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).
"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]. "
[Show abstract][Hide abstract] 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 · 1.79 Impact Factor
"But studies examining the risk factors for SIDS have found the risk of bed sharing to be so profound that the protective effect of breastfeeding did not significantly influence the magnitude of the risk associated with bed sharing [39–41]. This has been hypothesized to be due to the lifestyle and socioeconomic class that decides both breastfeeding and SIDS rates supported by findings from developed versus developing or Asian countries [40, 42]. Finally, it is actually difficult to isolate breastfeeding and bed sharing from other risk factors related to SIDS. "
[Show abstract][Hide abstract] ABSTRACT: Background. There is conflicting evidence regarding the safety and efficacy of bed sharing during infancy-while it has been shown to facilitate breastfeeding and provide protection against hypothermia, it has been identified as a risk factor for SIDS. Methods. A systematic search of major databases was conducted. Eligible studies were observational studies that enrolled infants in the first 4 weeks of life and followed them up for a variable period of time thereafter. Results. A total of 21 studies were included. Though the quality of evidence was low, bed sharing was found to be associated with higher breastfeeding rates at 4 weeks of age (75.5% versus 50%, OR 3.09 (95% CI 2.67 to 3.58), P = 0.043) and an increased risk of SIDS (23.3% versus 11.2%, OR 2.36 (95% CI 1.97 to 2.83), P = 0.025). Majority of the studies were from developed countries, and the effect was almost consistent across the studies. Conclusion. There is low quality evidence that bed sharing is associated with higher breast feeding rates at 4 weeks of age and an increased risk of SIDS. We need more studies that look at bed sharing, breast feeding, and hazardous circumstance that put babies at risk.
International Journal of Pediatrics 01/2014; 2014:468538. DOI:10.1155/2014/468538
"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 . "
[Show abstract][Hide abstract] 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.
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