Secondhand smoke reduction

According to the US Surgeon General's Report, secondhand smoke is connected to SIDS.[96] Infants who die from SIDS tend to have higher concentrations of nicotine and cotinine (a biological marker for secondhand smoke exposure) in their body fluids than those who die from other causes.[97] Parents who smoke can significantly reduce their children's risk of SIDS by either quitting or smoking only outside and leaving their house completely smoke-free.

The maternal pregnancy smoking rate decreased by 38% between 1990 and 2002.[98]

Sleep positioning

Main article: Back to Sleep

A plot of SIDS rate from 1988 to 2006

Sleeping on the back has been recommended by (among others) the American Academy of Pediatrics (starting in 1992) to avoid SIDS, with the catchphrases "Back To Bed" and "Back to Sleep". The incidence of SIDS has fallen sharply in a number of countries in which the back-to-bed recommendation has been widely adopted, such as the U.S. and New Zealand.[99]

Among the theories supporting the Back-to-Sleep recommendation is the idea that small infants with little or no control of their heads may, while face down, inhale their exhaled breath (high in carbon dioxide) or smother themselves on their bedding; the brain-stem anomaly research (above) suggests that babies with that particular genetic makeup do not react "normally" by moving away from the pooled CO2, and thus smother. Another theory[100] is that babies sleep more soundly when placed on their stomachs, and are unable to rouse themselves when they have an incidence of sleep apnea, which is thought to be common in infants.

Hospital neonatal-intensive-care-unit (NICU) staff commonly place preterm newborns on their stomach, although they advise parents to place their infants on their backs after going home from the hospital.[101]

Many have started to link the introduction of the Back-to-Sleep recommendation to the increased number of children suffering from Plagiocephaly and Brachycephaly. This is likely due to babies spending more time on their backs.[102] However, these theories are currently unproven.[citation needed]

Sleep sacks

In colder environments where bedding is required to maintain a baby's body temperature, the use of a "baby sleep bag" or "sleep sack" is becoming more popular. This is a soft bag with holes for the baby's arms and head. A zipper allows the bag to be closed around the baby. A study published in the European Journal of Pediatrics in August 1998[103] has shown the protective effects of a sleep sack as reducing the incidence of turning from back to front during sleep, reinforcing putting a baby to sleep on its back for placement into the sleep sack and preventing bedding from coming up over the face which leads to increased temperature and carbon dioxide rebreathing. They conclude in their study "The use of a sleeping-sack should be particularly promoted for infants with a low birth weight." The American Academy of Pediatrics also recommends them as a type of bedding that warms the baby without covering its head.[104]

Epidemiology

SIDS was responsible for 0.543 deaths per 1,000 live births in the US in 2005.[15] It is responsible for far fewer deaths than congenital disorders and disorders related to short gestation, though it is the leading cause of death in healthy infants after one month of age.]]

SIDS deaths in the US decreased from 4,895 in 1992 to 2,247 in 2004.[105] But, during a similar time period, 1989 to 2004, SIDS being listed as the cause of death for sudden infant death (SID) decreased from 80% to 55%.[105] According to Dr. John Kattwinkel, chairman of the Centers for Disease Control and Prevention (CDC) Special Task Force on SIDS "A lot of us are concerned that the rate (of SIDS) isn't decreasing significantly, but that a lot of it is just code shifting".[105]

A set of 14 epidemiologic characteristics associated with SIDS have been identified:[106][107]

A characteristic 4-parameter lognormal age distribution;

Increased risk associated with prone sleep position;

Prone and supine SIDS have same age and gender distributions;

Male and female SIDS have same age distribution;

Total sudden respiratory deaths at home have same age and gender distributions;[108]

No evidence of cause of death at forensic autopsy and death scene investigation;

SIDS spares infants at birth[?];

Seasonality: winter maximum, summer minimum;

Increasing SIDS rate with Live Birth Order;

Consistent male excess of approximately 50%;

Low increased risk of SIDS in subsequent siblings of SIDS;

Parental smoking is a risk factor for SIDS;

Apparent Life Threatening Events (ALTE) are not a risk factor for subsequent SIDS;

SIDS risk is greatest during sleep.

Date: 2015-12-17; view: 618