Bedsharing and maternal smoking in a population-based survey of new mothers

Infant Care Practices, Caregiver Awareness of Safe Sleep Advice and Barriers to Implementation: A Scoping Review

Modifiable infant sleep and care practices are recognised as the most important factors parents and health practitioners can influence to reduce the risk of sleep-related infant mortality. Understanding caregiver awareness of, and perceptions relating to, public health messages and identifying trends in contemporary infant care practices are essential to appropriately inform and refine future infant safe sleep advice. This scoping review sought to examine the extent and nature of empirical literature concerning infant caregiver engagement with, and implementation of, safe sleep risk-reduction advice relating to Sudden Unexpected Deaths in Infancy (SUDI). Databases including PubMed, CINAHL, Scopus, Medline, EMBASE and Ovid were searched for relevant peer reviewed publications with publication dates set between January 2000–May 2021. A total of 137 articles met eligibility criteria. Review results map current infant sleeping and care practices that families adopt, primary infant caregivers’ awareness of safe infant sleep advice and the challenges that families encounter implementing safe sleep recommendations when caring for their infant. Findings demonstrate a need for ongoing monitoring of infant sleep practices and family engagement with safe sleep advice so that potential disparities and population groups at greater risk can be identified, with focused support strategies applied.

Knowledge Assessment of Correct Infant Sleep Practices and Sudden Infant Death Syndrome Among Mothers

INTRODUCTION

Sudden infant death syndrome (SIDS) is characterized as the sudden unexpected death of a healthy infant below the age of 12 months with an unknown cause even after careful death scene assessment. The aim of this study is to estimate the percentage of proper sleep practices among infants and assess the knowledge and awareness of SIDS and its associated risk factors among Saudi and non-Saudi mothers.

METHODS

This cross-sectional study was done in Riyadh, Saudi Arabia. The data were collected using an anonymous, self-administered questionnaire that consisted of 36 items that were divided into demographic data of the parents and child, observations of the child's sleep practice, and knowledge and awareness of SIDS and its associated risk factors.

RESULTS

A total of 667 participants completed the questionnaire. The mean age of the mothers was 31.44 + 7.55. As for the nationality, 527 (79%) were Saudi and 140 (21%) were non-Saudi. The majority had bachelors' degrees 407 (61%). Sleep practices assessment demonstrated that 391 (58.6%) of infants were sleeping in the supine position. A total of 329 (49.3%) participants reported hearing about SIDS from social media and websites as being the major source of information. SIDS acknowledgment was higher in non-Saudi mothers compared to Saudis.

CONCLUSION

The results provide informative descriptive data on childcare practices in Saudi Arabia. Considerable variation was noted and the results from this study are intended to have a better understanding of the prevalence of childcare practices and knowledge of SIDS risk factors in Saudi and non-Saudi mothers.

Two-Year Test-Retest Reliability of the Breastfeeding Duration Question Used By the Pregnancy Risk Assessment Monitoring System (PRAMS): Implications for Research

INTRODUCTION

A large literature exists on positive sequelae of breastfeeding, relying heavily on maternal self-reported infant feeding behaviors. Many such studies use PRAMS data, though estimates of reliability for the breastfeeding duration question on PRAMS have not been published.

METHODS

We used data from Oregon PRAMS (respondents are a median 3.5 months postpartum) and PRAMS-2 (median 25 months) to assess test-retest reliability of maternal self-reported breastfeeding duration, among women who had weaned prior to completing the PRAMS survey.

RESULTS

The sample-wide kappa for the paired, self-reported breastfeeding duration was 0.014, and the intraclass correlation coefficient was 0.17, both of which indicate poor agreement. More than 80% of women reported a longer duration on PRAMS-2; the median (interquartile range) difference was +1.0 (0.31 - 2.1) months.

DISCUSSION

Recent literature on this topic from high-income countries falls into two categories: entirely retrospective versus "prospective" reliability assessments. Entirely retrospective assessments (both inquiries occur well after weaning) universally report exceedingly high reliability, whereas "prospective" assessments (women report infant feeding behavior during infancy, immediately after weaning, and some years later are asked to replicate their original answer) universally report poorer reliability. Interestingly, all "prospective" reliability studies, including ours, found that women over-report past breastfeeding durations by about 1 month upon the second inquiry. Researchers need not refrain from using maternal self-reported breastfeeding durations, because participants are largely still ranked correctly, relative to each other. However, such research efforts must avoid attempting to determine any optimal threshold duration.

Utilizing Datasets to Advance Perinatal Research

Many organizations collect and make available perinatal data for research and quality improvement initiatives. Analysis of existing data and use of retrospective study design has many advantages for perinatal researchers. These advantages include large samples, inclusion of women from diverse groups, data reflective of actual clinical processes and outcomes, and decreased risk of direct maternal and fetal harm. We review 11 publicly available datasets relevant to perinatal research and quality improvement, detail the availability of interactive websites, and discuss strategies to locate additional datasets. While analysis of existing data has limitations, it may provide statistical power to study rare perinatal outcomes, support research applicable to diverse populations, and facilitate timely and ethical well-woman research immediately relevant to clinical care.

Exposure to paternal tobacco smoking increased child hospitalization for lower respiratory infections but not for other diseases in Vietnam

Exposure to environmental tobacco smoke (ETS) is an important modifiable risk factor for child hospitalization, although its contribution is not well documented in countries where ETS due to maternal tobacco smoking is negligible. We conducted a birth cohort study of 1999 neonates between May 2009 and May 2010 in Nha Trang, Vietnam, to evaluate paternal tobacco smoking as a risk factor for infectious and non-infectious diseases. Hospitalizations during a 24-month observation period were identified using hospital records. The effect of paternal exposure during pregnancy and infancy on infectious disease incidence was evaluated using Poisson regression models. In total, 35.6% of 1624 children who attended follow-up visits required at least one hospitalization by 2 years of age, and the most common reason for hospitalization was lower respiratory tract infection (LRTI). Paternal tobacco smoking independently increased the risk of LRTI 1.76-fold (95% CI: 1.24-2.51) after adjusting for possible confounders but was not associated with any other cause of hospitalization. The population attributable fraction indicated that effective interventions to prevent paternal smoking in the presence of children would reduce LRTI-related hospitalizations by 14.8% in this epidemiological setting.

Hazard Patterns Associated With Co-sleepers

We conducted a retrospective review of incidents associated with co-sleepers. A total of 26 incidents (6 deaths and 20 injuries) were reported to the Consumer Product Safety Commission. Of these, 5 deaths were caused by asphyxia, and 1 was attributed to sudden infant death syndrome (SIDS). The mean age at death was 3.1 months. Two-thirds of deaths had known risk factors for SIDS. Of the 20 injuries, entrapment (60%) and suffocation (35%) hazards were most common. Almost half of the injuries occurred after the co-sleeper was improperly assembled. Infant deaths and injuries associated with co-sleepers are infrequent. Most deaths were associated with other SIDS risk factors. Many deaths and injuries were associated with improper use or assembly of the co-sleeper. It is important for pediatricians to advise parents not to use previously owned co-sleepers or to use co-sleepers in any way other than what is specifically stated in the product instructions to avoid infant injury or death.

The relationship between planned and reported home infant sleep locations among mothers of late preterm and term infants

To compare maternal report of planned and practiced home sleep locations of infants born late preterm (34 0/7 to 36 6/7 gestational weeks) with those infants born term (≥37 0/7 gestational weeks) over the first postpartum month. Open-ended semi-structured maternal interviews were conducted in a US hospital following birth and by phone at 1 month postpartum during 2010-2012. Participants were 56 mother-infant dyads: 26 late preterm and 30 term. Most women planned to room share at home with their infants and reported doing so for some or all of the first postpartum month. More women reported bed sharing during the first postpartum month than had planned to do so in both the late preterm and term groups. The primary reason for unplanned bed sharing was to soothe nighttime infant fussiness. Those participants who avoided bed sharing at home commonly discussed their fear for infant safety. A few parents reported their infants were sleeping propped on pillows and co-sleeping on a recliner. Some women in both the late preterm and term groups reported lack of opportunity to obtain a bassinet prior to childbirth. The discrepancy between plans for infant sleep location at home and maternally reported practices were similar in late preterm and term groups. Close maternal proximity to their infants at night was derived from the need to assess infant well-being, caring for infants, and women's preferences. Bed sharing concerns related to infant safety and the establishment of an undesirable habit, and alternative arrangements included shared recliner sleep.

Development of the National Healthy Sleep Awareness Project Sleep Health Surveillance Questions

OBJECTIVES

For the first time ever, as emphasized by inclusion in the Healthy People 2020 goals, sleep health is an emphasis of national health aims. The National Healthy Sleep Awareness Project (NHSAP) was tasked to propose questions for inclusion in the next Behavioral Risk Factor Surveillance System (BRFSS), a survey that includes a number of questions that target behaviors thought to impact health, as a means to measure community sleep health. The total number of questions could not exceed five, and had to include an assessment of the risk for obstructive sleep apnea (OSA).

METHODS

An appointed workgroup met via teleconference and face-to-face venues to develop an inventory of published survey questions being used to identify sleep health, to develop a framework on which to analyze the strengths and weaknesses of current survey questions concerning sleep, and to develop recommendations for sleep health and disease surveillance questions going forward.

RESULTS

The recommendation was to focus on certain existing BRFSS questions pertaining to sleep duration, quality, satisfaction, daytime alertness, and to add to these other BRFSS existing questions to make a modified STOP-BANG questionnaire (minus the N for neck circumference) to assess for risk of OSA.

CONCLUSIONS

Sleep health is an important dimension of health that has previously received less attention in national health surveys. We believe that 5 questions recommended for the upcoming BRFSS question banks will assist as important measures of sleep health, and may help to evaluate the effectiveness of interventions to improve sleep health in our nation.

Trends and factors associated with infant bed sharing, 1993-2010: the National Infant Sleep Position Study

IMPORTANCE

A strong association between infant bed sharing and sudden infant death syndrome or unintentional sleep-related death in infants has been established. Occurrences of unintentional sleep-related deaths among infants appear to be increasing.

OBJECTIVES

To determine the trends and factors associated with infant bed sharing from 1993 through 2010, including the association of physician advice on bed sharing.

DESIGN

National Infant Sleep Position study conducted with annual telephone surveys.

SETTING

The 48 contiguous states.

PARTICIPANTS

Nighttime caregivers of infants born within 7 months of each survey administration. Approximately 1000 interviews were completed annually.

MAIN OUTCOMES AND MEASURES

Infant bed sharing as a usual practice.

RESULTS

Of 18 986 participants, 11.2% reported an infant sharing a bed as a usual practice. Bed sharing increased from 1993 (6.5%) to 2010 (13.5%). Although bed sharing increased significantly among white respondents from 1993 to 2000 (P < .001), the increase from 2001 to 2010 was not significant (P = .48). Black and Hispanic respondents reported an increase in bed sharing throughout the study period, with no difference between the earlier and later periods (P = .63 and P = .77, respectively). After accounting for the study year, factors associated with increase in infant bed sharing as a usual practice included maternal educational level of less than high school compared with college or greater (adjusted odds ratio, 1.42 [95% CI, 1.12-1.79]); black (3.47 [2.97-4.05]), Hispanic (1.33 [1.10-1.61]), and other (2.46 [2.03-2.97]) maternal race or ethnicity compared with white race; household income of less than $20,000 (1.69 [1.44-1.99]) and $20,000 to $50,000 (1.29 [1.14-1.45]) compared with greater than $50,000; living in the West (1.61 [1.38-1.88]) or the South (1.47 [1.30-1.66]) compared with the Midwest; infants younger than 8 weeks (1.45 [1.21-1.73]) or ages 8 to 15 weeks (1.31 [1.17-1.45]) compared with 16 weeks or older; and being born prematurely compared with full-term (1.41 [1.22-1.62]). Almost 46% of the participants reported talking to a physician about bed sharing. Compared with those who did not receive advice from a physician, those who reported their physicians had a negative attitude were less likely to have the infant share a bed (adjusted odds ratio, 0.66 [95% CI, 0.53-0.82]), whereas a neutral attitude was associated with increased bed sharing (1.38 [1.05-1.80]).

CONCLUSIONS AND RELEVANCE

Our finding of a continual increase in bed sharing throughout the study period among black and Hispanic infants suggests that the current American Academy of Pediatrics recommendation about bed sharing is not universally followed. The factors associated with infant bed sharing may be useful in evaluating the impact of a broad intervention to change behavior.

Sudden twin infant death on the same day: a case report and review of the literature

Sudden infant death syndrome (SIDS) is a major contributor to infant mortality. The cause of death is unknown: suggested possibilities include cardiovascular disease, anaphylactic shock, and suffocation. The occurrence of simultaneous sudden infant death syndrome is uncommon, such cases being extremely rare in forensic pathologic practice. We report two 10-week-old male twins who appeared well at the time of their evening feeding, yet died while sleeping on their backs. Both infants had petechial hemorrhages on the visceral pleura, epicardial surface of the heart, and thymus gland. Microscopic examination revealed pulmonary edema, intra-alveolar hemorrhage, and minor lymphocytic infiltration, again in both infants. In this report, we discuss the risk factors for SIDS, which should be considered individually or in combination as possible causes of death.

Cardiac ion channelopathies and the sudden infant death syndrome

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

Infant gender, shared sleeping and sudden death

AIM

To determine whether there is a gender imbalance in infant deaths in shared sleeping compared to solitary sleeping situations.

METHODS

Examination of autopsy reports of 133 infants aged between 7 and 364 days autopsied over a 19-year period from January 1991 to December 2009 was undertaken where death had either been attributed to SIDS, or had been classified as undetermined or unascertained. Cases were divided into two groups of solitary sleepers and shared sleepers, and the ratio of male to female cases was compared.

RESULTS

Ninety-five solitary sleepers were aged from 1 to 11 months (average 4.1 months) and consisted of 63 males (age range 1 to 11 months) and 32 females (age range 1 to 10 months). The 38 shared sleepers were aged from 1 week to 12 months (average 2.6 months) and consisted of 17 males (age range 2 weeks to 5 months) and 21 females (age range 1 week to 10 months). The male to female ratio in the solitary sleepers was approximately 2:1 and in the shared sleepers was 0.8:1, a statistically significant difference (p = 0.02).

CONCLUSION

The lack of a male predominance typical of SIDS cases in infants who were sleeping with others, compared to those who were sleeping alone, suggests that these situations may be different. It is possible, therefore, that different lethal mechanisms may be involved in some shared sleeping situations.

Evolutionary perspectives on mother-infant sleep proximity and breastfeeding in a laboratory setting

Human maternal and infant biology likely coevolved in a context of close physical contact and some approximation of frequent, "infant-initiated" breastfeeding. Still, mothers and infants commonly sleep apart from one another in many western societies, indicating a possible "mismatch" between cultural norms and infant biology. Here we present data from a 3-night laboratory-based study that examines differences in mother-infant sleep physiology and behavior when mothers and infants sleep together on the same surface (bedsharing) and apart in separate rooms (solitary). We analyze breastfeeding frequency and interval data from the first laboratory night (FN) for 52 complementary breastfeeding mothers and infants (26 total mother-infant pairs), of which 12 pairs were routine bedsharers (RB) and 14 were routine solitary sleepers (RS). RB infants were 12.0 ± 2.7 (SD) weeks old; RS infants were 13.0 ± 2.4 weeks old. On the FN, RB mother-infant pairs (while bedsharing) engaged in a greater number of feeds per night compared to RS (while sleeping alone) (P < 0.001). RB also showed lower intervals (min) between feeds relative to RS (P < 0.05). When we evaluated data from all three laboratory nights (n = 36), post hoc, RB breastfed significantly more often (P < 0.01) and showed a trend towards lower intervals between feeds (P < 0.10). Given the widely known risks associated with little or no breastfeeding, the demonstrated mutually regulatory relationship between bedsharing and breastfeeding should be considered in future studies evaluating determinants of breastfeeding outcomes.

Sudden infant death syndrome: how much mothers and health professionals know

BACKGROUND

Behavioral risk factors are associated with sudden infant death syndrome (SIDS). Education about the risk factors of SIDS is important for prevention. Our aim was to determine the knowledge and attitude of parents and health professionals about SIDS.

METHODS

A total of 174 health professionals and 150 mothers were enrolled in this study. Mothers' data were collected by telephone interview and health-care professionals were interviewed by the same investigator.

RESULTS

Only 39% of mothers were aware of SIDS. Forty-six percent of the mothers preferred a supine sleeping position for their infant and 16% of the parents were bed-sharing with their infants. Seventy-three percent of health professionals selected side, 17% supine and 10% prone sleeping position as the safest sleeping position. Frequencies for awareness of risk factors were: bed-sharing (75%), soft bedding (70%), pillow use (52%), toys in bed (90%), high room temperature (67%) and smoking (88%). Total knowledge score of health professionals who selected supine sleeping position as the safest was significantly higher (P < 0.001).

CONCLUSION

Most of the mothers were unaware of SIDS and less than half preferred a supine sleeping position for their infant. Only 72% of health professionals recommended a certain sleeping position during family interviews. Health professionals are more often recommending the side sleeping position or prone. Education of families and health professionals for the risk factors of SIDS may reduce the number of deaths from SIDS in Istanbul.

An animal model of cigarette smoke-induced in utero growth retardation

Maternal/fetal genetic constitution and environmental factors are vital to delivery of a healthy baby. In the United States (US), a low birth weight (LBW) baby is born every minute and a half. LBW, defined as weighing less than 5.5 lbs at birth, affects nearly 1 in 12 infants born in the US with resultant costs for the nation of more than 15 billion dollars annually. Infant birth weight is the single most important factor affecting neonatal mortality. Various environmental and genetic risk factors for LBW have been identified. Several risks are preventable, such as cigarette smoking during pregnancy. Over one million babies are exposed prenatally to cigarette smoke accounting for over 20% of the LBW incidence in the US. Cigarette smoke exposure in utero results in a variety of adverse developmental outcomes with intrauterine growth restriction and infant LBW being the most well documented. However, the mechanisms underlying the causes of LBW remain poorly understood. The purpose of this study was: (1) to establish an animal model of cigarette smoke-induced in utero growth retardation and LBW using physiologically relevant inhalation exposure conditions which simulate "active" and "passive" tobacco smoke exposures, and (2) to determine whether particular stages of development are more susceptible than others to the adverse effects of in utero smoke exposure on embryo/fetal growth. Pregnant C57BL/6J mice were exposed to cigarette smoke during three periods of gestation: pre-/peri-implantation (gestational days [gds] 1-5), post-implantation (gds 6-18), and throughout gestation (gds 1-17). Reproductive and fetal outcomes were assessed on gd 18.5. Exposure of dams to mainstream/sidestream cigarette smoke, simulating "active" maternal smoking, resulted in decreases in fetal weight and crown-rump length when exposed throughout gestation (gds 1-17). Similar results were seen when dams were exposed only during the first 5 days of gestation (pre-/peri-implantation period gds 1-5). Exposure of dams from the post-implantation period through gestation (gds 6-18) did not result in reduced fetal weight, although a significant reduction in crown-rump length remained evident. Interestingly, maternal sidestream smoke exposure, simulating exposure to environmental tobacco smoke (ETS), during the pre-/peri-implantation period of development also produced significant decreases in fetal weight and crown-rump length. Collectively, results from the present study confirm an association between prenatal exposure to either "active" or "passive" cigarette smoke and in utero growth retardation. The data also identify a period of susceptibility to in utero cigarette smoke exposure-induced growth retardation and LBW during pre-/peri-implantation embryonic development.

Mother-infant cosleeping, breastfeeding and sudden infant death syndrome: what biological anthropology has discovered about normal infant sleep and pediatric sleep medicine

Twenty years ago a new area of inquiry was launched when anthropologists proposed that an evolutionary perspective on infancy could contribute to our understanding of unexplained infant deaths. Here we review two decades of research examining parent-infant sleep practices and the variability of maternal and infant sleep physiology and behavior in social and solitary sleeping environments. The results challenge clinical wisdom regarding "normal" infant sleep, and over the past two decades the perspective of evolutionary pediatrics has challenged the supremacy of pediatric sleep medicine in defining what are appropriate sleep environments and behaviors for healthy human infants. In this review, we employ a biocultural approach that integrates diverse lines of evidence in order to illustrate the limitations of pediatric sleep medicine in adopting a view of infants that prioritizes recent western social values over the human infant's biological heritage. We review what is known regarding infant sleeping arrangements among nonhuman primates and briefly explore the possible paleoecological context within which early human sleep patterns and parent-infant sleeping arrangements might have evolved. The first challenges made by anthropologists to the pediatric and SIDS research communities are traced, and two decades of studies into the behavior and physiology of mothers and infants sleeping together are presented up to the present. Laboratory, hospital and home studies are used to assess the biological functions of shared mother-infant sleep, especially with regard to breastfeeding promotion and SIDS reduction. Finally, we encourage other anthropologists to participate in pediatric sleep research using the unique skills and insights anthropological data provide. By employing comparative, evolutionary and cross-cultural perspectives an anthropological approach stimulates new research insights that influence the traditional medical paradigm and help to make it more inclusive. That this review will potentially stimulate similar research by other anthropologists is one obvious goal. That this article might do so makes it ever more possible that anthropologically inspired work on infant sleep will ultimately lead to infant sleep scientists, pediatricians, and parents becoming more informed about the consequences of caring for human infants in ways that are not congruent with their evolutionary biology.

Effect of parental smoking on cotinine levels in newborns

BACKGROUND

Smoking is a major risk factor for cot death. Many infants smoke passively as a result of parental smoking. This paper reports on infants exposed to a smoking environment and how they accumulate metabolites of cigarette smoke, such as cotinine, which may be physiologically harmful.

AIM

To assess cotinine levels in infants of smoking parents.

METHOD

Cotinine excretion in urine was assessed in 104 infants, of whom 71 had smoking parents and 33 had non-smoking parents. All cotinine levels were measured at approximately 12 weeks of age. The subjects were selected from a database of infants in developmental physiological studies which assessed the impact of various factors on early postnatal development.

RESULTS

On average babies with at least one parent who was a current cigarette smoker excreted 5.58 (95% CI 3.4 to 9.5) times as much cotinine in the urine as did the babies of non-smoking parents. Maternal smoking was the largest contributing factor. Co-sleeping (p = 0.037) and the minimum room temperature (p = 0.028) were significant contributory factors.

CONCLUSION

Infants from smoking households accumulate cotinine, a metabolite of nicotine, which may have a detrimental effect on the cardiorespiratory system.

Bed-sharing in the first four months of life: a risk factor for sudden infant death

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.

Disparities in access to essential new prescription drugs between non-Hispanic whites, non-Hispanic blacks, and Hispanic whites

Prior studies do not address racial and ethnic disparities in essential new drug use and whether disparities decrease through time. Using the Medical Expenditure Panel Survey (1996-2001), racial and ethnic disparities were examined separately by comparing non-Hispanic whites to non-Hispanic blacks and Hispanic whites, respectively. New drugs were defined as approved within the past 5 years, and an expert panel identified essential drugs. Negative binomial models adjusted for socioeconomic and health characteristics. The mean annual number of times essential new drugs were obtained among non-Hispanic whites, non-Hispanic blacks, and Hispanic whites were 1.02, 0.94, and 0.70, respectively. After adjusting for confounders, ethnic disparities generally were not significant, but racial disparities became significant. This study did not identify declining disparities during early years of drugs' life cycles. Disparities exist in new, essential drug acquisition between non-Hispanic whites and non-Hispanic blacks. Socioeconomic and health characteristics explain many of the observed disparities.

Breastfeeding: factors associated with the continuation of breastfeeding, the current situation in Japan, and recommendations for further research

There are a number of research reports that address the various advantages that breastfeeding brings to mothers and children, as well as to families and society, and in addition to a number of physically positive effects, breastfeeding has an important role in terms of mental and psychological effects.Ninety-five % of mothers desire to breastfeed, which reflects social acceptance, but the actual breastfeeding rate of the first month after childbirth is 42%, which accounts for about a half of all mothers. Breastfeeding is a natural behavior, but it cannot be performed only by instinct, so mothers discontinue breastfeeding for various reasons. While these reasons for the discontinuation of breastfeeding have been studied in many countries, research regarding the usability of care to support breastfeeding is being conducted in other countries at a level that can be considered evidential, but not yet in Japan. In addition, the current situation is that breastfeeding is strongly promoted but the support provided remains inadequate for mothers who cannot breastfeed, regardless of whatever efforts they make. This article will review several factors associated with the continuation of breastfeeding and the current situation in Japan, with the intention of identifying desirable areas for further research.

Maternal-Infant Bedsharing: Risk Factors for Bedsharing in a Population-Based Survey of New Mothers and Implications for SIDS Risk Reduction

OBJECTIVES

Maternal-infant bedsharing is a common but controversial practice. Little has been published about who bedshares in the United States. This information would be useful to inform public policy, to guide clinical practice and to help focus research. The objective was to explore the prevalence and determinants of bedsharing in Oregon.

METHODS

Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) surveys a population-based random sample of women after a live birth. Women were asked if they shared a bed with their infant "always," "almost always," "sometimes" or "never."

RESULTS

1867 women completed the survey in 1998-99 (73.5% weighted response rate). Of the respondents, 20.5% reported bedsharing always, 14.7% almost always, 41.4% sometimes, and 23.4% never. In multivariable logistic regression, Hispanics (adjusted odds ratio [ORa] 1.69, 95% Confidence Interval [CI] 1.17-2.43), blacks (ORa 3.11, 95% CI 2.03-4.76) and Asians/Pacific Islanders (ORa 2.14, 95% CI 1.51-3.03), women who breastfed more than 4 weeks (ORa 2.65, 95% CI 1.72-4.08), had annual family incomes less than $30,000 (ORa 2.44, 95% CI 1.44-4.15), or were single (ORa 1.55, 95% CI 1.03-2.35) were more likely to bedshare frequently (always or almost always). Among Hispanic and black women, bedsharing did not vary significantly by income level. Bedsharing black, American Indian/Alaska Native and white infants were much more likely to be exposed to smoking mothers than Hispanic or Asian/Pacific Islander infants (p < .0001).

CONCLUSIONS

Bedsharing is common in Oregon. The women most likely to bedshare are non-white, single, breastfeeding and low-income. Non-economic factors are also important, particularly among blacks and Hispanics. Campaigns to decrease bedsharing by providing cribs may have limited effectiveness if mothers are bedsharing because of cultural norms.

The Controversy About What Constitutes Safe and Nurturant Infant Sleep Environments

In 1999, the U.S. Consumer Product Safety Commission stated that cribs provide the safest sleep environment for infants. Scientific data fails to support that statement and controversy continues in the scientific, medical, and parenting communities. Recent data demonstrate that cribs may represent the most unsafe sleep. This article seeks to inform health care professionals of the issues involved in the controversy and to offer guidelines for educating parents about safe and unsafe sleep practices.

Sleep environment, positional, lifestyle, and demographic characteristics associated with bed sharing in sudden infant death syndrome cases: a population-based study

BACKGROUND

In 2005, the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome recommended that infants not bed share during sleep.

OBJECTIVE

Our goal was to characterize the profile of risk factors associated with bed sharing in sudden infant death syndrome cases.

DESIGN/METHODS

We conducted a population-based retrospective review of sudden infant death syndrome cases in New Jersey (1996-2000) dichotomized by bed-sharing status and compared demographic, lifestyle, bedding-environment, and sleep-position status.

RESULTS

Bed-sharing status was reported in 239 of 251 cases, with sharing in 39%. Bed-sharing cases had a higher percentage of bedding risks (44.1% vs 24.7%), exposure to bedding risks in infants discovered prone (57.1% vs 28.2%), and lateral sleep placement (28.9% vs 17.8%). The prone position was more common for bed-sharing and non-bed-sharing cases at placement (45.8% and 51.1%, respectively) and discovery (59.0% and 64.4%, respectively). In multivariable logistic-regression analyses, black race, mother <19 years, gravida >2, and maternal smoking were associated with bed sharing. There was a trend toward less breastfeeding in bed-sharing cases (22% vs 35%). In bed-sharing cases, those breastfed were younger than those who were not and somewhat more exposed to bedding risks (64.7% vs 45.1%) but less likely to be placed prone (11.8% vs 52.9%) or have maternal smoking (33% vs 66%).

CONCLUSIONS

Bed-sharing cases were more likely to have had bedding-environment and sleep-position risks and higher ratios of demographic and lifestyle risk factors. Bed-sharing subjects who breastfed had a risk profile distinct from those who were not breastfed cases. Risk and situational profiles can be used to identify families in greater need of early guidance and to prepare educational content to promote safe sleep.

Unexplained infant and child death: a review of sudden infant death syndrome, sudden unexplained infant death, and child maltreatment fatalities including shaken baby syndrome

PURPOSE OF REVIEW

This review will examine the most recent published literature on Sudden Infant Death, Sudden Unexplained Infant Death, infant and child death due to maltreatment, and Shaken Baby Syndrome.

RECENT FINDINGS

New recommendations from the American Academy of Pediatrics about the evaluation and prevention of possible Sudden Infant Death Syndrome cases were published this year, with a focus not only on the Back to Sleep campaign, but other factors that may contribute to the risk of Sudden Infant Death Syndrome. Additionally, the controversial issue of bed sharing is addressed, with advice given not to bed share in the first 3 months of life. The possibility of a second sudden infant death within a family is discussed. Attention is also paid to the importance of considering inflicted injury in the differential diagnosis of every unexplained infant or child death, and the recent literature on child maltreatment deaths is reviewed.

SUMMARY

The grieving family who has lost an infant should receive immediate attention and support, and a multidisciplinary investigation team should be involved as soon as possible so that a full investigation can take place. Investigation of unexplained infant or child death should always involve a thorough interview with all adults involved, as well as a proper scene investigation and post-mortem examination.