Tuesday, January 27, 2009

Health Care and SIDS

Thousands of infants die suddenly every year in the U.S. from Sudden Infant Death Syndrome (SIDS). According to the American SIDS Institute, SIDS is the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history. (Willinger et al, 1991). In a typical situation parents check on their supposedly sleeping infant to find him or her dead. This is the worse tragedy parents can face, a tragedy which leaves them with a sadness and a feeling of vulnerability that lasts throughout their lives. Since medicine can not tell them why their baby died, they blame themselves and often other innocent people. Their lives and those around them are changed forever. Unfortunately, we cannot expect to prevent all SIDS deaths now. To do so requires a much greater understanding of SIDS, which will be achieved only with a commitment from those who value babies and with a considerably expanded research effort.

According to BabyCenter.com, researchers have learned a great deal about SIDS in the past three decades, but they still have no definitive answer to that question. Some experts believe that SIDS happens when a baby with an underlying abnormality (for example, a brain defect that affects breathing) sleeps tummy-down or is faced with an environmental challenge such as secondhand smoke during a critical period of growth. Others have published studies that contradict this hypothesis.

KidsHealth by the Nemours Foundation reports that a lack of answers is part of what makes sudden infant death syndrome (SIDS) so frightening. SIDS is the leading cause of death among infants 1 month to 1 year old, and claims the lives of about 2,500 each year in the United States. It remains unpredictable despite years of research. Even so, the risk of SIDS can be greatly reduced. First and foremost, infants younger than 1 year old should be placed on their backs to sleep — never face-down on their stomachs. As the name implies, SIDS is the sudden and unexplained death of an infant who is younger than 1 year old. It's a frightening prospect because it can strike without warning, usually in seemingly healthy babies. Most SIDS deaths are associated with sleep (hence the common reference to "crib death") and infants who die of SIDS show no signs of suffering. While most conditions or diseases usually are diagnosed by the presence of specific symptoms, most SIDS diagnoses come only after all other possible causes of death have been ruled out through a review of the infant's medical history and environment. This review helps distinguish true SIDS deaths from those resulting from accidents, abuse, and previously undiagnosed conditions, such as cardiac or metabolic disorders. When considering which babies could be most at risk, no single risk factor is likely to be sufficient to cause a SIDS death. Rather, several risk factors combined may contribute to cause an at-risk infant to die of SIDS. Most deaths due to SIDS occur between 2 and 4 months of age, and incidence increases during cold weather. African-American infants are twice as likely and Native American infants are about three times more likely to die of SIDS than caucasian infants. More boys than girls fall victim to SIDS. Other potential risk factors include:
--smoking, drinking, or drug use during pregnancy
--poor prenatal care
--prematurity or low birth-weight
--mothers younger than 20
--tobacco smoke exposure following birth
--overheating from excessive sleepwear and bedding
--stomach sleeping

According to KidsHealth, foremost among these risk factors is stomach sleeping. Numerous studies have found a higher incidence of SIDS among babies placed on their stomachs to sleep than among those sleeping on their backs or sides. Some researchers have hypothesized that stomach sleeping puts pressure on a child's jaw, therefore narrowing the airway and hampering breathing. Another theory is that stomach sleeping can increase an infant's risk of "rebreathing" his or her own exhaled air, particularly if the infant is sleeping on a soft mattress or with bedding, stuffed toys, or a pillow near the face. In that scenario, the soft surface could create a small enclosure around the baby's mouth and trap exhaled air. As the baby breathes exhaled air, the oxygen level in the body drops and carbon dioxide accumulates. Eventually, this lack of oxygen could contribute to SIDS. Also, infants who succumb to SIDS may have an abnormality in the arcuate nucleus, a part of the brain that may help control breathing and awakening during sleep. If a baby is breathing stale air and not getting enough oxygen, the brain usually triggers the baby to wake up and cry. That movement changes the breathing and heart rate, making up for the lack of oxygen. But a problem with the arcuate nucleus could deprive the baby of this involuntary reaction and put him or her at greater risk for SIDS.

However, there are things that can be done to reduce the risk of SIDS according to the American SIDS Institute:

Parents-To-Be:
1. Get medical care early in pregnancy, preferably within the first three months, followed by regular checkups at the doctor's office or health clinic. Make every effort to assure good nutrition. These measures can reduce the risk of premature birth, a major risk factor for SIDS.
2. Do not smoke, use cocaine, or use heroin. Tobacco, cocaine, or heroin use during pregnancy increases the infant's risk for SIDS.
3. Don’t get pregnant during the teenage years. If you are a teen and already have one infant, take extreme caution not to become pregnant again. The SIDS rate decreases for babies born to older mothers. It is highest for babies born to teenage mothers. The more babies a teen mother has, the greater at risk they are.
4. Wait at least one year between the birth of a child and the next pregnancy.The shorter the interval between pregnancies, the higher the SIDS rate.

Parents:
1. Place infants to sleep on their backs, even though they may sleep more soundly on their stomachs. Infants who sleep on their stomachs and sides have a much higher rate of SIDS than infants who sleep on their backs.
2. Place infants to sleep in a baby bed with a firm mattress. There should be nothing in the bed but the baby - no covers, no pillows, no bumper pads, no positioning devices and no toys. Soft mattresses and heavy covering are associated with the risk for SIDS.
3. Keep your baby’s crib in the parents’ room until the infant is at least 6 months of age. Studies clearly show that infants are safest when their beds are close to their mothers.
4. Do not place your baby to sleep in an adult bed. Typical adult beds are not safe for babies. Do not fall asleep with your baby on a couch or in a chair.
5. Do not over-clothe the infant while she sleeps. Just use enough clothes to keep the baby warm without having to use cover. Keep the room at a temperature that is comfortable for you. Overheating an infant may increase the risk for SIDS.
6. Avoid exposing the infant to tobacco smoke. Don't have your infant in the same house or car with someone who is smoking. The greater the exposure to tobacco smoke, the greater the risk of SIDS.
7. Breast-feed babies whenever possible. Breast milk decreases the occurrence of respiratory and gastrointestinal infections. Studies show that breast-fed babies have a lower SIDS rate than formula-fed babies do.
8. Avoid exposing the infant to people with respiratory infections. Avoid crowds. Carefully clean anything that comes in contact with the baby. Have people wash their hands before holding or playing with your baby. SIDS often occurs in association with relatively minor respiratory (mild cold) and gastrointestinal infections (vomiting and diarrhea).
9. Offer your baby a pacifier. Some studies have shown a lower rate of SIDS among babies who use pacifiers.
10. If your baby has periods of not breathing, going limp or turning blue, tell your pediatrician at once.
11. If your baby stops breathing or gags excessively after spitting up, discuss this with your pediatrician immediately.
12. Thoroughly discuss each of the above points with all caregivers. If you take your baby to daycare or leave him with a sitter, provide a copy of this list to them. Make sure they follow all recommendations.

According to BabyCenter.com, a great resource for SIDS information, put your baby to sleep on his back. This is the single most important thing you can do to help protect your baby.The rate of deaths from SIDS has dropped more than 50 percent since 1994, when the Back to Sleep campaign was launched by the American Academy of Pediatrics (AAP), the U.S. Public Health Service, the SIDS Alliance, and the Association of SIDS and Infant Mortality Programs. Make sure that anyone who cares for your baby — relatives and babysitters, for example — knows not to place your baby on his tummy to sleep. Most people don't know that side sleeping isn't safe, either. In fact, if your baby sleeps on his side rather than on his back, his risk of SIDS is doubled. That's because babies placed on their side can easily end up on their tummy. Of course, by the time your baby is 5 or 6 months old, he may be able to roll over in both directions, making it a challenge to keep him on his back at night. At this age his risk for SIDS starts to drop, though, so just do your best to get him settled on his back, and then don't worry if he rolls over. Keep in mind that putting your baby on his back all the time can cause him to develop a flat spot on the back or side of his head, called plagiocephaly or flat head syndrome. You can help prevent this condition by learning how to position your baby when you lay him down. (If you have any questions about your baby's sleep position, talk to your doctor or nurse.)

SIDS is a tragedy whenever it happens, and too often occurs as a result of unintentional negligence on the part of parents or caregivers. However, when a baby succumbs to death by SIDS, everyone suffers--family, friends, pediatricians, and the community mourn the loss of innocent life. More education and research needs to happen on the part of new parents and medical providers to ensure that the statistics of SIDS death are reversed to a vastly reduced rate of infant mortality.

Until next time. Let me know what you think.

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