[Technical report] SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment
ABSTRACT Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death that occur during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from focusing only on SIDS to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths, including SIDS. The recommendations described in this policy statement include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunizations, consideration of using a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in the accompanying "Technical Report--SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment," which is included in this issue of Pediatrics (www.pediatrics.org/cgi/content/full/128/5/e1341).
- SourceAvailable from: Martine Hackett
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- "Because SIDS is a diagnosis of exclusion, if the presence of factors indicating the possibility that a death may have been due to injury are present (e.g., unsafe sleep positioning, bedsharing , excess bedding), it is not certified as SIDS . Infant injury deaths have been identified as important for public health intervention because they may be preventable by reducing the modifiable risk factors related to sleep position and sleep environment  . Sleep-related infant care practices that have been identified as possible risk factors for sleep-related infant deaths include the placement of infants in prone or side sleep position, the sharing of a sleep surface with an adult (i.e., bed-sharing), and the use of excess bedding [8–13]. "
ABSTRACT: Half of all births in New York City are to women born outside of the United States whose infant care practices may differ from official recommendations from the American Academy of Pediatrics. These infants have an overall lower infant mortality rate than those of their US-born counterparts.AimsThe aims of this study were to examine sleep-related infant injury death, a leading cause of infant mortality, and its risk factors among infants of US-born and foreign-born women in a large, diverse urban area.Study designData for 344 infant death cases from medical examiner and vital statistics records were analyzed. Rate ratios and 95% CIs, calculated with Poisson regression models, were used to quantify differences in death rates by maternal and infant characteristics. Bivariate and logistic regression analyses were used to examine differences within the sample of sleep-related infant injury deaths.Outcome measuresThe outcome measures were rate of sleep-related injury death, and behavioral risk factors associated with these deaths: unsafe sleep positioning, bed-sharing, and excess bedding.ResultsUS-born mothers had a sleep-related infant injury death rate that was over three times that of foreign-born mothers, even when controlling for maternal race/ethnicity, education, and age. However, adverse sleep-related practices were not consistently more prevalent among US-born infants in the sample of deaths, even when controlling for those same demographic factors.Conclusions The higher rate of sleep-related infant injury death among infants of US-born mothers may be explained by more complex socio-demographic factors, or factors outside of infant sleep practices.Early Human Development 11/2014; 91(1). DOI:10.1016/j.earlhumdev.2014.10.005 · 1.93 Impact Factor
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- "In conclusion, body positioning can be considered an effective strategy to manage both acid and nonacid GORs in preterm infants; improvements of GOR indexes are observed in prone and left lateral positions, whereas supine and right lateral positioning seem to play a worsening effect. However, due to the established risk of sudden infant death syndrome (SIDS) linked to prone positioning , this measure is limited to hospitalized babies and should not be applied in symptomatic infants discharged without cardiorespiratory monitoring. Placing the babies on a head-up slope is a measure frequently adopted in clinical practice . "
ABSTRACT: Gastroesophageal reflux (GOR) is very common among preterm infants, due to several physiological mechanisms. Although GOR should not be usually considered a pathological condition, its therapeutic management still represents a controversial issue among neonatologists; pharmacological overtreatment, often unuseful and potentially harmful, is increasingly widespread. Hence, a stepwise approach, firstly promoting conservative strategies such as body positioning, milk thickening, or changes of feeding modalities, should be considered the most advisable choice in preterm infants with GOR. This review focuses on the conservative management of GOR in the preterm population, aiming to provide a complete overview, based on currently available evidence, on potential benefits and adverse effects of nonpharmacological measures. Nonpharmacological management of GOR might represent a useful tool for neonatologists to reduce the use of antireflux medications, which should be limited to selected cases of symptomatic babies.09/2013; 2013:141967. DOI:10.1155/2013/141967
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- "Besides, the concern of a possible association between milk thickening and the development of necrotizing enterocolitis has been raised  . Eventually, it should be noticed that a worsening in acid GER's features has been reported after HM fortification , while evidencess regarding the effect of nonnutritive sucking  and intragastric tubes   are still limited and controversial. "
ABSTRACT: Although gastroesophageal reflux (GER) is a very common phenomenon among preterm infants, its therapeutic management is still an issue of debate among neonatologists. A step-wise approach should be advisable, firstly promoting nonpharmacological interventions and limiting drugs to selected infants unresponsive to the conservative measures or who are suffering from severe GER with clinical complications. Despite of this, a concerning pharmacological overtreatment has been increasingly reported. Most of the antireflux drugs, however, have not been specifically assessed in preterm infants; moreover, serious adverse effects have been noticed in association to their administration. This review mainly aims to draw the state of the art regarding the pharmacological management of GER in preterm infants, analyzing the best piecies of evidence currently available on the most prescribed anti-reflux drugs. Although further trials are required, sodium alginate-based formulations might be considered promising; however, data regarding their safety are still limited. Few piecies of evidence on the efficacy of histamine-2 receptor blockers and proton pump inhibitors in preterm infants with GER are currently available. Nevertheless, a significantly increased risk of necrotizing enterocolitis and infections has been largely reported in association with their use, thereby leading to an unfavorable risk-benefit ratio. The efficacy of metoclopramide in GER's improvement still needs to be clarified. Other prokinetic agents, such as domperidone and erythromycin, have been reported to be ineffective, whereas cisapride has been withdrawn due to its remarkable cardiac adverse effects.Gastroenterology Research and Practice 06/2013; 2013:714564. DOI:10.1155/2013/714564 · 1.75 Impact Factor