L.A. Best Babies Network First Five Los Angeles February 13 ...welcomebaby.labestbabies.org/wp-content/uploads/2018/02/...No Conflicts of Interest to Disclose Sudden Infant Death Syndrome

No Conflicts of Interest to Disclose

Sudden Infant Death Syndrome and

Safe Infant Sleep

L.A. Best Babies Network First Five Los Angeles

February 13, 2018

Thomas G. Keens, M.D. Chair, California SIDS Advisory Council.

Professor of Pediatrics, Physiology and Biophysics, Keck School of Medicine of the University of Southern California.

Division of Pediatric Pulmonology and Sleep Medicine, Children’s Hospital Los Angeles.

“And this woman's son died in the night ...”

1 Kings 3: 19 (950 B.C.)

Antoon Claeissens, The Judgment of Solomon, ~1600.

Figure Courtesy of Doctor Maria Valdes-Dapena

4

5

Sudden Death

of an Infant

Emergency Responders

Coroner's Investigation

Autopsy

Determination of the Cause

of Death

The sudden unexpected death of an infant, under one-year of age, with onset of the fatal

episode apparently occurring during sleep, that remains unexplained after a thorough

investigation, including performance of a complete autopsy, and review of the

circumstances of death and the clinical history.

Krous, H.F., J.B. Beckwith, R.W. Byard, T.O. Rognum, T. Bajanowski, T, Corey, E. Cutz,

R. Hanzlick, T.G. Keens, and E.A. Mitchell. Pediatrics, 114: 234-238, 2004.

Sudden Infant Death Syndrome

In this presentation, the following terms are considered synonymous:

• SIDS • SUID • SUDI • Undetermined

They all mean the same thing; that the infant’s death is unexpected and unexplained.

Cutz, E. JAMA Pediatr., 170: 315-316, 2016.


8

0.0

0.5

1.0

1.5

2.0

1980 1985 1990 1995 2000 2005 2010 2015

SID

S R

ate

per

1,0

00 L

ive B

irth

s

CaliforniaUSA

Gunteroth, W.G., and P.S. Spier. Pediatrics, 110: 110;e64, 2002.

14

13

0

20

40

60

80

100

White/Other AfricanAmerican

Asian/PacificIslander

Multiple Race Hispanic

Race/Ethnicity

Rat

e p

er 1

00,0

00 R

ace/

Eth

nic

S

pec

ific

Liv

e B

irth

s

SIDSUndeterminedAll Other

California 2002-2003 Birth & 2003 Death Statistical Master Files & SUID Database, 2003. California Department of Health Services, MCAH/OFP, September 2005.

Infant Deaths by Race/Ethnicity Carrie Florez

Infant Deaths by Gestational Age

Ostfeld, B.M., et al. Pediatrics, 140: e20163334, 2017.

• No identifiable cause of death.

• No signs of severe illness. • No signs of significant

stress. • Diagnosis of exclusion

SIDS Autopsy Findings

With the perseverance of Trojans ...

Faithful. Scholarly. Skillful. Courageous. Ambitious.

“Here are provided seats of meditative joy, Where shall arise again the destined reign of Troy.”

Virgil, Aeneid

How Are We to Understand SIDS?

Modified after Professor Jacopo P. Mortola. McGill University.

Imagine a car driving up a steep mountain road. The car has stopped.

Why can’t the car continue up the hill?

How Are We to Understand SIDS? Imagine a car driving up a steep mountain

road. The car has stopped. Why can’t the car continue up the hill?

•Medical Model. • There is a flat tire. • Identify the problem. • Find a solution to the problem. • Fix the problem.


• Cardiac causes. • Respiratory causes. • Arousal disorders. • Metabolic disorders. • Infections. • Vitamin deficiency. • Environmental toxins.

Medical Model of SIDS

How Are We to Understand SIDS? Imagine a car driving up a steep mountain

road. The car has stopped. Why can’t the car continue up the hill?

•A New Way of Thinking. • There are too many passengers. • The engine is not powerful enough. • The road is too rocky. • The road is too steep.


Kinney, H.C., and B.T. Thach. N. Eng. J. Med., 361: 795-805, 2009.

↓ brainstem serotonin: Autonomic Dysfunction Disrupting Cardiorespiratory Control

Filiano, J.J., and H.C. Kinney. Biol. Neonate, 65: 194-197, 1994.

Hannah Kinney

Infant Vulnerability

Development Environment

SIDS

↓ brainstem serotonin: Autonomic Dysfunction Disrupting Cardiorespiatory Control


Hannah Kinney


Environment Development

SIDS

• Any system in transition is intrinsically unstable.

• Infant cardiorespiratory physiology undergoes rapid changes in the first 3-6 months of life.

• Thus, infant physiological responses are immature and do not function optimally.

Fleming, P.J., M.R. Levine, A.M. Long, and J.P. Cleave. Ann. N.Y. Acad. Sci., 533: 305-313, 1988.

Ramanathan, R., and CHIME. J. Amer. Med. Assoc., 285: 2199-2207, 2001.

• Clinical Sites. • Los Angeles, California. • Chicago, Illinois. • Honolulu, Hawaii. • Cleveland, Ohio. • Toledo, Ohio.

• Clinical Trial Operation Center. • Data Coordinating and Analysis Center. • NICHD.

The CHIME Study


• Clinical Sites. • Los Angeles, California. • Chicago, Illinois. • Honolulu, Hawaii. • Cleveland, Ohio. • Toledo, Ohio.

• Clinical Trial Operation Center. • Data Coordinating and Analysis Center. • NICHD.

The CHIME Study

Healthy Term Infants

Home monitoring up to 66 wks PCA (age 6 months).

Preterm Infants

Home monitoring up to 56 wks PCA (age 4 months).

ALTE Infants Until infant has no real alarms for 3-months.

SIDS Siblings Until 66 wks PCA, or 4 wks past age of death of SIDS.


The CHIME Study Plan

The CHIME Home Monitor • Respiratory Inductance Plethysmography.

• Central and Obstructive Apneas.

• Electrocardiogram.

• Pulse Oximeter.

• Body Position.

• Computer to record events and normative data.

Neuman, M.R., et al., and CHIME. Physiol. Meas., 22: 267-286, 2001. Ramanathan, R., and CHIME. J. Amer. Med. Assoc., 285: 2199-2207, 2001.

The CHIME Home Monitor (Non Invasive Monitoring Systems, Miami, Florida, U.S.A.) Neuman, M.R., et al., and CHIME. Physiol. Meas., 22: 267-286, 2001.

Neuman, M.R., et al., and CHIME. Physiol. Meas., 22: 267-286, 2001.

Neuman, M.R., et al., and CHIME. Physiol. Meas., 22: 267-286, 2001.

• Average baseline Spo2 was 97.9%, and did not change with age.

• Hypoxia (Spo2 <90%) occurred in 59% of infants.

• Hypoxia (Spo2 <90%) occurred 0.6% of epochs.

• Acute desaturations were most common in periodic breathing and short apneas.

Hunt, C.E., and CHIME. J. Pediatr., 135: 580-586, 1999.

Carl Hunt

Oxygen Saturation in Healthy Infants During Sleep at Home

Is SIDS a Catastrophic Physiologic Crisis?

• If normal infants do not precisely control breathing, heart rate, and oxygenation …

• Then SIDS may not have to be a catastrophic physiological crisis.

• Maybe it just needs to be a small problem which nudges or pushes a vulnerable infant over the edge.

34

0

10

20

30

40

50

60

70

30 35 40 45 50 55 60PCA (weeks) at beginning of 4-week observation period

SIDS


Rat

e of

at l

east

1 e

xtre

me

even

t



Hannah Kinney



SIDS



Panigrahy, A., et. al. J. Neuropath. Exp. Neurol., 59: 377-384, 2000. Kinney, H.C., et al. J. Neuropath. Exp. Neurol., 60: 228-247, 2001.

Kinney, H.C., et al. J. Neuropath. Exp. Neurol., 62: 1178-1191, 2003. Paterson, D.S., et al. J. Amer. Med. Assoc., 296: 2124-2132, 2006.

Duncan, J.R., et al. J. Amer. Med. Assoc., 303: 430-437, 2010. Randall, B.B., et al. Pediatrics, doi: 10.1542/peds.2013-0700. 2013

Professor Hannah Kinney. Neuropathologist.

Harvard Medical School.

Brainstem Neurotransmitters in SIDS

• Brainstem is the life support portion of the brain.

• Autopsy studies found decreased serotonin (5-HT) and serotonergic neurotransmitter receptor binding activity in brainstems of SIDS vs controls infants.

Paterson, D.S., et al. J. Amer. Med. Assoc., 296: 2124-2132, 2006.

5-HT1A Receptor Binding Density in the SIDS Mid-Medulla

40 Duncan, J.R., et al. J. Amer. Med. Assoc., 303: 430-437, 2010.

Hannah Kinney

0

20

40

60

80

100

RapheObscurus

PGCLBra

inst

em S

erot

onin

Con

cent

ratio

n (p

mol

/mg)

SIDS (n=35)Controls(n=5)Hospitalized(n=5)

P <0.05 P <0.04

Randall, B.B., et al. Pediatrics, doi: 10.1542/peds.2013-0700. 2013.

Sudden death without Asphyxia Sudden death with Asphyxia Known Cause of Death

p<0.001

p<0.001

42

Randall, B.B., et al. Pediatrics, doi: 10.1542/peds.2013-0700. 2013. Goldstein, R.D., et al. Pediatrics, 137: e20154661, 2016.

Accidental Asphyxia or Suffocation

Sudden Death without

Asphyxia

Sudden Death with Asphyxia

Brain Abnormality Small Intermediate Severe

Asphyxial Insult Severe Intermediate Small



Hannah Kinney


Development

SIDS

Environment

Ostfeld, B.M., et al. Pediatrics, 125: 447-453, 2010.

0

5

10

15

20

25

30

0 1 2 3 4 5 6 7

SID

S Vi

ctim

s (%

)

Number of Risk Factors (modifiable and nonmodifiable) present per case

244 SIDS victims from New Jersey,

1996-2000.

The majority of SIDS victims have ≥1 Risk Factor

Trachtenberg, F.L., et al. Pediatrics, 129: 630-638, 2012.

The majority of SIDS victims have ≥1 Risk Factor

2.1 2.1

0

1

2

3

Nu

mb

er o

f M

od

ifia

ble

Ris

k F

ac

tors

Modifiable Risk Factors per Case

91.7

64.5

89.368.7

0

20

40

60

80

100

1 or More 2 or More

SIDS

Vic

tims (

%)

Pre-BTS 1991-1993 (n=169) BTS 1996-2008 (n=307)

How can we, as a population, reduce the

risks of SIDS?

• Most infants with risk factors will not die from SIDS.

• Some infants without risk factors will die from SIDS.

• However, infants with risk factors are at increased risk of dying from SIDS.

= Causes / Risk Factors

48 AAP Policy Statement. Pediatrics, 138: e20162938, 2016.

Babies Should Sleep on their Backs for Every Sleep

AAP Policy Statement. Pediatrics, 138: e20162938, 2016. http://www.medscape.com/features/slideshow/safe-sleep-principles?

Vennemann, M.M., et al. Pediatrics, 123: 1162-1170, 2009. Blair, P.S., et al. B.M.J., 339: b3666, 2009.

Li, D-K, et al. Am. J. Epidemiol., 157: 446-455, 2003. Mitchell, E.A., et al. Arch. Pediatr. Adolesc. Med., 153: 1136-1141, 1999.

Mitchell, E.A., et al. Pediatrics, 100: 835-840, 1997. Oyen, N., et al. Pediatrics, 100: 613-621, 1997.

0 5 10 15 20

Oyen, 1997

Mitchell, 1997

Mitchell, 1999

Li, 2003

Blair, 2009

Vennemann, 2009

Prone Sleeping and SIDS (Odds Ratios vs Non-Prone Sleeping)

0%

20%

40%

60%

80%

100%

1992 1995 1998 2001 2004 2007

SupineSideProne

Willinger, M., et al. J. Amer. Med. Assoc., 280: 329-335, 1998. Colson, E.R., et al. Arch. Pediatr. Adolesc Med., 163: 1122-1128, 2009.

M. Willinger

National Infant Sleep Position Study (U.S.A.)

0.5

1.0

1.5

0

M. Willinger, et al. J. Amer. Med. Assoc., 280: 329-335, 1998. Colson, E.R., et al. Arch. Pediatr. Adolesc Med., 163: 1122-1128, 2009.

0

20

40

60

80

1990 1992 1994 1996 1998 2000 2002 2004 2006

U.S. Prone Sleeping and SIDS Rate

53

0

5

10

15

20

25

Mitchell Oyen

SID

S R

isk

Odd

s R

atio

vs

Supi

ne

Slee

p P

ositi

on

ProneSide

Mitchell, E.A., et al. Pediatrics, 100: 835-840, 1997. Oyen, N., et al. Pediatrics, 100: 613-621, 1997.

54

SIDS Risk Odds Ratio vs Supine Sleep Position

Oyen, N., et al. Pediatrics, 100: 613-621, 1997.

0

5

10

15

20

25

30

All Infants 13-24 wks0

15

30

45

60

75

90

BW <2.5 kg Preterm

ProneSide

SIDS Risk Reduction: Curriculum for Nurses, NICHD, 2006. NIH Publication No. 06-6005.

Supine Prone

56 Mitchell, E.A., et al. Arch. Pediatr. Adolesc. Med., 153: 1136-1141, 1999.

• 1987-1990, case control study in New Zealand.

• 20% of SIDS deaths involved lack of experience with prone position.

0

5

10

15

20

Routine SupineSleeper

Routine ProneSleeper

UnaccustomedProne Sleep

SID

S O

dd

s R

ati

o v

s S

up

ine

Sle

ep

485 SIDS 1,800 Controls

Ed Mitchell

Unaccustomed Prone Sleeping ↑ SIDS Risk

California Infants

Placed on the Back to

Sleep: 76.1%

Data Source: Maternal and Infant Health Assessment Survey Prepared by: Maternal, Child and Adolescent Health Program, Center for Family Health, California Department of Public Health

http://www.cdph.ca.gov/data/surveys/MIHA/MIHAComparisonMaps/CompareRegSleepPos2012.pdf

http://www.cdph.ca.gov/data/surveys/MIHA/MIHAComparisonMaps/CompareRegSleepPos2012.pdf

Use a Firm Sleep Surface. Firm Crib Mattress and Fitted Sheet


Sitting Devices are Not Recommended for Routine Sleep


Roomsharing, Without Bedsharing, is Recommended.


Roomsharing, Without Bedsharing, is Recommended.


• In 1892, a Scottish police surgeon, Templeman, first drew attention to the potential role of excessive alcohol consumption and overlaying.

• 258 cases of suffocation in infants.

• More than half of deaths occurred Saturday night.

• Postulated that intoxication impaired arousal responses of parents sleeping with infants, thus increasing the risk of accidental suffocation.

Templeman, C. Edinburgh Med. J., 38: 322-329, 1892.

Early Study of Maternal Overlaying

Bedsharing Around the World

Mileva-Seitz, V.R., et al. Sleep Med. Rev., S1087-0792(16)00026-5. doi: 10.1016, 2016.

64

79.167.1

80.3 87.6 85.3

0

20

40

60

80

100

All White Latina Afr-Am API

Infa

nts

who

Eve

r Bed

shar

ed (%

) n = 6,246

Los Angeles Mommy and Baby (LAMB) Project, 2007 National Child and Adolescent Health Research, Evaluation, and Planning Unit

Los Angeles County Department of Public Health Health Resources and Services Administration (HRSA) R40MC06635

Infant Bedsharing in Los Angeles County

California Infants

Who Always or

Often Bedshare:

39.3% Data Source: Maternal and Infant Health Assessment Survey Prepared by: Maternal, Child and Adolescent Health

Program, Center for Family Health, California Department of Public Health http://www.cdph.ca.gov/data/surveys/MIHA/MIHAComparisonMaps/CompareRegBedshare2011.pdf

http://www.cdph.ca.gov/data/surveys/MIHA/MIHAComparisonMaps/CompareRegBedshare2011.pdf

Richard, C., et al. Sleep, 19: 685-690, 214-219, 1996. McKenna, J.J., et al. Pediatrics, 100: 214-219, 1997.

Mosko, S., et al. Am. J. Physical Anthropol., 103: 315-328, 1997. Richard, C.A., et al. J. Appl. Physiol., 84: 1374-1380, 1998.

McKenna, J.J., and T. McDade. Paediatr. Respir. Rev., 6: 134-152, 2005. Ball, H.L., et al. Arch. Dis. Child., 91: 1005-1010, 2006.

• Increased breastfeeding, but not when compared to room-sharing.

• No decrease in apnea. • No stimulation of breathing. • Increased arousals (baby wakes mother). • Decrease in deep sleep. • No apparent physiological protection.

SIDS Bedsharing, Breathing, and Infant Sleep

67 McGarvey, C., et al. Arch. Dis. Child., 88: 1058-1064, 2003.

0

5

10

15

20

25

AnyBedsharing

BedhsaringLast Sleep

MaternalSmoking

Age >20weeks

Supine Sleep

Odd

s R

atio

Bed

shar

ing

vs N

ot B

edsh

arin

g

203 SIDS. 622 controls.

4.31

16.47

21.84

2.63 1.07

Bedsharing and SIDS in Ireland, 1994-1998

68 Tappin, D, et al. J. Pediatr., 147: 32-37, 2005.

• 123 SIDS. • 263 controls.

0

10

20

30

40

50

60

70

All Couch <11 weeksold

>11 weeksold

SeparateRoom

Odd

s R

atio

SID

S vs

Con

rols

2.89

10.20

1.07 3.26

66.90

123 SIDS. 263 controls.

Bedsharing and SIDS in Scotland, 1996-2000

69 Blair, P.S., et al. Br. Med. J., 319: 457-462, 1999.

0 10 20 30 40 50

Separate Room

Bedshare onSofa

BedshareWhole Night

Bedshare, butreturn to cot

SIDS = 325 Controls = 1300

P. Fleming & P. Blair

Bedsharing and SIDS Risk: CESDI Study (Odds Ratios vs did not sleep with an adult)

70 Blair, P.S., et al. PLoS ONE 9(9): e107799. doi:10.1371, 2014.

• 123 SIDS. • 263 controls.

3.9

18.3 18.3

8.9

1.10

5

10

15

20

All Couch WithParent

Who DrankEtOH

WithParentWho

Smoked

Absence ofOther

Hazards

Odd

s R

atio

SID

S vs

Con

rols

400 SIDS. 1,386 controls.

P. Fleming & P. Blair

Bedsharing and SIDS in the U.K.

• Infant’s crib or bassinet should be placed in the parents’ bedroom close to the parents’ bed.

• Infant can be brought to bed for breastfeeding, but then returned to the crib.

• Devices promoted to make bedsharing “safe” are not recommended.

Roomsharing

AAP Policy Statement. Pediatrics, 138: e20162938, 2016.

• Infant <3-months of age. • Parent cigarette smoking. • Parent is excessively tired; such as sleep

deprivation (<4-hours sleep the previous night). • Parent depressant medication or alcohol use. • With non-parent or multiple persons. • Soft or unsafe bed. • Duvets, pillows, or soft covers. • Sleeping on a sofa, armchair, or couch.

SIDS Bedsharing is Especially Unsafe with:


James J. McKenna, Ph.D. Professor and Chair. Department of Anthropology. University of Notre Dame. South Bend, Indiana.

James J. McKenna, Ph.D. Professor and Chair, Anthropology.

University of Notre Dame

Thomas G. Keens, M.D. Professor of Pediatrics,

Physiology and Biophysics, USC.

October 21, 2017 Notre Dame Stadium

University of Notre Dame South Bend, Indiana

USC 14 Notre Dame 49

• All other risk factors should be eliminated.

• Bed in the middle of the floor away from walls or furniture.

• Mattress out of its frame covered with simple, lightweight blankets, tight fitting sheets, and firm pillows.

• Do not bedshare with other children.

• Do not bedshare if parents ever smoked cigarettes.

McKenna, J.J. Sleeping with Your Baby. 2007.

McKenna’s Bedsharing Recommendations

McKenna, J.J. Sleeping with Your Baby: A Parent’s Guide to Cosleeping. Platypus, Media, 2007.

• Roomsharing, with the infant in a crib in the parents’ room next to the adult bed, is safest, and is safer than bedsharing.

• Infants brought to bed for breastfeeding should return to a separate crib.

• Do not bedshare if parents smoke cigarettes. • Do not bedshare if the parents’ arousal is

depressed (alcohol, drugs, sleep deprived <4-hours sleep the night before).

• Do not sleep with an infant on a sofa or chair.

SIDS AAP Recommendations


• Skin-to-skin care is encouraged right after birth and subsequently.

• Mother should be awake and able to respond to her infant.

• Mother-infant dyad should be monitored to assure it is done safely.

• Rooming in is encouraged, but bedsharing should be avoided if the mother is not awake.

• Safe infant sleep education should be given.

Skin-to-Skin Care and Rooming In for Neonates


Keep Soft Objects and Loose Bedding Out of the Crib


Consider Offering a Pacifier at Nap Time and Bedtime


Avoid Cigarette Smoking Both During Pregnancy and After Birth


Li, D-K, et al. Am. J. Epidemiol., 157: 446-455, 2003. Shah, T., et al. Am. J. Public Health, 96: 1757-1759, 2006.

Blair, P.S., et al. B.M.J., 339: b3666, 2009. Mollborg, P., and B. Alm. Acta Paediatr., 99: 94-98, 2010.

0

5

10

15

Li, 2003 Shah, 2006 Blair, 2009 Mollborg,2010

SID

S O

dds

Rat

io M

othe

r Pr

enat

al S

mok

ing

vs N

o M

ater

nal P

rena

tal S

mok

ing

P.S. Blair, et al. Br. Med. J., 313: 195-198, 1996.

0

2

4

6

8

10

1 to 9 10 to 19 >20Cigarettes Smoked per Day

SID

S O

dd

s R

atio

vs

No

S

mo

kin

gP. Fleming & P. Blair

SIDS and Maternal Smoking During Pregnancy

Mitchell, E.A., et al. Pediatrics, 100: 835-840, 1997.

0

5

10

15

20

25

Mother <1pk/day

Birth

Mother>1pk/day

Birth

Mother <1pk/dayat 2-mo

Mother >1pk/dayat 2-mo

Father atBirth

Father at 2-mo

SID

S O

dds

Rat

io P

aren

t Pos

tnat

al S

mok

ing

vs N

o S

mok

ing

Ed Mitchell

SIDS and Parent Postnatal Cigarette Smoking

P.S. Blair, et al. Br. Med. J., 313: 195-198, 1996.

0

2

4

6

8

10

Hours of Cigarette Exposure per Day

SID

S O

dds

Rat

io v

s N

o Ex

posu

re

1-2 3-5 6-8 >8

SIDS and Infant Exposure to Cigarette Smoke Fleming & Blair

Breastfeeding is Recommended. Protection increases with Exclusivity.


Infants Should be Immunized according to AAP and CDCP Advice.


Avoid Overheating and Overbundling. Infant should not feel hot to the touch.


Avoid Alcohol and Illicit Drug Use During Pregnancy and After Birth.


Avoid Use of Commercial Devices Inconsistent with Safe Infant Sleep


Encourage Tummy Time when the Infant is Awake and Observed.


97

Infant Swaddling

Infant Swaddling

Swaddling and SIDS

Pease, A.S., et al. Pediatrics, 137: e20153275, 2016.

SIDS 760 Controls 1759

• Prone sleeping position. • Thick blankets. • Face covered. • For infants older than 3-

months. There is a danger when infants begin to roll from supine to prone, the swaddled infant can not regain the supine position.

Ponsonby, A.L., et al. N. Eng. J. Med., 329: 377-382, 1993. Wilson, C.A., et al. J. Paed. Child Health, 30: 506-512, 1994.

L’Hoir, M.P., et al. Eur. J. Pediatr., 157: 681-688, 1998. Van Sleuwen, B.E., et al. Pediatrics, 210: e1097-e1106, 2007.

Pease, A.S., et al. Pediatrics, 137: e20153275, 2016. AAP Policy Statement. Pediatrics, 138: e20161889, 2016.

Avoid Swaddling if … SIDS

102

0.0

0.5

1.0

1.5

2.0

1980 1985 1990 1995 2000 2005 2010 2015

SID

S R

ate

per

1,0

00 L

ive B

irth

s

CaliforniaUSA

103

73

28

65

3853

0

20

40

60

80

100

Items inCribs

Prone Sleep BedshareEver

BedshareRoutine

Bedshare onCouch

Prop

ortio

n of

Mot

hers

(%) n = 4,547

Dreisbach, S. American Baby Magazine, March, 2014, issue. http://www.parents.com/baby/safety/nursery/how-safe-is-your-babys-sleep/?page=3

Parents Ignore Safe Infant Sleep Recommendations

Varghese, S., et al. J. Perinatol., doi:10.1038/jp.2015.111, 2015.

229

318

2022

0 5 10 15 20 25

Put Soft Items in CribDo Not Immunize

Smoke CigarettesDo Not Breastfeed

Do BedshareProne or Side Sleep

Parents of Newborn Infants (%)

Many Parents Do Not Follow Safe Infant Sleep Recommendations

n = 121 parents

Eron, N.B., et al. Health Promot. Pract., 10: 1-9. 2009. 0 20 40 60 80 100

Give Written Material

Do Discuss SIDS Risk

Should Discuss SIDS Risk

Knows Back Sleep Safest

Behavior Can Reduce SIDS

N = 214

Primary Care Physicians Do Not Discuss SIDS Risk Reduction

Eisenberg, S.R., et al. Pediatrics, 136: DOI: 10.1542/peds.2015-0551, 2015.

Mothers Commonly Receive No Advice on Infant Care Practices

Advice from Physicians

0% 20% 40% 60% 80% 100%

Pacifier Use

Sleep Location

Sleep Position

Breastfeeding

Immunizations

AAP Advice Against AAP Advice No Advice

Eisenberg, S.R., et al. Pediatrics, 136: DOI: 10.1542/peds.2015-0551, 2015.

SIDS Mothers Commonly Receive No Advice on Infant Care Practices

Advice from Nurses

0% 20% 40% 60% 80% 100%

Pacifier Use

Sleep Location

Sleep Position

Breastfeeding

Immunizations

AAP Advice Against AAP Advice No Advice

108 Stastny, P.F., et al. Nursing Research, 53: 122-129, 2004.

68%

31%

Prone Side Supine

Penny Stastny

Safest Sleeping Position to Reduce the Risk for SIDS Cited by Nurses

0

20

40

60

80Nu

rses

(%)

2% 8%

72%

18%

Side or Supine

n = 96 nurses


0

20

40

60

80N

urse

s (%

)

1%

68%

31%

n = 96 nurses

Prone Side Supine

Infant Sleep Position Chosen by Nursery Staff in Hospital Normal Newborn Nurseries

Penny Stastny


0

20

40

60M

othe

rs (%

)

1%

49% 37%

14%

Prone Side Supine Side or Supine

Reported by Mothers, N = 579

Infant Sleep Position Modeled by Nursery Staff in Hospital Normal Newborn Nurseries

Penny Stastny


0

20

40

60M

othe

rs (%

)

1%

49% 37%

14%



Infant Sleep Position Modeled by Nursery Staff in Hospital Normal Newborn Nurseries

Penny Stastny



Penny Stastny

0

20

40

60

1%

50% 36%

12%


Infant Sleep Position Mothers will Choose to Use at Home Pa

rent

s (%

)


0

20

40

60

80

100M

othe

rs w

ho w

ill p

lace

thei

r bab

ies

supi

ne a

t hom

e (%

)

80%

61% 55%

7%

N = 579 mothers R/M R/NoM NoR/M NoR/NoM

R = Recommendation M = Modeling

Mothers’ Willingness to Follow Safe Infant Sleep Guidelines at Home

Penny Stastny

0% 25% 50% 75% 100%

Head Nurse Instruction

Physician Instruction

Verbal Policy

Written Policy

Personal Knowledge

Fear of Aspiration

n = 96 nurses

Stastny, P.F., et al. Nursing Research, 53: 122-129, 2004.

91%

41%

5%

6%

3%

3%

Penny Stastny

Why Did Some Nurses Choose the Side Sleeping Position?

0%

2%

4%

6%

8%

10%

Awake Asleep

Hea

lthy

New

born

Infa

nts

(%) n = 3,240 neonates

Tablizo, M.A., et al. Arch. Pediatr. & Adolesc. Med.: 161: 507-510, 2007.

Mary Anne Tablizo

3.4% 3.7%

Infants who “Spit-up”

0%

20%

40%

60%

80%

None Bulb syringe Stimulation Wall Suction

Eve

nts

(%) R

equi

ring

inte

rven

tion Supine (n=130)

Side (n=12)

Tablizo, M.A., et al. Arch. Pediatr. & Adolesc. Med.: 161: 507-510, 2007.

Mary Anne Tablizo

Interventions for Infants who “Spit-up” while Asleep

Supine

Alone

Firm mattress

Empty crib

118

0.0

0.5

1.0

1.5

2.0

1980 1985 1990 1995 2000 2005 2010

SID

S R

ate

per

1,0

00 L

ive B

irth

s

CaliforniaUSA

Primary Care Physician

Public Health Nurse

SIDS Parent Support

SIDS

Stastny, P.F., et al. Publ. Health Nurs., 33: 242-248, 2016

Guilt Grief

• Meet with the parents. • Refer them to a SIDS Parent Support group. • As an authority on healthcare, tell them:

• There is nothing they did to cause the death.

• There is nothing they could have done to prevent the death.

• Recognize that health care professionals also feel guilty.

If you have a SIDS death in your practice …

Stastny, P.F., et al. Publ. Health Nurs., 33: 242-248, 2016

WARNING The cause of SIDS is not yet known.

This information has not been proved to be the cause of SIDS.

However, I have attempted to give you some idea about some current

directions of SIDS research.



Hannah Kinney



SIDS

• Most common cause of infant death between age 1-month and 1-year.

• Cause remains unknown.

• Can not be predicted in infants prior to death.

• Reduction in SIDS in populations through public health intervention.

• But SIDS has not been eliminated!


Documents

L.A. Best Babies Network First Five Los Angeles February 13 ...welcomebaby.labestbabies.org/wp-content/uploads/2018/02/...No Conflicts of Interest to Disclose Sudden Infant Death Syndrome