleep Med 2008; 10:464-70. [PMID: 18684666 DOI: 10.1016/j.sleep.2008.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 03/11/2008] [Accepted: 03/15/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE It has been reported that pacifiers might reduce the risk of SIDS by favouring infants' arousability from sleep. We evaluated the influence of a pacifier on the frequency and duration of spontaneous arousals in healthy infants. METHODS Polygraphic recordings were performed in 14 infants with an age of 51.7+/-19.9 days (means+/-SD) who regularly used a pacifier during sleep. Cortical and subcortical arousals were scored according to the recommendations of the "International Paediatric Work Group on Arousals." The number of arousals per 10-min-period and the duration of arousals were determined for periods of pacifier use as well as for periods after pacifier dislodgement and were compared with the data of 10 control infants (age 49.8+/-16.5 days) who never used a pacifier. RESULTS Altogether, 211 arousals in pacifier users and 225 arousals in non-users were scored. In pacifier users, 2.0+/-1.6 arousals per 10-min-period with a duration of 12.2+/-3.0 s occurred during pacifier use, and 1.7+/-1.6 arousals per 10-min-period with a duration of 12.2+/-3.1s occurred during periods without pacifier. In pacifier non-users, 2.3+/-1.2 arousals per 10-min-period (duration 13.9+/-2.9s) were scored. The results did not show a significant difference concerning frequency and duration of spontaneous arousals between pacifier users and non-users. CONCLUSIONS Our findings suggest that factors other than arousal mechanisms might be responsible for the efficacy of pacifiers in SIDS prophylaxis.
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Affiliation(s)
- Marie Hanzer
- Department of Pediatrics, Medical University of Graz, Auenbruggerplatz 30, 8036 Graz, Styria, Austria
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Abstract
Despite declines in prevalence during the past two decades, sudden infant death syndrome (SIDS) continues to be the leading cause of death for infants aged between 1 month and 1 year in developed countries. Behavioural risk factors identified in epidemiological studies include prone and side positions for infant sleep, smoke exposure, soft bedding and sleep surfaces, and overheating. Evidence also suggests that pacifier use at sleep time and room sharing without bed sharing are associated with decreased risk of SIDS. Although the cause of SIDS is unknown, immature cardiorespiratory autonomic control and failure of arousal responsiveness from sleep are important factors. Gene polymorphisms relating to serotonin transport and autonomic nervous system development might make affected infants more vulnerable to SIDS. Campaigns for risk reduction have helped to reduce SIDS incidence by 50-90%. However, to reduce the incidence even further, greater strides must be made in reducing prenatal smoke exposure and implementing other recommended infant care practices. Continued research is needed to identify the pathophysiological basis of SIDS.
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Affiliation(s)
- Rachel Y Moon
- Goldberg Center for Community Pediatric Health, Children's National Medical Center and George Washington University School of Medicine and Health Sciences, Washington, DC 20010, USA.
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Moon RY, Kington M, Oden R, Iglesias J, Hauck FR. Physician recommendations regarding SIDS risk reduction: a national survey of pediatricians and family physicians. Clin Pediatr (Phila) 2007; 46:791-800. [PMID: 17641121 DOI: 10.1177/0009922807303894] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sudden infant death syndrome (SIDS) is a leading cause of death among infants. Recently, new SIDS risk factors have emerged. OBJECTIVE To determine knowledge and recommendations of pediatricians and family physicians regarding SIDS-relevant practices. METHODS Cross-sectional survey of 3005 pediatricians and family physicians. RESULTS Of the 783 respondents, pediatricians comprised 64% and females 52%; 78% recognized supine as the recommended sleep position; 69% recommended supine. Almost all physicians recommended a firm mattress, 82% recommended a crib or bassinet, and 42% recommended a separate room for infants; 63% had no preference about or did not recommend restricting pacifier use. Pediatricians were more likely to discuss infant sleep position and room sharing at every well-child visit. CONCLUSIONS Knowledge about recommended infant sleep position is relatively high, but there are gaps in physician knowledge regarding safe sleep recommendations. Greater dissemination of information is required, and barriers to implementation need to be identified and addressed.
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Affiliation(s)
- Rachel Y Moon
- Division of General and Community Pediatrics, Diana L. and Stephen A. Goldberg Center for Community Pediatric Health, Washington, DC, USA.
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Ruys JH, de Jonge GA, Brand R, Engelberts AC, Semmekrot BA. Bed-sharing in the first four months of life: a risk factor for sudden infant death. Acta Paediatr 2007; 96:1399-403. [PMID: 17714547 DOI: 10.1111/j.1651-2227.2007.00413.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To investigate the risk of sudden infant death in the Netherlands during bed-sharing in the first half year of life and the protective effect of breastfeeding on it. METHODS During a 10-year period between September 1996 and September 2006 nationwide, 213 cot deaths were investigated. RESULTS AND DISCUSSION Of 138 cot deaths of less than 6 months of age, 36 (26%) bed-shared. In a reference group of 1628 babies from infant welfare centres only 9.4% were bed-sharing in the night prior to the interview. After correction for smoking of one or both parents the odds ratio for cot death during bed-sharing with parents decreased with age from 9.1 (CI 4.2-19.4) at 1 month, to 4.0 (CI 2.3-6.7) at 2 months, to 1.7 (CI 0.9-3.4) at 3 months and to 1.3 (CI 1.0-1.6) at 4 through 5 months of age. The excess risk (OR > 1) associated with bed-sharing is itself not significantly influenced by the presence or absence of breastfeeding. CONCLUSION Bed-sharing is a serious risk factor for sudden infant death for all babies of less than 4 months of age. From 4 months onwards bed-sharing did not contribute significantly to the risk of cot death anymore in our study.
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Affiliation(s)
- Jan H Ruys
- Leiden University Medical Center, Reviuslaan 38, 2343 JR Oegstgeest, The Netherlands.
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Efe E, Sarvan S, Kukulu K. Sleep practices and environment and the risk of sudden infant death syndrome in Turkey. J SPEC PEDIATR NURS 2007; 12:253-63. [PMID: 17956373 DOI: 10.1111/j.1744-6155.2007.00120.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study is to determine what mothers know about infant sleep practices and the environment. DESIGN AND METHODS Data were collected with a semistructured questionnaire. The research was conducted with 231 mothers who delivered an infant and who agreed to participate between September and December 2005. RESULTS It was determined that 70.6% (n = 163) of mothers would use a pillow with their sleeping infants, and 44.2% (n = 102) would cover their infants' faces. When infants were alone in a room, 96.5% of mothers would leave them in the supine position. PRACTICE IMPLICATIONS Public health interventions should alert women to the increased risk of sudden infant death syndrome associated with identifiable risk factors, and specific intervention campaigns for safe sleeping can be developed for Turkish families.
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Affiliation(s)
- Emine Efe
- Child Health Nursing Department, School of Health, Akdeniz University, Antalya, Turkey.
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