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Sangaré LR, Kaufman L, Bardwell RA, Nichols D, Bryan M. The risk of sleep-related death in an inclined sleep environment. BMC Public Health 2024; 24:2186. [PMID: 39135049 PMCID: PMC11320768 DOI: 10.1186/s12889-024-19731-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 08/08/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Unsafe sleep environments are the primary modifiable risk factor for sudden unexpected infant death (SUID). Despite this knowledge, products that deviate from the American Academy of Pediatrics (AAP) safe sleep recommendations continue to be commonplace, such as inclined sleepers. Analyses to estimate risk among these products are lacking, perpetuating their presence in the marketplace. We present a method of comparing risk of SUID in an inclined sleeper to an AAP-recommended sleep environment. METHODS A case-control analysis using publicly available and previously published survey data was conducted for SUID events occurring between January 1, 2018 and April 12, 2019 (the date of the first inclined sleeper recall). SUID deaths were categorized as occurring in an AAP-recommended sleep environments or in an inclined sleeper. Exposure Odds Ratios (OR) are reported as the risk of SUID among infants using inclined sleepers relative to an AAP-recommended sleep environment. RESULTS During the study period, 4,900,573 births and 4,363 SUID deaths occurred in the US. Control characteristics were similar between previous night users of an AAP-recommended sleep environment (24%) and inclined sleepers (3.8%). Inclined sleepers were associated with a 5-fold (OR: 5.1; 95% CI: 3.2, 7.9) increased risk of SUID among infants < 12 months compared to infants in an AAP-recommended sleep environment. This risk was greatest among infants ≥ 4 months (RR: 10.4; 95% CI: 5.1, 21.5). CONCLUSIONS This novel analysis fills a longstanding gap in risk assessments of inclined infant sleep products. More timely risk analyses may improve the safety of the marketplace.
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Affiliation(s)
- Laura R Sangaré
- EpiAdvantage, Portland, OR, US.
- University of Washington, Seattle, Washington, US.
| | | | | | | | - Mersine Bryan
- University of Washington, Seattle, Washington, US
- Seattle Children's Research Institute, Seattle, Washington, US
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Howard S, Dancy S. Promoting Safe Sleep: The Role of Doulas in Black Communities. Matern Child Health J 2024; 28:1422-1431. [PMID: 38833178 PMCID: PMC11269406 DOI: 10.1007/s10995-024-03928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Accidental suffocation and strangulation in bed continues to be a critical issue in Black communities, despite the widespread initiatives to promote safe sleep. Doulas are in an ideal position to promote safe sleep, particularly in hard-to-reach communities that are more distrusting of conventional medical providers. Little is known about their practices and perspectives for putting infants down to rest. This study informs this gap in the literature. PURPOSE The purpose of this study was to explore doulas' perspectives and practices in the field of putting infants down to sleep. The researchers aimed to determine whether Black caregivers that work with doulas are likely to encounter safe sleep education. METHODS The researchers used a descriptive approach to inquiry. They conducted three focus groups with a total of 17 Black doulas. The researchers independently and critically reviewed the transcriptions and observation notes from each group to identify codes. They then triangulated the results using Artificial Intelligence-driven tools. FINDINGS The study found four themes: (1) Individualized Services, (2) Cultural Sensitivity, (3) Negotiating Safety, and (4) Safe Sleep Education. CONCLUSIONS The study concluded doulas have a commitment to promoting safe sleep. The researchers found that doulas engage in practices that help caregivers to integrate safe sleep practices into their lifestyle and to adapt them to meet their needs. The researchers also documented a desire for more information and instruction on safe sleep among practicing doulas.
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Affiliation(s)
- Stephenie Howard
- School of Social Work, Norfolk State University, Brown Memorial Hall, 700 Park Ave, Norfolk, VA, 23504, USA.
| | - Shannon Dancy
- School of Social Work, Norfolk State University, Brown Memorial Hall, 700 Park Ave, Norfolk, VA, 23504, USA
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Tanner D, Ramirez JM, Weeks WB, Lavista Ferres JM, Mitchell EA. Maternal Obesity and Risk of Sudden Unexpected Infant Death. JAMA Pediatr 2024:2821643. [PMID: 39073792 PMCID: PMC11287443 DOI: 10.1001/jamapediatrics.2024.2455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/10/2024] [Indexed: 07/30/2024]
Abstract
Importance Rates of maternal obesity are increasing in the US. Although obesity is a well-documented risk factor for numerous poor pregnancy outcomes, it is not currently a recognized risk factor for sudden unexpected infant death (SUID). Objective To determine whether maternal obesity is a risk factor for SUID and the proportion of SUID cases attributable to maternal obesity. Design, Setting, and Participants This was a US nationwide cohort study using Centers for Disease Control and Prevention National Center for Health Statistics linked birth-infant death records for birth cohorts in 2015 through 2019. All US live births for the study years occurring at 28 weeks' gestation or later from complete reporting areas were eligible; SUID cases were deaths occurring at 7 to 364 days after birth with International Statistical Classification of Diseases, Tenth Revision cause of death code R95 (sudden infant death syndrome), R99 (ill-defined and unknown causes), or W75 (accidental suffocation and strangulation in bed). Data were analyzed from October 1 through November 15, 2023. Exposure Maternal prepregnancy body mass index (BMI; calculated as weight in kilograms divided by height in meters squared). Main Outcome and Measure SUID. Results Of 18 857 694 live births eligible for analysis (median [IQR] age: maternal, 29 [9] years; paternal, 31 [9] years; gestational, 39 [2] weeks), 16 545 died of SUID (SUID rate, 0.88/1000 live births). After confounder adjustment, compared with mothers with normal BMI (BMI 18.5-24.9), infants born to mothers with obesity had a higher SUID risk that increased with increasing obesity severity. Infants of mothers with class I obesity (BMI 30.0-34.9) were at increased SUID risk (adjusted odds ratio [aOR], 1.10; 95% CI, 1.05-1.16); with class II obesity (BMI 35.0-39.9), a higher risk (aOR, 1.20; 95% CI, 1.13-1.27); and class III obesity (BMI ≥40.0), an even higher risk (aOR, 1.39; 95% CI, 1.31-1.47). A generalized additive model showed that increased BMI was monotonically associated with increased SUID risk, with an acceleration of risk for BMIs greater than approximately 25 to 30. Approximately 5.4% of SUID cases were attributable to maternal obesity. Conclusions and Relevance The findings suggest that infants born to mothers with obesity are at increased risk of SUID, with a dose-dependent association between increasing maternal BMI and SUID risk. Maternal obesity should be added to the list of known risk factors for SUID. With maternal obesity rates increasing, research should identify potential causal mechanisms for this association.
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Affiliation(s)
- Darren Tanner
- AI for Good Research Lab, Microsoft Corporation, Redmond, Washington
| | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, Washington
- Department of Neurological Surgery, School of Medicine, University of Washington, Seattle
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
| | - William B. Weeks
- AI for Good Research Lab, Microsoft Corporation, Redmond, Washington
| | | | - Edwin A. Mitchell
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
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Ikels AK, Herting E, Stichtenoth G. Higher awakening threshold of preterm infants in prone position may be a risk factor for SIDS. Acta Paediatr 2024; 113:1562-1568. [PMID: 38469704 DOI: 10.1111/apa.17194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/13/2024]
Abstract
AIM The supine sleeping position in the prevention of sudden infant death syndrome in preterm infants is poorly understood. We aimed to investigate the effect of sleep posture on cardiorespiratory parameters and movement patterns in preterm infants close to discharge. METHODS This observational study included neonates born in 2022 at the University Hospital Schleswig-Holstein, Lübeck, Germany. Motion sensor data, heart rate, respiratory rate and oxygen saturation were recorded for infants with postconceptional age 35-37 weeks during sleep in the prone and supine positions. RESULTS We recorded data from 50 infants, born at 31 (24-35) weeks of gestation (mean(range)), aged 5.2 ± 3.7 weeks (mean ± SD), of whom 48% were female. Five typical movement patterns were identified. In the prone position, the percentage of calm, regular breathing was higher and active movement was less frequent when compared to the supine position. The percentage of calm irregular breathing, number of apnoeas, bradycardias, desaturations and vital sign changes were not influenced by position. CONCLUSION The prone position seems to be associated with a higher arousal threshold. The supine position appears advantageous for escape from life-threatening situations such as sudden infant death syndrome.
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Affiliation(s)
| | - Egbert Herting
- Department of Paediatrics, University of Lübeck, Lubeck, Germany
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Gates K, Chahin S, Damashek A, Dickson C, Lubwama G, Lenz D, Bautista T, Kothari C. The Relation of Maternal Psychosocial Risk Factors to Infant Safe Sleep Practices. Matern Child Health J 2024; 28:1061-1071. [PMID: 38460074 DOI: 10.1007/s10995-023-03880-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 03/11/2024]
Abstract
OBJECTIVES Sleep-related infant deaths are a common and preventable cause of infant mortality in the United States. Moreover, infants of color are at a greater risk of sleep-related deaths than are White infants. The American Academy of Pediatrics (AAP) published safe sleep guidelines to minimize the number of sleep-related infant deaths; however, many families face barriers to following these guidelines. Research on the role of psychosocial risk factors (i.e., depression, stress, domestic violence, substance use) in mothers' engagement in safe sleep practices is limited. The present study examined the role of maternal psychosocial risk factors on maternal safe sleep practices and the moderating effects of maternal race on this relationship. METHODS Participants in this study were mothers (N = 274) who were recruited from a Midwestern hospital postpartum. Data on the participants' psychosocial risk factors, and safe sleep practices were collected via telephone interview 2-4 months following the birth of their infant. RESULTS Predictive models indicated that depression and stress impacted mothers' engagement in following the safe sleep guidelines. Specifically, higher levels of maternal depression predicted greater likelihood of co-sleeping, regardless of mothers' race. Higher levels of maternal stress also predicted lower engagement in safe sleep behaviors for White mothers only. CONCLUSION FOR PRACTICE Early interventions to address stress and depression may help to increase maternal adherence to the AAP's safe sleep guidelines. Additional research on the underlying mechanisms of depression and stress on maternal safe sleep engagement is needed.
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Affiliation(s)
- Kalani Gates
- Department of Psychology, Western Michigan University, 1903 W. Michigan, Kalamazoo, MI, 49008, USA
| | - Summer Chahin
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage St., Kalamazoo, MI, 49007, USA
| | - Amy Damashek
- Department of Psychology, Western Michigan University, 1903 W. Michigan, Kalamazoo, MI, 49008, USA.
| | - Cheryl Dickson
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage St., Kalamazoo, MI, 49007, USA
| | - Grace Lubwama
- Kalamazoo Community Foundation, 402 E. Michigan, Kalamazoo, MI, 49007, USA
| | - Debra Lenz
- Kalamazoo County Health and Community Services Department, 311 E. Alcott St., Kalamazoo, MI, 49006, USA
| | | | - Catherine Kothari
- Department of Biomedical Sciences, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Dr., Kalamazoo, MI, 49008, USA
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Salm Ward TC. "Things changed very quickly": Maternal intentions and decision-making about infant sleep surface, location, and position. Birth 2024; 51:373-383. [PMID: 37921270 DOI: 10.1111/birt.12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/27/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Approximately 3400 infants die suddenly and unexpectedly each year in the United States; many of these deaths include modifiable risk factors (such as a non-supine position, sleeping on a soft surface, or loose bedding or items in the environment). Interventions have been successful at improving parental knowledge about recommendations to reduce risk of sleep-related infant deaths, as well as improving intention to adopt recommendations. However, follow-up studies have found a disconnect between knowledge/intentions to adhere to recommendations and actual practices. Exploring maternal decision-making about infant sleep practices can better elucidate the disconnect between knowledge of infant sleep recommendations and the practice of it, and thus, inform more effective safe sleep interventions. The purpose of this study was to gain a more in-depth understanding of decision-making around infant sleep practices, and barriers and facilitators to adopting safe infant sleep recommendations. METHODS Semi-structured in-home interviews were conducted with 22 families (20 mothers and 2 mother-father dyads) of infants up to 6 months of age. RESULTS Thematic analysis of the transcripts revealed six themes: Plans changed when baby came, Trying things to figure out what works (infant preferences), Safety concerns, What's comfortable for me (maternal preferences), They say…(advice), and Trying to be careful. CONCLUSION These results suggest that knowledge of infant sleep recommendations alone is not enough to ensure adherence and that decision-making is a dynamic and ongoing process affected by multiple factors. Findings have implications for timing and content of risk reduction efforts, as well as for data collection in research studies.
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Napolitano SK, Boswell NL, Froese P, Henkel RD, Barnes-Davis ME, Parham DK. Early and consistent safe sleep practices in the neonatal intensive care unit: a sustained regional quality improvement initiative. J Perinatol 2024; 44:908-915. [PMID: 38253677 DOI: 10.1038/s41372-023-01855-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/17/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To increase compliance with standardized safe sleep recommendations for patients in a cohort of regional level III/IV neonatal intensive care units (NICUs) in accordance with recently revised guidelines issued by the American Academy of Pediatrics (AAP). STUDY DESIGN A regional quality improvement (QI) initiative led by a multidisciplinary task force standardized safe sleep criteria across participating NICU sites. Universal and unit-specific interventions were implemented via Plan-Do-Study-Act (PDSA) cycles with evaluation of compliance through routine crib audits, run chart completion, and Pareto chart analysis. RESULTS Following QI implementation, compliance with safe sleep guidelines for eligible NICU infants improved from 34% to 90% from October 2019 through September 2022. CONCLUSION Compliance with early, consistent modeling of safe sleep practices nearly tripled in this cohort of regional NICUs. A standardized, timely approach to safe sleep transition demonstrated dramatic and sustained improvement in the practice and modeling of safe sleep behaviors in the NICU.
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Affiliation(s)
- Stephanie K Napolitano
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Nicole L Boswell
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Patricia Froese
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rebecca D Henkel
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Maria E Barnes-Davis
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Danielle K Parham
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
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Massare BA, Irvin CN, Hicks SD. Increased Sleep Latency and Decreased Sleep Duration are Associated With Elevated Risk of Bed Sharing Among Mother-Infant Dyads. Clin Pediatr (Phila) 2024; 63:708-713. [PMID: 37488931 PMCID: PMC11070114 DOI: 10.1177/00099228231188211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Bed sharing increases risk of sleep-related infant deaths. We hypothesized that infant sleep difficulties increase bed sharing, independent of social determinants of health (SDOH). In total, 191 mother-infant dyads in a prospective, longitudinal cohort study completed the Brief Infant Sleep Questionnaire at 1, 4, 6, and 12 months. Sleep characteristics at 1 month (latency, duration, night awakenings) were compared between dyads with/without bed sharing in the first 12 months. Infants who participated in bed sharing slept fewer hours at night (7.1 ± 1.7 hours vs 8.3 ± 1.5 hours, P = .001, d = -0.79), and took longer to fall asleep (0.7 ± 0.6 hours vs 0.5 ± 0.5 hours, P = .021, d = 0.43), even when controlling for SDOH variables that influence bed sharing. Maternal perception of sleep problems did not differ between groups (P = .12). Our findings suggest that infants with quantifiable sleep difficulties at 1 month are more likely to bed share.
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Affiliation(s)
- Brittany A. Massare
- Department of Pediatrics, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Christine N. Irvin
- Department of Pediatrics, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Steven D. Hicks
- Department of Pediatrics, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Rodrigues L, De Souza AV, Del Risco Sánchez O, Carmona EV. Knowledge, attitudes and practice on sudden infant death: study protocol of a scoping review. BMJ Open 2024; 14:e080107. [PMID: 38802277 PMCID: PMC11131110 DOI: 10.1136/bmjopen-2023-080107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Sudden infant death syndrome (SIDS) is the unexpected death of an infant less than 1 year old, which occurs without presentation of any signs of mortality risk and it is not explained even after investigation, necropsy and review of the site of death. The nurse is an essential healthcare professional working with children and families who can contribute to preventing avoidable deaths of infants. Because SIDS is preventable, permanent education of the healthcare team, family members and infant caregivers is necessary. OBJECTIVE To explore the scientific literature about knowledge, attitudes and practice on SIDS. METHODS AND ANALYSIS A scoping review will be conducted. Quantitative or qualitative primary studies, theses, dissertations and technical and governmental documents in English, Spanish, French or Portuguese will be considered, without a time limit for selection with search, in the databases: Pubmed, Embase, Scopus, Virtual Health Library, Digital Library of Theses and Dissertations of the Brazilian Institute and Cochrane. A search strategy will be elaborated with the keywords in the following themes: knowledge, attitudes, practice, sudden infant death and healthcare. The eligibility criteria will be applied to references of selected articles to identify new studies. The studies selected will be subjected to thematic content analysis, which allows data interpretation through a systematic classification process for coding themes to the analysis of quantitative and qualitative studies and meta-aggregation. NVIVO V.14 software will be used to organise, code and validate the data. ETHICS AND DISSEMINATION Ethics approval is not required. The results will be disseminated to the health science community through professional networks, conference presentations and publication in a scientific journal.
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Affiliation(s)
- Larissa Rodrigues
- Obstetrics & Gynecology, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Brazil
| | | | - Odette Del Risco Sánchez
- Obstetrics & Gynecology, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Brazil
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Kim TH, Lee H, Woo S, Lee H, Park J, Fond G, Boyer L, Hahn JW, Kang J, Yon DK. Prenatal and postnatal factors associated with sudden infant death syndrome: an umbrella review of meta-analyses. World J Pediatr 2024; 20:451-460. [PMID: 38684567 DOI: 10.1007/s12519-024-00806-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/11/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Comprehensive quantitative evidence on the risk and protective factors for sudden infant death syndrome (SIDS) effects is lacking. We investigated the risk and protective factors related to SIDS. METHODS We conducted an umbrella review of meta-analyses of observational and interventional studies assessing SIDS-related factors. PubMed/MEDLINE, Embase, EBSCO, and Google Scholar were searched from inception until January 18, 2023. Data extraction, quality assessment, and certainty of evidence were assessed by using A Measurement Tool Assessment Systematic Reviews 2 following PRISMA guidelines. According to observational evidence, credibility was graded and classified by class and quality of evidence (CE; convincing, highly suggestive, suggestive, weak, or not significant). Our study protocol was registered with PROSPERO (CRD42023458696). The risk and protective factors related to SIDS are presented as equivalent odds ratios (eORs). RESULTS We identified eight original meta-analyses, including 152 original articles, covering 12 unique risk and protective factors for SIDS across 21 countries/regions and five continents. Several risk factors, including prenatal drug exposure [eOR = 7.84 (95% CI = 4.81-12.79), CE = highly suggestive], prenatal opioid exposure [9.55 (95% CI = 4.87-18.72), CE = suggestive], prenatal methadone exposure [9.52 (95% CI = 3.34-27.10), CE = weak], prenatal cocaine exposure [4.38 (95% CI = 1.95-9.86), CE = weak], prenatal maternal smoking [2.25 (95% CI = 1.95-2.60), CE = highly suggestive], postnatal maternal smoking [1.97 (95% CI = 1.75-2.22), CE = weak], bed sharing [2.89 (95% CI = 1.81-4.60), CE = weak], and infants found with heads covered by bedclothes after last sleep [11.01 (95% CI = 5.40-22.45), CE = suggestive], were identified. On the other hand, three protective factors, namely, breastfeeding [0.57 (95% CI = 0.39-0.83), CE = non-significant], supine sleeping position [0.48 (95% CI = 0.37-0.63), CE = suggestive], and pacifier use [0.44 (95% CI = 0.30-0.65), CE = weak], were also identified. CONCLUSIONS Based on the evidence, we propose several risk and protective factors for SIDS. This study suggests the need for further studies on SIDS-related factors supported by weak credibility, no association, or a lack of adequate research.
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Affiliation(s)
- Tae Hyeon Kim
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyeri Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Selin Woo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hayeon Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Jaeyu Park
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Guillaume Fond
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Jong Woo Hahn
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jiseung Kang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 149 13th Street, Room 4140, Charlestown, Boston, MA, USA.
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.
| | - Dong Keon Yon
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea.
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea.
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea.
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11
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Bartick M. Losing Women, Losing Breastfeeding: A Crisis of Words. Breastfeed Med 2024; 19:313-315. [PMID: 38606817 DOI: 10.1089/bfm.2024.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Affiliation(s)
- Melissa Bartick
- -Melissa Bartick, MD, MS, MPH, Mount Auburn Hospital/Beth Israel Lahey Health
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12
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Gutman CE, Scott PA, Morad A, Barker B, Scott TA. Safe to Sleep in Tennessee: A Statewide Quality Improvement Initiative. Am J Perinatol 2024; 41:e1747-e1755. [PMID: 37168012 DOI: 10.1055/s-0043-1768705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Sleep-related deaths were the fourth leading cause of infant death in Tennessee between 2014 and 2018. In response, the Tennessee Initiative for Perinatal Quality Care developed a statewide quality improvement project, which focused on the demonstration and enforcement of a safe sleep environment in participating birthing hospitals to help families learn and practice the same at home. The project's aim was to improve the percent of infants audited for safe sleep practices (0-12 mo of age, cared for in participating newborn nurseries or neonatal intensive care units) that were compliant with the practices recommended by the 2016 American Academy of Pediatrics (AAP) Task Force on Sudden Infant Death Syndrome. STUDY DESIGN Participating teams were required to develop and implement safe sleep policies in compliance with the AAP recommendations, provide safe sleep education to staff and families, and complete monthly safe sleep audits. A tool was provided to assess whether each audited infant was compliant with safe sleep recommendations and any reason(s) the infant was not compliant. Teams met virtually for monthly huddles and semiannual learning sessions to discuss the development and testing of change ideas. RESULTS The project teams were able to improve the percent of infants audited that were compliant with safe sleep recommendations by 22% over the course of the project. Audits revealed the main reasons for noncompliance were additional objects in the crib (49%, 329/671), unsafe bedding (27%, 181/671), and head of bed elevation (24%, 164/671). CONCLUSION This project demonstrates the positive impact that a statewide quality improvement initiative can have on identifying and addressing barriers, sharing resources and education, and monitoring local and statewide data, which led to increased compliance with safe sleep recommendations in the hospital. Safe sleep education and monitoring should be ongoing as new parents and staff always need to be educated on safe sleep principles. KEY POINTS · In 2020, 25% of all infant deaths in Tennessee were due to an unsafe sleep environment.. · Sleep-related deaths in infants are frequently preventable.. · State quality improvement projects are effective in increasing safe sleep compliance.. · State perinatal quality collaboratives can partner with their State Department of Health, local hospitals, and providers, to increase awareness, educate parents, and model a safe sleep environment..
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Affiliation(s)
- Courtney E Gutman
- Division of Neonatology, Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, Tennessee
- Tennessee Initiative for Perinatal Quality Care, Nashville, Tennessee
| | - Patricia A Scott
- Tennessee Initiative for Perinatal Quality Care, Nashville, Tennessee
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Anna Morad
- Division of Academic General Pediatrics, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brenda Barker
- Tennessee Initiative for Perinatal Quality Care, Nashville, Tennessee
- Division of Academic General Pediatrics, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Theresa A Scott
- Tennessee Initiative for Perinatal Quality Care, Nashville, Tennessee
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Himemiya-Hakucho A, Taketani A, Nakagawa A, Sakai H, Shigemoto A, Takase I. Practices and Awareness Regarding an Infant's Sleep Environment among Japanese Caregivers: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:471. [PMID: 38673381 PMCID: PMC11050700 DOI: 10.3390/ijerph21040471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Preventing sudden, unexpected infant death related to sleep, especially suffocation and sudden infant death syndrome, remains challenging globally. To evaluate factors associated with an unsafe sleep environment (SE) for infants in Japan, this cross-sectional study investigated the current status of practices and awareness among caregivers about a safe SE. Two hundred and fifty-four caregivers of infants in Yamaguchi Prefecture participated. Among the caregivers, 96.0% could not thoroughly practice a safe SE, although 65.0% had knowledge about a safe SE. More unsafe SE practices were significantly associated with 8- to 11-month-old infants than with 0- to 3-month-old infants, using the same practice as for an older child than with accessing information or a familiar person than with mass media as the most useful source of information. The differences in having knowledge were not associated with their practice. Many caregivers obtained information about an infant's SE from mass media and a familiar person. They preferred education via a face-to-face method by medical experts to raise awareness about a safe SE. Thus, efforts need to be developed in Japan in which experts who directly attend to caregivers can truly educate them to ensure that caregivers are continuously aware of the importance of an SE.
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Affiliation(s)
- Ayako Himemiya-Hakucho
- Department of Legal Medicine, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan; (A.N.); (H.S.); (A.S.); (I.T.)
| | - Ayumi Taketani
- Undergraduate Courses of Medicine, Faculty of Medicine and Health Sciences, Yamaguchi University, Yamaguchi 755-8505, Japan;
| | - Aoi Nakagawa
- Department of Legal Medicine, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan; (A.N.); (H.S.); (A.S.); (I.T.)
| | - Hiroki Sakai
- Department of Legal Medicine, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan; (A.N.); (H.S.); (A.S.); (I.T.)
| | - Azumi Shigemoto
- Department of Legal Medicine, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan; (A.N.); (H.S.); (A.S.); (I.T.)
| | - Izumi Takase
- Department of Legal Medicine, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan; (A.N.); (H.S.); (A.S.); (I.T.)
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14
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Moon RY, Mindell JA, Honaker S, Keim S, Roberts KJ, McAdams RJ, McKenzie LB. The Tension Between AAP Safe Sleep Guidelines and Infant Sleep. Pediatrics 2024; 153:e2023064675. [PMID: 38529562 DOI: 10.1542/peds.2023-064675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVES To understand tension mothers experience when attempting to follow American Academy of Pediatrics safe sleep guidelines and enhancing infant and parental sleep. METHODS Surveys and focus groups were conducted from November 2022 and March 2023 with United States-based English-speaking mothers of infants <6 months of age recruited via social media and who reported a nonrecommended sleep position and/or location ≥2 times the prior week. RESULTS Twenty-five mothers participated in focus groups and surveys. A total of 80% reported holding or rocking their infant to sleep; 76% fed their infant to sleep. Almost all were aware of the ABCs (Alone, Back, Crib) of safe sleep and intended to follow them before delivery. Many felt that ABCs were unrealistic and placed their infants in nonrecommended locations or positions because they perceived them as more comfortable and helping their infant fall and stay asleep. Mothers were more likely to use nonrecommended practices when they were awake or sleeping nearby and believed they could closely monitor their infant. Some questioned whether ABCs were the only way to achieve safe sleep. Some prioritized other safety concerns (eg, fall prevention) over sudden infant death syndrome or sudden unexpected infant death prevention. Mothers expressed confidence about getting their baby to sleep in general but were less confident that they could do this while following guidelines. CONCLUSIONS Despite awareness of the ABCs, mothers regularly engaged in nonrecommended practices with the goal of improving their own and their infant's sleep. Interventions focused on improving infant and parental sleep while maintaining sleep safety are needed.
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Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Jodi A Mindell
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Psychology, Saint Joseph's University, Philadelphia, Pennsylvania
| | - Sarah Honaker
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sarah Keim
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Kristin J Roberts
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Rebecca J McAdams
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Lara B McKenzie
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
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15
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Olson M, Toffoli S, Vander Wyst KB, Zhou F, Reifsnider E, Petrov ME, Whisner CM. Associations of Infant Feeding, Sleep, and Weight Gain with the Toddler Gut Microbiome. Microorganisms 2024; 12:549. [PMID: 38543600 PMCID: PMC10972346 DOI: 10.3390/microorganisms12030549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/02/2024] [Accepted: 03/08/2024] [Indexed: 05/05/2024] Open
Abstract
This study examines how feeding, sleep, and growth during infancy impact the gut microbiome (GM) in toddlers. The research was conducted on toddlers (n = 36), born to Latina women of low-income with obesity. Their mothers completed retrospective feeding and sleeping questionnaires at 1, 6, and 12 months; at 36 months, fecal samples were collected. Sequencing of the 16S rRNA gene (V4 region) revealed that breastfeeding for at least 1 month and the introduction of solids before 6 months differentiated the GM in toddlerhood (Bray-Curtis, pseudo-F = 1.805, p = 0.018, and pseudo-F = 1.651, p = 0.044, respectively). Sleep had an effect across time; at 1 and 6 months of age, a lower proportion of nighttime sleep (relative to 24 h total sleep) was associated with a richer GM at three years of age (Shannon H = 4.395, p = 0.036 and OTU H = 5.559, p = 0.018, respectively). Toddlers experiencing rapid weight gain from birth to 6 months had lower phylogenetic diversity (Faith PD H = 3.633, p = 0.057). These findings suggest that early life nutrition, sleeping patterns, and growth rate in infancy may influence the GM composition. Further verification of these results with objective sleep data and a larger sample is needed.
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Affiliation(s)
- Magdalena Olson
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; (M.O.); (S.T.); (K.B.V.W.); (F.Z.)
- Center for Health Through Microbiomes, The Biodesign Institute, Arizona State University, Tempe, AZ 85281, USA
| | - Samantha Toffoli
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; (M.O.); (S.T.); (K.B.V.W.); (F.Z.)
| | - Kiley B. Vander Wyst
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; (M.O.); (S.T.); (K.B.V.W.); (F.Z.)
| | - Fang Zhou
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; (M.O.); (S.T.); (K.B.V.W.); (F.Z.)
| | - Elizabeth Reifsnider
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA; (E.R.); (M.E.P.)
| | - Megan E. Petrov
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA; (E.R.); (M.E.P.)
| | - Corrie M. Whisner
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; (M.O.); (S.T.); (K.B.V.W.); (F.Z.)
- Center for Health Through Microbiomes, The Biodesign Institute, Arizona State University, Tempe, AZ 85281, USA
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16
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Beth Howard M, Parrish BT, Singletary J, Jarvis L. Infant Safe Sleep in the District of Columbia: Better for Both. Health Promot Pract 2024; 25:196-203. [PMID: 36367280 DOI: 10.1177/15248399221131834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Sudden unexpected infant death (SUID) rates within the District of Columbia (DC) vary, with rates 3 times higher in certain geographical areas than the cumulative rate in DC and 7 times higher than the national rate. The majority SUIDs are due to unsafe sleep practices. Although safe sleep education and resources are available in these areas, the high sleep-related infant mortality suggests unmet barriers to infant safe sleep. We sought to investigate potential contributions to local infant mortality through focus groups regarding infant sleep practices among DC caregivers. In this qualitative study, caregivers were probed regarding barriers and facilitators of infant sleep practices. Data were collected until thematic saturation was reached, then coded. Themes were developed and revised in an iterative manner. Fifteen caregivers participated in three focus groups. Themes included sources of infant sleep knowledge, challenges for infant sleep, and motivators for infant sleep choice. All caregivers reported knowledge of safe sleep practices. Infant sleep practices varied, and included unsafe practices such as bed sharing, co-sleeping, and use of swings or bouncers for infant sleep. Challenges of adhering to safe sleep practices included infant needs, competing family demands, the overwhelming nature of newborn sleep, threats, and conflicting information. Motivators for infant sleep practices included better sleep, convenience, safety, tradition, and needs of the infant and caregiver. Although caregivers report knowledge of safe sleep recommendations, actual infant sleep practices vary and include unsafe sleep practices. More focused interventions are needed to address this gap between safe sleep knowledge and practice.
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Affiliation(s)
| | | | | | - Lenore Jarvis
- Children's National Hospital, Washington, DC, USA
- The George Washington University, Washington, DC, USA
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17
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Erck Lambert AB, Shapiro-Mendoza CK, Parks SE, Cottengim C, Faulkner M, Hauck FR. Characteristics of Sudden Unexpected Infant Deaths on Shared and Nonshared Sleep Surfaces. Pediatrics 2024; 153:e2023061984. [PMID: 38374785 PMCID: PMC11117443 DOI: 10.1542/peds.2023-061984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Describe characteristics of sudden unexpected infant deaths (SUID) occurring on shared or nonshared sleep surfaces. METHODS We examined SUID among residents of 23 US jurisdictions who died during 2011 to 2020. We calculated frequencies and percentages of demographic, sleep environment, and other characteristics by sleep surface sharing status and reported differences of at least 5% between surface sharing and nonsharing infants. RESULTS Of 7595 SUID cases, 59.5% were sleep surface sharing when they died. Compared with nonsharing infants, sharing infants were more often aged 0 to 3 months, non-Hispanic Black, publicly insured, found supine, found in an adult bed or chair/couch, had a higher number of unsafe sleep factors present, were exposed to maternal cigarette smoking prenatally, were supervised by a parent at the time of death, or had a supervisor who was impaired by drugs or alcohol at the time of death. At least 76% of all SUID had multiple unsafe sleep factors present. Among surface-sharing SUID, most were sharing with adults only (68.2%), in an adult bed (75.9%), and with 1 other person (51.6%). Surface sharing was more common among multiples than singletons. CONCLUSIONS Among SUID, surface sharing and nonsharing infants varied by age at death, race and ethnicity, insurance type, presence of unsafe sleep factors, prenatal smoke exposure, and supervisor impairment. Most SUID, regardless of sleep location, had multiple unsafe sleep factors present, demonstrating the need for comprehensive safe sleep counseling for every family at every encounter.
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Affiliation(s)
- Alexa B. Erck Lambert
- Centers for Disease Control and Prevention, Division of
Reproductive Health, Atlanta, Georgia
- DB Consulting Group, Inc., Silver Springs, Maryland
| | | | - Sharyn E. Parks
- Centers for Disease Control and Prevention, Division of
Reproductive Health, Atlanta, Georgia
| | - Carri Cottengim
- Centers for Disease Control and Prevention, Division of
Reproductive Health, Atlanta, Georgia
| | - Meghan Faulkner
- Michigan Public Health Institute, Center for National
Prevention Initiatives, Okemos, Michigan
| | - Fern R. Hauck
- Unversity of Virginia, Department of Family Medicine,
Charlottesville, Virginia
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18
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Nath A. Brainstem Encephalitis as a Cause of Sudden Infant Death Syndrome. JAMA Neurol 2024; 81:231-232. [PMID: 38285466 DOI: 10.1001/jamaneurol.2023.5384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- Avindra Nath
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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19
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Cummings KJ, Leiter JC, Trachtenberg FL, Okaty BW, Darnall RA, Haas EA, Harper RM, Nattie EE, Krous HF, Mena OJ, Richerson GB, Dymecki SM, Kinney HC, Haynes RL. Altered 5-HT2A/C receptor binding in the medulla oblongata in the sudden infant death syndrome (SIDS): Part II. Age-associated alterations in serotonin receptor binding profiles within medullary nuclei supporting cardiorespiratory homeostasis. J Neuropathol Exp Neurol 2024; 83:144-160. [PMID: 38323418 PMCID: PMC10880067 DOI: 10.1093/jnen/nlae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
The failure of chemoreflexes, arousal, and/or autoresuscitation to asphyxia may underlie some sudden infant death syndrome (SIDS) cases. In Part I, we showed that some SIDS infants had altered 5-hydroxytryptamine (5-HT)2A/C receptor binding in medullary nuclei supporting chemoreflexes, arousal, and autoresuscitation. Here, using the same dataset, we tested the hypotheses that the prevalence of low 5-HT1A and/or 5-HT2A/C receptor binding (defined as levels below the 95% confidence interval of controls-a new approach), and the percentages of nuclei affected are greater in SIDS versus controls, and that the distribution of low binding varied with age of death. The prevalence and percentage of nuclei with low 5-HT1A and 5-HT2A/C binding in SIDS were twice that of controls. The percentage of nuclei with low 5-HT2A/C binding was greater in older SIDS infants. In >80% of older SIDS infants, low 5-HT2A/C binding characterized the hypoglossal nucleus, vagal dorsal nucleus, nucleus of solitary tract, and nuclei of the olivocerebellar subnetwork (important for blood pressure regulation). Together, our findings from SIDS infants and from animal models of serotonergic dysfunction suggest that some SIDS cases represent a serotonopathy. We present new hypotheses, yet to be tested, about how defects within serotonergic subnetworks may lead to SIDS.
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Affiliation(s)
- Kevin J Cummings
- Department of Biomedical Sciences, Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri, USA
| | - James C Leiter
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | - Benjamin W Okaty
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert A Darnall
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Elisabeth A Haas
- Department of Research, Rady’s Children’s Hospital, San Diego, California, USA
| | - Ronald M Harper
- Department of Neurobiology and the Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Eugene E Nattie
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Henry F Krous
- Department of Pediatrics, University of California San Diego, San Diego, California, USA
- Departments of Pathology and Pediatrics, Rady Children’s Hospital, San Diego, California, USA
| | - Othon J Mena
- San Diego County Medical Examiner Office, San Diego, California, USA
| | - George B Richerson
- Departments of Neurology and Molecular Physiology & Biophysics, University of Iowa, Iowa City, Iowa, USA
| | - Susan M Dymecki
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
| | - Hannah C Kinney
- Department of Pathology, CJ Murphy Laboratory for SIDS Research, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robin L Haynes
- Department of Pathology, CJ Murphy Laboratory for SIDS Research, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
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20
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Gould L, Reid CA, Rodriguez AJ, Devinsky O. Video Analyses of Sudden Unexplained Deaths in Toddlers. Neurology 2024; 102:e208038. [PMID: 38175965 PMCID: PMC11097764 DOI: 10.1212/wnl.0000000000208038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES More than 2,900 US children aged younger than 4 years die from unknown causes each year, accounting for more than 219,000 life years lost annually. They are mostly sleep-related and unwitnessed with unremarkable autopsies, limiting our understanding of death mechanisms. We sought to understand potential mechanisms of death by evaluating videos of sudden deaths in toddlers. METHODS In our registry of 301 sudden unexplained child deaths, a series of 7 consecutively enrolled cases with home video recordings of the child's last sleep period were independently assessed by 8 physicians for video quality, movement, and sound. RESULTS Four boys and 3 girls (13-27 months at death) with terminal videos shared similar demographic features to the 293 other registry cases without video recordings. Five video recordings were continuous and 2 were triggered by sound or motion. Two lacked audio. All continuous recordings included a terminal convulsive event lasting 8-50 seconds; 4 children survived for >2.5 minutes postconvulsion. Among discontinuous videos, time lapses limited review; 1 suggested a convulsive event. Six were prone with face down, and 1 had autopsy evidence of airway obstruction. Primary cardiac arrhythmias were not supported; all 7 children had normal cardiac pathology and whole-exome sequencing identified no known cardiac disease variants. DISCUSSION Audio-visual recordings in 7 toddlers with unexplained sudden deaths strongly implicate that deaths were related to convulsive seizures, suggesting that many unexplained sleep-related deaths may result from seizures.
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Affiliation(s)
- Laura Gould
- From the NYU Grossman School of Medicine (L.G., C.-A.R., A.J.R., O.D.), and NYU Comprehensive Epilepsy Center (L.G., C.-A.R., A.J.R., O.D.), New York
| | - Codi-Ann Reid
- From the NYU Grossman School of Medicine (L.G., C.-A.R., A.J.R., O.D.), and NYU Comprehensive Epilepsy Center (L.G., C.-A.R., A.J.R., O.D.), New York
| | - Alcibiades J Rodriguez
- From the NYU Grossman School of Medicine (L.G., C.-A.R., A.J.R., O.D.), and NYU Comprehensive Epilepsy Center (L.G., C.-A.R., A.J.R., O.D.), New York
| | - Orrin Devinsky
- From the NYU Grossman School of Medicine (L.G., C.-A.R., A.J.R., O.D.), and NYU Comprehensive Epilepsy Center (L.G., C.-A.R., A.J.R., O.D.), New York
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21
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Hayashi Y, Tachiki C, Morikawa T, Aihara Y, Matsunaga S, Sugahara K, Watanabe A, Kawamata T, Nishii Y. Three-Dimensional Analysis of the Cranial Base Structure in Patients with Facial Asymmetry. Diagnostics (Basel) 2023; 14:24. [PMID: 38201333 PMCID: PMC10795710 DOI: 10.3390/diagnostics14010024] [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: 11/14/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Facial asymmetry is often seen in patients with skeletal mandibular prognathism and is associated with deformities in the maxillofacial and head regions. The maxillofacial deviation is three-dimensional and affects not only the lateral deviation of the mandible and midface, but also the cranium. This study conducted a three-dimensional morphological evaluation of the cranial base morphology of patients with skeletal mandibular prognathism (ANB < 0°, Wits < 0 mm) with the aim of examining the relationship between deformities of the head region and facial asymmetry. Data obtained from computed tomography conducted during the initial examination of patients with and without skeletal mandibular prognathism with facial asymmetry were used. Differences in the position of structures present in the cranial base were measured, and the association between cranial deformities and mandibular deviation was assessed. The middle cranial base area and the lateral deviation of the mandibular fossa were significantly larger in patients with facial asymmetry compared to those without facial asymmetry. In addition, a correlation between the amount of mandibular deviation and the area of the anterior cranial base was identified in patients with significant cranial deformity (p = 0.012). Given the identified association between the structure of the head region and facial asymmetry, further studies are needed to determine the factors implicated in the growth process.
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Affiliation(s)
- Yuki Hayashi
- Department of Orthodontics, Tokyo Dental College, 2-9-18 Chiyoda-Ku, Tokyo 101-0061, Japan; (Y.H.); (T.M.); (Y.N.)
| | - Chie Tachiki
- Department of Orthodontics, Tokyo Dental College, 2-9-18 Chiyoda-Ku, Tokyo 101-0061, Japan; (Y.H.); (T.M.); (Y.N.)
| | - Taiki Morikawa
- Department of Orthodontics, Tokyo Dental College, 2-9-18 Chiyoda-Ku, Tokyo 101-0061, Japan; (Y.H.); (T.M.); (Y.N.)
| | - Yasuo Aihara
- Department of Neurosurgery, Tokyo Women’s Medical University, 8-1 Shinjuku-Ku, Tokyo 162-8666, Japan; (Y.A.); (T.K.)
| | - Satoru Matsunaga
- Department of Anatomy, Tokyo Dental College, 2-9-18 Chiyoda-Ku, Tokyo 101-0061, Japan;
| | - Keisuke Sugahara
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Chiyoda-Ku, Tokyo 101-0061, Japan;
| | - Akira Watanabe
- Department of Oral & Maxillofacial Surgery, Tokyo Dental College, 2-9-18 Chiyoda-Ku, Tokyo 101-0061, Japan;
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women’s Medical University, 8-1 Shinjuku-Ku, Tokyo 162-8666, Japan; (Y.A.); (T.K.)
| | - Yasushi Nishii
- Department of Orthodontics, Tokyo Dental College, 2-9-18 Chiyoda-Ku, Tokyo 101-0061, Japan; (Y.H.); (T.M.); (Y.N.)
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22
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Mahar TJ, Keyes K, Ely SF, Dennison EH, Gill JR. Assessing Neglect in Pediatric Environmental Deaths: A Survey of Manner of Death Determinations. Am J Forensic Med Pathol 2023; 44:251-257. [PMID: 37728903 DOI: 10.1097/paf.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
ABSTRACT There are 4 common types of environmental pediatric deaths that may involve various degrees of neglect: hyperthermia, ingestion, drownings, and unsafe infant sleep practices. Because the circumstances surrounding each are disparate, there is no set of standards by which these factors may be weighed and interpreted. Given the same facts, the manner of death certification may differ depending upon training/experience and/or local practice.To assess certification variations, 147 board-certified forensic pathologists were surveyed for the choice of manner in scenarios with different degrees of negligence intent. In addition to evaluating certification consistency, the survey examined whether certain factors affected the choice. The results demonstrated strong consistency in certain scenarios and widely disparate certifications in others.Medical examiner/coroner certifications are administrative decisions for vital statistical purposes. The manner of death reflects an evidence-based conclusion, but because it is ultimately an opinion, determinations may vary. Based on the survey, some certification criteria were identified (ie, intent, child age, and knowingly placing a child in an environment with a reasonable risk of harm). Using these criteria may improve consistency, but it is unreasonable to expect 100% concordance. Understanding the certificate's role helps to place the manner in the proper legal and public health contexts.
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Affiliation(s)
- Tara J Mahar
- From the Erie County Medical Examiner's Office, Buffalo, NY
| | - Kelly Keyes
- Investigations Program, RTI International, Center for Forensic Science Advancement and Application, Raleigh, NC
| | - Susan F Ely
- New York City Office of Chief Medical Examiner, New York, NY
| | | | - James R Gill
- Connecticut Office of the Chief Medical Examiner, Farmington, CT
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23
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Ahlers-Schmidt CR, Okut H, Jacobson LT, Hervey A, Schunn C, Torres M, Kuhlmann Z. Characteristics Associated with Sudden Unexpected Infant Death in a Rural Hispanic Population: A Case-Control Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01854-5. [PMID: 37947954 DOI: 10.1007/s40615-023-01854-5] [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: 09/25/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Sudden unexpected infant death (SUID) is the leading cause of death among U.S. infants aged 28 days to 1 year. In Kansas, Hispanic infant mortality is nearly 50% higher than non-Hispanic White. Further, the SUID rate did not change between 2005-2018, while rates for non-Hispanic Black and White infants decreased significantly. This study sought to identify characteristics and behaviors of Hispanic birthing persons related to SUID. METHODS Linked Kansas birth/death vital statistics data (2005-2018) identified Hispanic birthing persons with a singleton birth who experienced SUID. To reduce confounding effects, greedy nearest neighbor matching paired each SUID case sequentially with the four nearest controls based on age, race, payor source and parity. Matching procedures, likelihood-ratio χ2, Fisher exact test and multiple logistic regression model with Firth's penalized maximum likelihood estimation were computed. RESULTS Of 86,052 Hispanic singleton births, 66 involved SUID and were matched with 264 controls. No differences were related to marital status, population density of residence, education level, language spoken, prenatal BMI, weight gained during pregnancy, adequacy of prenatal care, enrollment in WIC, or state immunization registry participation (all p>0.05). However, tobacco use during pregnancy contributed to a three times greater risk of SUID (OR=3.208; 95% CI=1.438 to 7.154). Multivariable models for behavioral variables revealed low predictive accuracy with area under the ROC curve=0.6303. CONCLUSION This study suggests SUID deaths to rural Hispanic families are likely multifaceted. Study results inform educational programs on the importance of addressing tobacco cessation in SUID risk reduction interventions for Hispanic families.
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Affiliation(s)
- Carolyn R Ahlers-Schmidt
- Center for Research for Infant Birth and Survival, University of Kansas School of Medicine-Wichita, 3243 E. Murdock, Suite 604, Wichita, KS, 67208, USA.
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, 3243 E. Murdock, Suite 604, Wichita, KS, 67208, USA.
| | - Hayrettin Okut
- Office of Research, University of Kansas School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS, 67214, USA
| | - Lisette T Jacobson
- Department of Population Health, University of Kansas School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS, 67214, USA
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS, 67214, USA
| | - Ashley Hervey
- Center for Research for Infant Birth and Survival, University of Kansas School of Medicine-Wichita, 3243 E. Murdock, Suite 604, Wichita, KS, 67208, USA
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, 3243 E. Murdock, Suite 604, Wichita, KS, 67208, USA
| | - Christy Schunn
- Kansas Infant Death and SIDS (KIDS) Network, 300 W. Douglas, Suite 145, Wichita, KS, 67202, USA
| | - Maria Torres
- Kansas Infant Death and SIDS (KIDS) Network, 300 W. Douglas, Suite 145, Wichita, KS, 67202, USA
| | - Zachary Kuhlmann
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS, 67214, USA
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Lazzeri J, Giordano NA, Christ L, Polomano RC, Stringer M. Hats Off for Full-Term Healthy Newborns: No Benefits for Thermoregulation. J Perinat Neonatal Nurs 2023; 37:340-347. [PMID: 37773332 DOI: 10.1097/jpn.0000000000000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND Hyperthermia is a known risk for sudden unexpected infant death. The practice of hat placement at birth to prevent transient hypothermia may not be necessary and sets an early standard for clothing infants that may lead to hyperthermia postnatally. OBJECTIVE To examine the elimination of hats on thermoregulation (eg, hypothermia, <97.6°F) in full-term newborns with no abnormalities within 24 hours of birth. METHODS In 2018, an institution guideline discontinued the use of hats at birth. Subsequently, newborn body temperatures were respectively extracted from electronic health records and data were compared from 482 infants (>38 weeks' gestation and newborn birth weight >2500 g) prior to ( n = 257) and following ( n = 225) the practice change. Body temperatures prior to and after the practice change to eliminate hats use were compared. RESULTS No statistically significant difference was observed: (1) in the proportion of infants experiencing hypothermia with or without hat use, respectively, 23.7% compared with 31.1% ( P = .09) and (2) in the odds of an infant experiencing hypothermia when adjusting for relevant covariates (odds ratio = 1.44; 95% confidence interval 0.89-2.32; P = .14). CONCLUSIONS Our findings demonstrate that the use of hats on infants at birth had no measurable impact on newborn thermoregulation.
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Affiliation(s)
- Jessica Lazzeri
- Hospital of the University of Pennsylvania, Philadelphia (Ms Lazzeri and Drs Christ and Stringer); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr Giordano); Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Christ); and School of Nursing (Drs Polomano and Stringer) and Perelman School of Medicine (Drs Polomano and Stringer), University of Pennsylvania, Philadelphia
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Nazaruk D, Palacios AM, Chopak-Foss J, Mayo-Gamble TL, Marshall NA. Parental Knowledge and Perceptions on Prevention of Sudden Unexpected Infant Death and Infant Care. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1550. [PMID: 37761510 PMCID: PMC10529227 DOI: 10.3390/children10091550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
(1) Background: The study's purpose was to explore the knowledge, perceptions, and confidence of mothers about infant care to reduce the risk of sudden unexpected infant death. (2) Methods: A purposeful sampling method was used to recruit 15 first-time mothers from Georgia with infants under 1 year of age. The researchers utilized the Socio-ecological model to report the results. Participants also provided recommendations on how to improve infant care and reduce the risk of SUID. (3) Results: The confidence level of infant care among most participants was low but increased over time. Mothers' knowledge level about the prevention of SUID was high, but poor emotional health could hurt their parental abilities. Most participants recognized medical providers as the main source of reliable information. However, a lack of emotional and physical support was reported by mothers. (4) Conclusions: Results suggested that a more holistic approach to infant care is needed. The healthcare system and communities should provide more physical, social, and mental support to first-time mothers, a consolidated approach to care before and after birth, and easy access to services at all stages of the process to reduce the risk of SUID.
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Affiliation(s)
- Dziyana Nazaruk
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Sothern University, 11935 Abercorn Street, Savannah, GA 31419, USA
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Cruz AT, Baker JP. Forgotten Pediatrics: 8 Disturbing Windows on the Past. Pediatrics 2023; 152:e2023062806. [PMID: 37609776 DOI: 10.1542/peds.2023-062806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 08/24/2023] Open
Abstract
The 75 years since Pediatrics was first published has witnessed an explosion of the scientific knowledge base informing child health. Yet, the path leading to the present has not been linear. We examine several articles that illustrate some of the unexpected twists and turns that have characterized our specialty's history. We hope that it will provide a reminder of the ever-changing nature of scientific knowledge and the need to continually re-evaluate how our own cultural assumptions shape medical practice.
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Affiliation(s)
- Andrea T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Jeffrey P Baker
- Trent Center for Bioethics, Humanities, and History of Medicine, Duke University, Durham, North Carolina
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Jawed A, Ehrhardt C, Rye M. Handle with Care: A Narrative Review of Infant Safe Sleep Practices across Clinical Guidelines and Social Media to Reduce SIDS. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1365. [PMID: 37628364 PMCID: PMC10453545 DOI: 10.3390/children10081365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023]
Abstract
Sudden Infant Death Syndrome (SIDS) is a leading cause of infant mortality across the United States and the world. There are multiple environmental and behavioral determinants of sudden infant death which are modifiable risk factors and potential targets for intervention. In this increasingly digital era, health education and communication on SIDS have taken many forms, which extend to social media. Current published studies on coverage of infant safe sleep practices are scant and were published well before the newly revised guidelines of the American Academy of Pediatrics that review ways to prevent infant sleep-related deaths based on evidence-based SIDS-reduction measures. In this Perspective: Review of a Pediatric Field, the current state of published knowledge and coverage on a range of infant safe sleep considerations across social media are reviewed. We delineate gaps in the knowledge and practice as well as the central differences between the 2016 and 2022 AAP Safe Sleep guidelines. We also present recommendations for further research and practice which support coverage of future content on the revised guidelines across social media as the basis to present the most up-to-date and evidence-based information for reducing sudden infant death from sleep-related causes. Tapping into the potential of social media as a learning modality in health promotion also contributes towards the larger goal of the World Health Organization, United Nations International Children's Emergency Fund (UNICEF), and Healthy People 2030 to reduce infant mortality on both global and national levels.
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Affiliation(s)
- Aysha Jawed
- Johns Hopkins Children’s Center, Baltimore, MD 21287, USA; (C.E.); (M.R.)
- Department of Pediatric Social Work, Johns Hopkins Children’s Center, Baltimore, MD 21287, USA
| | - Catherine Ehrhardt
- Johns Hopkins Children’s Center, Baltimore, MD 21287, USA; (C.E.); (M.R.)
- Department of Pediatric Nursing, Johns Hopkins Children’s Center, Baltimore, MD 21287, USA
| | - Molly Rye
- Johns Hopkins Children’s Center, Baltimore, MD 21287, USA; (C.E.); (M.R.)
- Department of Pediatric Nursing, Johns Hopkins Children’s Center, Baltimore, MD 21287, USA
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28
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Parker JJ, Simon C, Bendelow A, Bryan M, Smith RA, Kortsmit K, Salvesen von Essen B, Williams L, Dieke A, Warner L, Garfield CF. Fathers, Breastfeeding, and Infant Sleep Practices: Findings From a State-Representative Survey. Pediatrics 2023; 152:e2022061008. [PMID: 37325869 PMCID: PMC10900127 DOI: 10.1542/peds.2022-061008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES To assess infant breastfeeding initiation and any breastfeeding at 8 weeks and safe sleep practices (back sleep position, approved sleep surface, and no soft objects or loose bedding ["soft bedding"]) by select paternal characteristics among a state-representative sample of fathers with new infants. METHODS Pregnancy Risk Assessment Monitoring System (PRAMS) for Dads, a novel population-based cross-sectional study, surveyed fathers in Georgia 2-6 months after their infant's birth. Fathers were eligible if the infant's mother was sampled for maternal PRAMS from October 2018 to July 2019. RESULTS Of 250 respondents, 86.1% reported their infants ever breastfed and 63.4% reported breastfeeding at 8 weeks. Initiation and breastfeeding at 8 weeks were more likely to be reported by fathers who reported wanting their infant's mother to breastfeed than those who did not want her to breastfeed or had no opinion (adjusted prevalence ratio [aPR] = 1.39; 95% confidence interval [CI], 1.15-1.68; aPR = 2.33; 95% CI, 1.59-3.42, respectively) and fathers who were college graduates than those with ≤high school diploma (aPR = 1.25; 95% CI, 1.06-1.46; aPR = 1.44; 95% CI, 1.08-1.91, respectively). Although about four-fifths (81.1%) of fathers reported usually placing their infants to sleep on their back, fewer fathers report avoiding soft bedding (44.1%) or using an approved sleep surface (31.9%). Non-Hispanic Black fathers were less likely to report back sleep position (aPR = 0.70; 95% CI, 0.54-0.90) and no soft bedding (aPR = 0.52; 95% CI, 0.30-0.89) than non-Hispanic white fathers. CONCLUSIONS Fathers reported suboptimal infant breastfeeding rates and safe sleep practices overall and by paternal characteristics, suggesting opportunities to include fathers in promotion of breastfeeding and infant safe sleep.
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Affiliation(s)
- John James Parker
- Family and Child Health Innovations Program, Smith Child Health Outcomes, Research and Evaluation Center
- Departments of Pediatrics
- Medicine, Northwestern University's Feinberg School of Medicine, Chicago, Illinois
| | - Clarissa Simon
- Family and Child Health Innovations Program, Smith Child Health Outcomes, Research and Evaluation Center
| | - Anne Bendelow
- Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Michael Bryan
- Georgia Department of Public Health, Department of Epidemiology, Atlanta, Georgia
| | - Ruben A Smith
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Katherine Kortsmit
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | | | - Letitia Williams
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Ada Dieke
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Lee Warner
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Craig F Garfield
- Family and Child Health Innovations Program, Smith Child Health Outcomes, Research and Evaluation Center
- Departments of Pediatrics
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Loo BKG, Sirisena D, Müller-Riemenschneider F, Chia MYH, Tan B, Tan NC, Teoh OH, Lim EJK, Zainuddin MA, Gao JS, Chan PC, Tan TSZ, Visruthan NK, Rajadurai VS, Chia MS, Ahmad Hatib NAB, Cai S, Ong JL, Lo JCY, Chong MFF, Lee LY, Chew ECS, Siriamornsarp R, Lee M, Sim A, Wong CM, Sherwood SA, Toh SH, Quah PL, Ng KC, Tan KH, Lee YS. Consensus statement on Singapore integrated 24-hour activity guide for early childhood. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:310-320. [PMID: 38904512 DOI: 10.47102/annals-acadmedsg.2022315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Introduction Early childhood is a critical period for growth and development. Adopting healthy lifestyle behaviours during this period forms the foundation for future well-being and offers the best protection against non-communicable diseases. Singapore studies have shown that many young children are not achieving the recommendations on physical activity, sedentary behaviour and sleep. A workgroup was set up to develop recommendations for caregivers of infants, toddlers and preschoolers (aged <7 years) on how to integrate beneficial activities within a daily 24-hour period for optimal development and metabolic health. Method The Grading of Recommendations Assessment, Development and Evaluation (GRADE)- ADOLOPMENT approach was employed for adoption, adaption or de novo development of recommendations. International and national guidelines were used as references, and an update of the literature reviews up to September 2021 was conducted through an electronic search of PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Results Four consensus statements were developed for each age group: infants, toddlers and preschoolers. The statements focus on achieving good metabolic health through regular physical activity, limiting sedentary behaviour, achieving adequate sleep and positive eating habits. The 13th consensus statement recognises that integration of these activities within a 24-hour period can help obtain the best results. Conclusion This set of recommendations guides and encourages caregivers of Singapore infants, toddlers and preschoolers to adopt beneficial lifestyle activities within each 24-hour period.
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Affiliation(s)
- Benny Kai Guo Loo
- Sport & Exercise Medicine Service, KK Women's and Children's Hospital, Singapore
| | - Dinesh Sirisena
- Department of Sports Medicine, Khoo Teck Puat Hospital, Singapore
| | | | - Michael Yong Hwa Chia
- Academic Group of Physical Education & Sports Science, National Institute of Education, Nanyang Technological University, Singapore
| | - Benedict Tan
- Department of Sport & Exercise Medicine, Changi General Hospital, Singapore
| | | | - Oon Hoe Teoh
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Ethel Jie Kai Lim
- Department of Nutrition & Dietetics, KK Women's and Children's Hospital, Singapore
| | | | - Joanne Shumin Gao
- Sport & Exercise Medicine Service, KK Women's and Children's Hospital, Singapore
| | - Poh Chong Chan
- Department of Paediatrics, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore
| | - Teresa Shu Zhen Tan
- Department of Paediatrics, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore
| | | | | | - Moira Suyin Chia
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | | | - Shirong Cai
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Ju Lynn Ong
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - June Chi Yan Lo
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Le Ye Lee
- Department of Neonatology, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore
| | | | | | - Miriam Lee
- Division of Children & Youth Programme Development, Sport Singapore, Singapore
| | - Aaron Sim
- Division of Physical Activity & Weight Management, Health Promotion Board, Singapore
| | - Chui Mae Wong
- Department of Child Development, KK Women's and Children's Hospital, Singapore
| | | | - Siao Hui Toh
- Physiotherapy Department, KK Women's and Children's Hospital, Singapore
| | - Phaik Ling Quah
- Division of Obstetrics & Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Kee Chong Ng
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Yung Seng Lee
- Department of Paediatrics, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore
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Schnell-Peskin LK, Day-Watkins J, Mery JN, Vladescu JC. The influence of video-based training on caregiver arrangement of infant sleeping environments. J Appl Behav Anal 2023. [PMID: 37191463 DOI: 10.1002/jaba.997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/27/2023] [Indexed: 05/17/2023]
Abstract
Recent behavior analytic studies have examined behavioral skills training to teach adults to arrange safe infant sleeping environments. These studies were conducted in an analogue environment and with all training components delivered by an expert staff trainer. The purpose of the current study was to replicate and extend this literature by substituting video-based training for behavioral skills training. We assessed whether expectant caregivers could arrange safe infant sleeping environments following video-based training. The results suggested that video-based training alone resulted in positive outcomes for a portion of participants, whereas a subset of participants required feedback to reach mastery criteria. The social validity data suggest that the participants found the training procedures favorable.
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Affiliation(s)
| | | | - Jacqueline N Mery
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jason C Vladescu
- Department of Applied Behavior Analysis, Caldwell University, Caldwell, NJ, USA
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31
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Paul IM, Shedlock KE, Schaefer EW, Stoute EJ, Rosen R. Pilot Study of Inclined Position and Infant Gastroesophageal Reflux Indicators. JPGN REPORTS 2023; 4:e312. [PMID: 37200720 PMCID: PMC10187856 DOI: 10.1097/pg9.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/18/2023] [Indexed: 05/20/2023]
Abstract
To reduce gastroesophageal reflux, infants are commonly placed in an inclined position. We sought to observe the extent to which infants exhibit (1) oxygen desaturation and bradycardia in supine and inclined positions and (2) signs and symptoms of post-feed regurgitation in these positions. Study Design Healthy infants aged 1-5 months with gastroesophageal reflux disease (GERD) (N = 25) and controls (N = 10) were enrolled into one post-feed observation. Infants were monitored in a prototype reclining device for consecutive 15-minute periods in supine position with head elevations of 0°, 10°, 18°, and 28° in random order. Continuous pulse oximetry assessed hypoxia (O2 saturation <94%) and bradycardia (heart rate <100). Regurgitation episodes and other symptoms were recorded. Mothers assessed comfort using an ordinal scale. Incident rate ratios were estimated using Poisson or negative binomial regression models. Results Among infants with GERD, in each position, most had no episodes of hypoxia, bradycardia, or regurgitation. Overall, 17 (68%) infants had 80 episodes of hypoxia (median 20 seconds duration), 13 (54%) had 33 episodes of bradycardia (median 22 seconds duration), and 15 (60%) had 28 episodes of regurgitation. For all 3 outcomes, incident rate ratios were not significantly different between positions, and no differences were discovered for observed symptoms or infant comfort. Conclusions Brief episodes of hypoxia and bradycardia as well as observed regurgitation are common for infants with GERD placed in the supine position after a feed with no differences in outcomes at various degrees of head elevation. These data may be used to power future, larger, and longer evaluations. ClinicalTrials.gov Identifier: NCT04542239.
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Affiliation(s)
- Ian M. Paul
- From the Pediatrics, Penn State College of Medicine, Hershey, PA
- Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | | | - Eric W. Schaefer
- Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Ellen J. Stoute
- From the Pediatrics, Penn State College of Medicine, Hershey, PA
| | - Rachel Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital, Boston, MA
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Murata Y, Sakakibara H. Neck Hair-Thread Tourniquet Syndrome by Co-sleeping With Family: A Case Report and Literature Review. Cureus 2023; 15:e39620. [PMID: 37256166 PMCID: PMC10226386 DOI: 10.7759/cureus.39620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/01/2023] Open
Abstract
Neck hair-thread tourniquet syndrome (NHTTS) is a rare condition that can be a pediatric emergency, occurring when a hair or thread becomes tightly wrapped around a body part, leading to vascular or tissue damage. NHTTS commonly affects infants and young children and can result in severe complications if not promptly diagnosed and treated. The unusual nature of this event, the diffuse petechial hemorrhage on the face, and the presentation of ligature marks extending around the neck led us to admit the child to the general pediatric ward for follow-up and further investigation of the possibility of non-accidental trauma. Co-sleeping is a common cultural practice in Japan where parents sleep in close proximity to their infants. This case report aims to raise awareness among pediatricians and parents about the possibility of NHTTS occurring in infants who co-sleep, particularly when a strand of hair becomes entangled around their neck, about the early detection and appropriate management of NHTTS. And we also summarize the reported NHTTS cases.
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Affiliation(s)
- Yuki Murata
- Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN
| | - Hiroshi Sakakibara
- Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN
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Poets CF, Paditz E, Erler T, Hübler A, Jückstock J, Quante M, Pauluschke-Fröhlich J, Schlüter B, Hoch B, Kerzel S, Abou-Dakn M, Schneider B, Wiater A. Prävention des plötzlichen Säuglingstods (SIDS, „sudden infant death syndrome“, ICD 10: R95). Monatsschr Kinderheilkd 2023. [DOI: 10.1007/s00112-023-01724-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
ZusammenfassungDieser Beitrag fasst die Datenlage zu den wichtigsten Handlungsanweisungen für Eltern bezüglich der Gewährleistung einer sicheren Schlafumgebung für Säuglinge zusammen. Hierzu gehören folgende: 1. Legen Sie Ihr Kind zum Schlafen auf den Rücken; benutzen Sie dabei eine feste und waagerechte Unterlage. 2. Legen Sie Ihr Kind tagsüber, solange es wach ist und Sie es gut beobachten können, regelmäßig für kurze Zeit auch auf den Bauch. 3. Vermeiden Sie Überwärmung: Während der Nacht ist eine Raumtemperatur von 18 °C optimal, anstelle einer Bettdecke empfiehlt sich die Verwendung eines Baby-Schlafsacks in altersentsprechender Größe. 4. Falls Sie keinen Schlafsack verwenden möchten, achten Sie darauf, dass Ihr Kind nicht mit dem Kopf unter die Bettdecke rutschen kann, indem Sie es so ins Bett legen, dass es mit den Füßen am Fußende anstößt. 6. Verzichten Sie auf Kopfkissen, Fellunterlagen, „Nestchen“, gepolsterte Bettumrandungen und größere Kuscheltiere, mit denen sich Ihr Kind überdecken könnte. 7. Wickeln Sie Ihr Kind zum Schlafen nicht fest ein. 8. lassen Sie Ihr Kind bei sich im Zimmer, aber im eigenen Kinderbett schlafen. 9. Achten Sie auf eine rauchfreie Umgebung für Ihr Kind auch schon während der gesamten Schwangerschaft. 10. Stillen Sie im 1. Lebensjahr, möglichst mindestens 4 bis 6 Monate. 11. Bieten Sie Ihrem Kind zum Schlafengehen einen Schnuller an. 12. Diese Empfehlungen gelten auch für die Zeit unmittelbar nach Geburt: Sollte Ihr Kind auf Ihrem Körper liegen, achten Sie darauf, dass es stets freie Atemwege hat.
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Zimmerman D, Bartick M, Feldman-Winter L, Ball HL. ABM Clinical Protocol #37: Physiological Infant Care-Managing Nighttime Breastfeeding in Young Infants. Breastfeed Med 2023; 18:159-168. [PMID: 36927076 PMCID: PMC10083892 DOI: 10.1089/bfm.2023.29236.abm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
A central goal of the Academy of Breastfeeding Medicine (ABM) is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The ABM empowers health professionals to provide safe, inclusive, patient-centered, and evidence-based care. Pregnant and lactating people identify with a broad spectrum of genders, pronouns, and terms for feeding and parenting. There are two reasons ABM's use of gender-inclusive language may be transitional or inconsistent across protocols. First, gender-inclusive language is nuanced and evolving across languages, cultures, and countries. Second, foundational research has not adequately described the experiences of gender-diverse individuals. Therefore, ABM advocates for, and will strive to use language that is as inclusive and accurate as possible within this framework. For more explanation, please read ABM Position Statements on Infant Feeding and Lactation-Related Language and Gender (https://doi.org/10.1089/bfm.2021.29188.abm) and Breastfeeding As a Basic Human Right (https://doi.org/10.1089/bfm.2022.29216.abm).
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Affiliation(s)
- Deena Zimmerman
- Maternal-Child and Adolescent Division, Public Health Service, Israel Ministry of Health, Jerusalem, Israel
| | - Melissa Bartick
- Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Lori Feldman-Winter
- Department of Pediatrics, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Helen L Ball
- Durham Infancy and Sleep Centre, Department of Anthropology, Durham University, Durham, United Kingdom
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Implementation of safe infant sleep recommendations during night-time sleep in the first year of life in a German birth cohort. Sci Rep 2023; 13:875. [PMID: 36650217 PMCID: PMC9845375 DOI: 10.1038/s41598-023-28008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
The aim of our study was to assess the extent to which families followed recommendations, issued by the German society for sleep medicine, for the prevention of sudden infant death syndrome (SIDS) during night-time sleep. Analyzing longitudinal data from a birth cohort located at the University Children's Hospital Regensburg in Bavaria (Germany), we determined data regarding the infant's sleep location, sleep settings and body position, and exposure to environmental factors. Data were collected in a structured interview after birth and by standardized questionnaires at 4 weeks, 6 months, and 1 year of life, respectively. The majority of 1,400 surveyed infants (94% at 4 weeks) were reported to sleep in the parents' sleeping room during the first months of life. While the most common furniture was a bedside sleeper (used by 48%), we also observed a considerable proportion of families who regularly practiced bed-sharing and, for 16% of infants, the parents' bed was the default sleeping place. 12% of infants were still put regularly in the prone position. The vast majority (87%) of the infants were breastfed at some timepoint and 17% lived in a household with one or more smokers. Although most parents implemented many SIDS recommendations, our analysis illustrates a considerable gap between recommendations and intentions after birth on the one hand and actual implementation in real life on the other. The number-one deviation from the current SIDS guidelines during night-time sleep was bed-sharing with an adult.
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Hughes K, Gill SL, Berndt A. Perceptions and Use of Safe Sleep Baby Boxes at Hospital Discharge by New Mothers. MCN Am J Matern Child Nurs 2023; 48:30-35. [PMID: 36469892 DOI: 10.1097/nmc.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND A large community hospital in South Texas began distributing safe sleep baby boxes to reduce sudden unexplained infant death (SUID) in 2017. PURPOSE To describe safe sleep practices among new mothers who received a safe sleep baby box at hospital discharge. METHODS An information sheet containing a link to an online survey was mailed to all women who received a safe sleep baby box prior to discharge from the hospital from January 2018 to January 2019. RESULTS N = 84 women participated. Most reported using the safe sleep baby box only during nap time (n = 62, 88.6%). Only 70.2% of participants reported that baby always slept their back (n = 59). Most reported their baby did not use a pacifier (n = 62, 73.8%), and many reported they were not breastfeeding their baby (n = 38, 45.2%). CLINICAL IMPLICATIONS Many women were not using the safe sleep baby box as intended and were not following many of the other safe sleep guidelines. Nurses should ask their patients about plans for infant safe sleep after discharge to provide individualized education or recommend specific resources to address the family's needs.
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Parks SE, DeSisto CL, Kortsmit K, Bombard JM, Shapiro-Mendoza CK. Risk Factors for Suffocation and Unexplained Causes of Infant Deaths. Pediatrics 2023; 151:e2022057771. [PMID: 36464994 PMCID: PMC9942004 DOI: 10.1542/peds.2022-057771] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Observational studies have improved our understanding of the risk factors for sudden infant death syndrome, but separate examination of risk for sleep-related suffocation and unexplained infant deaths has been limited. We examined the association between unsafe infant sleep practices and sudden infant deaths (sleep-related suffocation and unexplained causes including sudden infant death syndrome). METHODS We conducted a population-based case-control study using 2016 to 2017 Centers for Disease Control and Prevention data. Controls were liveborn infants from the Pregnancy Risk Assessment Monitoring System; cases were from the Sudden Unexpected Infant Death Case Registry. We calculated risk factor prevalence among cases and controls and crude and adjusted odds ratios. RESULTS We included 112 sleep-related suffocation cases with 448 age-matched controls and 300 unexplained infant death cases with 1200 age-matched controls. Adjusted odds for sleep-related suffocation ranged from 18.7 (95% confidence interval [CI]: 6.8-51.3) among infants not sharing a room with their mother or caregiver to 1.9 (95% CI: 0.9-4.1) among infants with nonsupine sleep positioning. Adjusted odds for unexplained death ranged from 7.6 (95% CI: 4.7-12.2) among infants not sharing a room with their mother or caregiver to 1.6 (95% CI: 1.1-2.4) among nonsupine positioned infants. COCLUSIONS We confirmed previously identified risk factors for unexplained infant death and independently estimated risk factors for sleep-related suffocation. Significance of associations for suffocation followed similar patterns but was of larger magnitude. This information can be used to improve messaging about safe infant sleep.
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Stone G, Chase A, Vidrine DC, Singleton WW, Kitto L, Laborde K, Harper J, Sutton EF. Safe Newborn Sleep Practices on a Large Volume Maternity Service. MCN Am J Matern Child Nurs 2023; 48:43-47. [PMID: 36469894 DOI: 10.1097/nmc.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Reinforcing safe infant sleep conditions in the hospital setting supports continuation of safe sleep practices after hospital discharge and should be considered the first line of defense for reducing risk for sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS) at home. The purpose of this study is to determine knowledge of perinatal nurses, nursing assistants, physicians, and ancillary personnel about safe sleep recommendations and implementation of safe sleep practices on the mother-baby unit. STUDY DESIGN AND METHODS Nurses and other members of the perinatal health care team in a level III maternity service were invited to participate in a survey about safe sleep knowledge and practices. An audit for safe sleep adherence was conducted on the mother-baby unit for 120 mother-baby couplets over 1 year as a process improvement project. RESULTS N = 144 surveys were completed; most participants (86%) were nurses. They had high levels of knowledge about safe sleep recommendations and 74% reported making at least one safe sleep adjustment during one shift per week. The most common modifications at least once per week were removing baby from a sleeping caregiver (30%) and removing items from baby's bassinet (26%). Safe sleep audit findings revealed 32 out of 120 couplets were not fully following safe sleep recommendations, with most common unsafe sleep practice metrics being items in the baby's bassinet (18%) and bassinets propped up (8%). CLINICAL IMPLICATIONS During the hospitalization for childbirth, new parents can learn about safe sleep practices from the perinatal health care team. Sharing information and role modeling safe sleep practices can promote continuation of safe sleep practices for the newborn at home after hospital discharge.
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Rodriguez VA, Koressel LR, Higgins Joyce A. Safe or Sorry? Risk Reduction and Humanism in Newborn Medicine. Hosp Pediatr 2023; 13:e20-e22. [PMID: 36458410 DOI: 10.1542/hpeds.2022-006857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Victoria A Rodriguez
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lindsay R Koressel
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alanna Higgins Joyce
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
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40
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Hsu E, Isbell L, Arnold D, Ekambaram M. Modeling of infant safe sleep practice in a newborn nursery: a quality improvement initiative. Proc AMIA Symp 2023; 36:181-185. [PMID: 36876256 PMCID: PMC9980643 DOI: 10.1080/08998280.2022.2139976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sudden infant death syndrome (SIDS) is a leading cause of infant mortality in the US. The American Academy of Pediatrics has provided recommendations for infant sleeping position and environment to decrease SIDS rates. These recommendations reinforce the importance of modeling safe sleep practices in the newborn nursery. Although many quality improvement initiatives have been undertaken to improve safe sleep in the nursery, such efforts are sparse in low-volume birth hospitals. This project aimed to improve infant sleep practices in a 10-bed level I nursery using visual cues (crib cards) and nursing education. We defined "safe sleep practice" if a newborn slept in a safe position in a flat bassinet and in a safe environment. We measured safe sleep practices before and after the intervention using an audit tool. As a result, safe sleep practices improved from 32% (30/95) preintervention to 75% (86/115) postintervention (P < 0.01). This study demonstrates that implementing a quality improvement initiative to improve infant sleep practices in a low-volume nursery is feasible and impactful.
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Affiliation(s)
- Eunice Hsu
- Department of Family Medicine, Baylor Scott & White Medical Center - Round Rock, Round Rock, Texas
| | - Lauren Isbell
- Department of Family Medicine, Baylor Scott & White Medical Center - Round Rock, Round Rock, Texas
| | - Danielle Arnold
- Department of Hospital Medicine, Baylor Scott & White Medical Center - Round Rock, Round Rock, Texas
| | - Maheswari Ekambaram
- Department of Hospital Medicine, Baylor Scott & White Medical Center - Round Rock, Round Rock, Texas
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41
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Isbey SC, Howard MB, Abdulrahman E, Giese K, Cuchara B, Gourishankar A. Characteristics and Geographic Variation in Sudden Unexpected Infant Deaths in the District of Columbia. Am J Forensic Med Pathol 2022; 43:328-333. [PMID: 36103406 DOI: 10.1097/paf.0000000000000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Sleep-related infant death is a major cause of infant mortality in the United States. In the District of Columbia, infant mortality varies widely among regions (2 to 14 per 1000 live births). The study objectives were to analyze the patient characteristics and related variables to sudden unexpected infant deaths at 2 pediatric emergency department (ED) sites and the geographic patterns of infant deaths and their relationship to social vulnerability. This retrospective cohort study examined infants under 1 year of age presenting with cardiac arrest at 2 ED sites from 2010 to 2020. Analysis showed 81 deaths with a median population age of 75 days (SD, 46 days). The most frequent demographics of deceased patients were African American Black (89%) with Medicaid insurance (63%), born at term gestation (66%), and without comorbidity (60%). The cause of death was most frequently undetermined (32%) and asphyxia (31%). Most cases involved bed-sharing (63%), despite more than half of those cases having a known safe sleep surface available. Infant death location showed that most deaths occurred in areas with the highest social vulnerability index, including near a community ED location. Understanding the etiologies of this geographic variability may enhance sleep-related infant death prevention strategies.
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Affiliation(s)
| | - Mary Beth Howard
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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42
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Holm IA, Poduri A, Goldstein RD. Re: Technical Report for Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics 2022; 150:190123. [PMID: 36443235 DOI: 10.1542/peds.2022-059737a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/30/2022] Open
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Menéndez M. Wrong Assignment of Strength of Recommendations in AAP Policy Statement. Pediatrics 2022; 150:189799. [PMID: 36305232 DOI: 10.1542/peds.2022-059507a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 02/25/2023] Open
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Stringer M, Ohnishi BR, Ferrarello D, Lazzeri J, Giordano NA, Polomano RC. Subject Matter Expert Nurses in Safe Sleep Program Implementation. MCN Am J Matern Child Nurs 2022; 47:337-344. [PMID: 35857024 DOI: 10.1097/nmc.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pennsylvania sudden unexpected infant death rates rank among the highest nationally. A nursing team developed, implemented, evaluated, and disseminated an evidence-based quality improvement (QI) program at birthing hospitals in Pennsylvania to address this issue. To facilitate implementation, clinical nurses were educated as Subject Matter Experts (SMEs) to empower them to transform and sustain outcomes-driven QI for infant safe sleep nursing practice. METHODS This descriptive study examined outcomes from 268 nurses who received comprehensive education on infant safe sleep and the SME role. Likert-type scale surveys measured knowledge gained and progress made in practice following education. A programmatic dashboard tracked program implementation. Descriptive statistics were used to report findings. INTERVENTION SME nurses ( N = 268) completed two interactive learning modules addressing safe sleep guidelines and teaching strategies and attended a workshop to acquire skills for program implementation. Key competencies included data collection and dissemination, policy development, and communication techniques. RESULTS Immediate posteducation surveys completed by SMEs indicated that over 98% of respondents strongly agreed or agreed they were able to effectively demonstrate communication strategies, identify SME role components, provide environment surveillance, and demonstrate best practices in infant safe sleep. To allow time for assimilation of the of SME role, a survey was initiated at 6 months to capture progress made. Seventy-eight SMEs responded to the survey and reported exceptional or substantial progress in 10 areas for SME responsibilities. CONCLUSION Use of the SME role for program implementation led to highly favorable SME-reported outcomes in leading a hospital-based QI program.
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Co-Rooming Accounts for Socioeconomic Disparities in Infant Sleep Quality among Families Living in Urban Environments. CHILDREN 2022; 9:children9101429. [PMID: 36291365 PMCID: PMC9600685 DOI: 10.3390/children9101429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/24/2022]
Abstract
Poor infant sleep quality is associated with negative maternal and infant health outcomes. This study measures socioeconomic disparities in infant sleep quality, and assesses whether child sleep location and maternal stress mediate associations between socioeconomic status (SES) and infant sleep quality. The study includes 86 socioeconomically diverse, mother-infant dyads living in an urban area with infants aged 6–12 months. Mothers reported socioeconomic demographics, infant sleep quality (Brief Infant Sleep Questionnaire) and maternal subjective stress (Perceived Stress Scale). Maternal objective stress was measured via hair cortisol concentration (HCC). The associations among SES, infant sleep quality, infant co-rooming, and maternal stress were assessed. Infants from families with lower income-to-needs (ITN) ratios had poorer infant sleep quality. The association between familial ITN and infant sleep quality was mediated by whether the child co-rooms with parents. Maternal perceived stress was independently associated with infant sleep quality, but HCC was not associated with infant sleep quality.
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46
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Maruyama N, Hageman JR. An Update on Infant Safe Sleep Recomendations. Pediatr Ann 2022; 51:e297-e298. [PMID: 35938896 DOI: 10.3928/19382359-20220712-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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47
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Mery JN, Vladescu JC, Day-Watkins J, Sidener TM, Reeve KF, Schnell LK. Training medical students to teach safe infant sleep environments using pyramidal behavioral skills training. J Appl Behav Anal 2022; 55:1239-1257. [PMID: 35854197 DOI: 10.1002/jaba.942] [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: 04/01/2021] [Accepted: 05/31/2022] [Indexed: 11/09/2022]
Abstract
Medical personnel play a critical role in caregiver safe infant sleep education. However, training outcomes in the safe infant sleep training literature have been mixed. Promising approaches that warrant further investigation are the use of behavioral skills training and pyramidal training. The current study consisted of two experiments. Experiment 1 extended Carrow et al. (2020) and Vladescu et al. (2020) by teaching medical students safe infant sleep practices using behavioral skills training. Discriminated responding was examined across trained and untrained environmental arrangements using a multiple-baseline design. All participants arranged safe sleep environments following behavioral skills training. In Experiment 2, we used pyramidal behavioral skills training to train medical students to teach others safe sleep practices. Results indicated high procedural integrity scores following training and generalization of skills.
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48
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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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49
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Bartick M, Young M, Louis-Jacques A, McKenna JJ, Ball HL. Bedsharing may partially explain the reduced risk of sleep-related death in breastfed infants. Front Pediatr 2022; 10:1081028. [PMID: 36582509 PMCID: PMC9792691 DOI: 10.3389/fped.2022.1081028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Melissa Bartick
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Michal Young
- Department of Pediatrics and Child Health, Howard University College of Medicine, Washington, DC, United States
| | - Adetola Louis-Jacques
- Department of Obstetrics and Gynecology, University of Florida Health, Gainesville, FL, United States
| | - James J McKenna
- Department of Anthropology, Santa Clara University, Santa Clara, CA, United States.,Department of Anthropology, University of Notre Dame, South Bend, IN, United States
| | - Helen L Ball
- Department of Anthropology, Durham Infancy & Sleep Centre, Durham University, Durham, United Kingdom
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50
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Dixley A, Ball HL. The effect of swaddling on infant sleep and arousal: A systematic review and narrative synthesis. Front Pediatr 2022; 10:1000180. [PMID: 36533224 PMCID: PMC9748185 DOI: 10.3389/fped.2022.1000180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/05/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Western parents swaddle infants to promote sleep and reduce night-waking, however recent evidence of the effects of swaddling on the sleep of healthy infants has not been systematically reviewed. OBJECTIVE To investigate the effect of swaddling on the sleep of infants up to 1 year of age using a narrative synthesis approach. DATA SOURCES We systematically searched five academic databases, including the Cochrane trial registry (Pubmed, PsycINFO, Embase, the Cochrane library, and Blackwell Synergy). We manually searched reference lists and citations of included studies and reference lists of existing reviews. STUDY SELECTION Studies of any type, published since 2007, reporting primary data whose subjects were humans up to 12 months of age with outcome measures relating to the impact of swaddling on sleep and arousal. DATA EXTRACTION By hand using a customized template. A narrative synthesis is used to present the results. RESULTS In total 171 studies were retrieved with 115 studies discarded at title. A further 43 were discarded at abstract, and six were discarded at full text. Two papers were combined as they reported on the same study giving a total of 6 studies that met the inclusion criteria for the review. An evidence hierarchy was used to assess Risk of Bias in the included studies; the results are presented via a narrative synthesis. Swaddling was associated with increased duration of quiet sleep in infants and a significantly reduced number of sleep state changes among infants naïve to the intervention. LIMITATIONS The integrity of the intervention (swaddling) including its baseline characteristics, was defined broadly across the included studies limiting the interpretation and transferability of the results of this review. CONCLUSIONS Swaddling appears to increase quiet sleep duration in infants and reduces the number of sleep state changes among infants naïve to the intervention. Parents should be made aware that implementing conditions unfavorable to arousability may increase SUDI risk among infant who have not previously been swaddled. This review has relevance for informing future practice recommendations and parent advice as well as in designing future studies.
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Affiliation(s)
- Allison Dixley
- Durham Infancy & Sleep Centre, Department of Anthropology, Durham University, Durham, United Kingdom
| | - Helen L Ball
- Durham Infancy & Sleep Centre, Department of Anthropology, Durham University, Durham, United Kingdom
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