Risk Of Sudden Infant Death Syndrome Research Articles

Fetal and infant death associated with short-term ozone exposure

Background: Air pollution is linked to adverse pregnancy outcomes such as preterm births, but few studies evaluated its acute impact on fetal and infant mortality. We evaluated short-term impacts of warm-season ozone and cold-season fine particulate matter <2.5 microns (PM2.5) exposures on the risk of fetal death (>20 weeks) and infant mortality (live birth to one year). Methods: This time-stratified case-crossover analysis includes 1,880 singleton fetal deaths (2007-2011) and 3,229 singleton infant deaths (2007-2015) from the San Joaquin Valley (SJV), California. Daily ozone and PM2.5 were estimated by the SJV Air Pollution Control District and geospatially linked to maternal zip code at birth. Critical exposure windows of interest included the day of death (lag 0) up to 14 days before (lag 14). Conditional logistic regression models estimated the odds ratio (OR) and 95% confidence intervals (CI) for each 5 units increase in pollutant. Results: In warm season (May-October), a 5-ppb increase in ozone was associated with a 7% (95% CI: 2%-13%) increased risk of fetal death and 6% (95% CI: 2%-10%) increased risk of infant death within two weeks. The estimates were generally consistent from lag 0 to lag 14 for both mortality outcomes, with evidence of slightly stronger estimates for fetal death compared to infant death during certain lags. During lag 7, a 5-ppb increase in ozone was associated with a 9% increased risk in fetal death (95% CI: 5%-14%) and a 4% (95% CI: 1%-7%) increased risk in infant death. No associations were observed for cold-season PM2.5. Conclusions: Ozone exposure is positively associated with short-term risk of fetal and infant mortality in the warm season. Given the ubiquitous nature of air pollution, these associations merit further investigation. Meanwhile, efforts to minimize exposures among pregnant women may be warranted. Keywords: pollution, infant mortality, fetal death, stillbirth, pregnancy, mortality, ozone

Non-standard therapeutic methods for severe bronchopulmonary dysplasia in a premature newborn – case report

Bronchopulmonary dysplasia is a lung disease that is the most common complication of prematurity and the most common chronic lung disease in neonates treated with mechanical ventilation and/or oxygen therapy. Children with bronchopulmonary dysplasia are at risk of cardiovascular complications, such as pulmonary arterial hypertension and left ventricular hypertrophy. The presented case concerns a premature infant born at 24 weeks gestation with severe bronchopulmonary dysplasia complicated by pulmonary arterial hypertension, interstitial emphysema and emphysema. The patient was subject to non-standard therapeutic procedures including L-citrulline, which may have a beneficial effect on the treatment of complications of severe bronchopulmonary dysplasia. Despite proper treatment, it is not always possible to avoid severe complications of bronchopulmonary dysplasia. Currently, available therapies are not always fully effective and it is necessary to continue searching and implementing new treatments to lower the risk of infant death and minimise long-term complications.

Implementation of the Exclusive Breastfeeding Program at the Umban Sari Health Center, Rumbai District, Pekanbaru City

Exclusive Mother's Milk (ASI) is breast milk that is given to babies from birth to 6 months without providing additional food or replacing it with other foods or drinks, except drugs, vitamins and minerals. Breast milk also contains colostrum which is rich in antibodies, because it contains protein to maintain the baby's immune system and kills germs in high quantities which can also reduce the risk of death in infants. Umban Sari Public Health Center, Rumbai District, is the area with the lowest coverage percentage, which is 48.5%. The problems found at the Umban Sari Health Center related to this exclusive breastfeeding program are HR/Health Personnel, Facilities and Infrastructure, Funding, Coordination, Counseling and Counseling. The purpose of this study was to determine the implementation of the exclusive breastfeeding program at the Umban Sari Health Center, Rumbai District in 2022. This type of research was a qualitative research with descriptive research methods to 8 informants consisting of the Head of the Puskesmas, PJ ASI, 2 Posyandu Cadres, 2 Mothers. Pregnant, Lurah and RW. This research was carried out in April 2022 at the Umban Sari Health Center, Rumbai District, Pekanbaru City in 2022. The results of this study indicate that human resources / health workers are still not optimal because there are still many who have double jobs and there are still no facilities and infrastructure such as diaper changing tables. for babies, breast pumps, etc. and for funding, namely the unavailability of special funds related to the exclusive breastfeeding program, for the coordination itself it has been going well but not specifically for the exclusive breastfeeding program but for all programs and for counseling activities, namely the lack of community participation and support from family during the implementation of this activity and for the outreach activities themselves, which are not carried out routinely every month and community participation is also still low

Factors Associated with Infant Deaths in Indonesia: An Analysis of the 2012 and 2017 Indonesia Demographic and Health Surveys.

This exploratory study aimed to investigate factors related to infant deaths using a conceptual framework that explains the risk factors of infant deaths in developing countries. The study adopted a cross-sectional study design and used data from the 2012 and 2017 Indonesia Demographic and Health Surveys, with a sample of 3694 singleton live births in 2012 and 3413 in 2017. Female infants had a lower chance of mortality compared to male infants [adjusted odds ratio (aOR) = 0.51; 95% confidence interval (CI) = 0.34-0.77]. Infants with a smaller birth size had a higher risk of infant death compared to those with an average size (aOR = 5.66; 95% CI = 3.66-8.77). The risk of infant death with a preceding birth interval of ≥24 months was lower than that with a preceding birth interval of <24 months (aOR = 0.48; 95% CI = 0.26-0.90). An older maternal age was a risk factor for infant death compared to younger mothers (aOR = 3.61; 95% CI = 1.42-9.23). Infants who were born in Sumatra (aOR = 0.38; 95% CI = 0.16-0.89) and Java and Bali (aOR = 0.33; 95% CI = 0.14-0.78) were less likely to die than infants who were born in Papua and Maluku. A higher infant death risk was associated with male babies and a shorter birth interval (<24 months). Mothers who perceived their babies to be small and mothers who were older (35-49 years old) were high-risk factors for infant mortality. Mothers who lived in Java and Bali as well as Sumatera were less likely to experience infant mortality compared to those who lived in Papua and Maluku.

Faktor-faktor yang Mempengaruhi Kejadian Hamil di Luar Nikah Pada Remaja Putri dalam Masa Pandemi Covid-19 di Wilayah Kerja Puskemas Tujuh Ulu Palembang 2021

Teenage pregnancy has a negative impact on both mother and baby. According to WHO, girls aged 10-14 years have a five times greater risk of dying in pregnancy and childbirth than women aged 20-24 years. Child marriage causes early pregnancy and childbirth which is associated with a high mortality rate and mothers who give birth under the age of 18 also have a risk of death in infants, namely premature and stunted babies, pregnant at a young age are also prone to bleeding, miscarriage. , pregnant with grapes and pregnant prematurely during pregnancy even give wrong parenting to children because of the limited knowledge of the nature of motherhood in psychology. This study aims to determine the relationship between knowledge, attitudes and the role of parents simultaneously with the incidence of pregnancy out of wedlock in adolescent girls during the Covid-19 pandemic in the Seven Ulu Public Health Center working area, Palembang in 2021. This study used an analytical survey with quantitative methods with a design design. cross sectional research, where the dependent variable is pregnant out of wedlock and the independent variable is knowledge, attitudes and the role of parents are collected simultaneously. The population in this study were all pregnant women in the Work Area of the Tujuh Ulu Health Center, Palembang in 2021, which were estimated to be 124 pregnant women from January-June. The sample is some of the mothers who are in the Working Area of the Tujuh Ulu Public Health Center Palembang in 2021. From the results of research that has been carried out at the Tujuh Ulu Health Center Palembang, it can be concluded that there is a partial relationship between knowledge and the incidence of pregnancy outside of marriage at the Tujuh Ulu Public Health Center Palembang in 2021, there is no partial relationship between maternal attitudes and the incidence of pregnancy outside marriage at the Tujuh Ulu Public Health Center Palembang in 2021 and there is a partial relationship between parental roles and the incidence of pregnancy outside of marriage at the Puskesmas.

Faktor-faktor yang Mempengaruhi Pengeluaran ASI pada Ibu Postpartum Di Wilayah Kerja Puskesmas Tanjung Agung Kecamatan Tanjung Agung Kabupaten Muara Enim Tahun 2021

Mother's milk contains a lot of colostrum which is rich in antibodies because it has protein content that is useful as an immune system that is useful for killing germs in large numbers so that giving breast milk can reduce the risk of infant death. This study used an analytic survey with a cross sectional research design. This research was conducted in the working area of the Tanjung Agung Public Health Center, Tanjung Agung District, Muara Enim Regency in August 2021. The population in this study were all postpartum mothers in the Tanjung Agung Health Center work area. The sample used amounted to 72 of the population taken by using the technique of determining the sample. Data analysis used univariate analysis (proportion) and bivariate analysis (Chi square test). The results of the analysis showed that diet, mother's knowledge, and nipple problems had a significant relationship with breastfeeding in postpartum mothers. The conclusion of this study is that there is a relationship between diet, knowledge of breast care and nipple problems simultaneously with breastfeeding in postpartum mothers in the Tanjung Agung Public Health Center, Tanjung Agung District, Muara Enim Regency in 2021. As a research suggestion, researchers hope that breastfeeding mothers can know what factors can affect milk production. so that the coverage of exclusive breastfeeding for infants continues to increase.

Effect of sleep position in term healthy newborns on sudden infant death syndrome and other infant outcomes: A systematic review.

BackgroundThough recommended by numerous guidelines, adherence to supine sleep position during the first year of life is variable across the globe.MethodsThis systematic review of randomized trials and observational studies assessed the effect of the supine compared to non-supine (prone or side) sleep position on healthy newborns. Key outcomes were neonatal mortality, sudden infant death syndrome (SIDS), sudden unexpected death in infancy (SUDI), acute life-threatening event (ALTE), neurodevelopment, and positional plagiocephaly. We searched MEDLINE via PubMed, Cochrane CENTRAL, EMBASE, and CINAHL (updated till November 2021). Two authors separately evaluated the risk of bias, extracted data, and synthesised effect estimates using relative risk (RR) or odds ratio (OR). The GRADE approach was used to assess the certainty of evidence.ResultsWe included 54 studies (43 observational studies and 11 intervention trials) involving 474 672 participants. A single study meeting the inclusion criteria suggested that the supine sleep position might reduce the risk of SUDI (0-1 year; OR = 0.39, 95% confidence interval (CI) = 0.23-0.65; 384 infants), compared to non-supine position. Supine sleep position might reduce the risk of SIDS (0-1 year; OR = 0.51, 95% CI = 0.42-0.61; 26 studies, 59332 infants) and unexplained SIDS/severe ALTE (neonatal period; OR = 0.16, 95% CI = 0.03-0.82; 1 study, 119 newborns), but the evidence was very uncertain. Supine sleep position probably increased the odds of being 0.5 standard deviation (SD) below mean on Gross Motor Scale at 6 months (OR = 1.67, 95% CI = 1.22-2.27; 1 study, 2097 participants), but might have little to no effect at 18 months of age (OR = 1.16, 95% CI = 0.96, 1.43; 1 study, 1919 participants). An increase in positional plagiocephaly at 2-7 months of age with supine sleep position is possible (OR = 2.77, 95% CI = 2.06-3.72; 6 studies, 1774 participants).ConclusionsLow- to very low-certainty evidence suggests that supine sleep position may reduce the risk of SUDI (0-1 year) and SIDS (0-1 year). Limited evidence suggests that supine sleeping probably delays short-term ‘gross motor’ development at 6 months, but the effect on long-term neurodevelopment at 18 months may be negligible.

Machine Learning Model Based on Lipidomic Profile Information to Predict Sudden Infant Death Syndrome

Sudden infant death syndrome (SIDS) represents the leading cause of death in under one year of age in developing countries. Even in our century, its etiology is not clear, and there is no biomarker that is discriminative enough to predict the risk of suffering from it. Therefore, in this work, taking a public dataset on the lipidomic profile of babies who died from this syndrome compared to a control group, a univariate analysis was performed using the Mann–Whitney U test, with the aim of identifying the characteristics that enable discriminating between both groups. Those characteristics with a p-value less than or equal to 0.05 were taken; once these characteristics were obtained, classification models were implemented (random forests (RF), logistic regression (LR), support vector machine (SVM) and naive Bayes (NB)). We used seventy percent of the data for model training, subjecting it to a cross-validation (k = 5) and later submitting to validation in a blind test with 30% of the remaining data, which allows simulating the scenario in real life—that is, with an unknown population for the model. The model with the best performance was RF, since in the blind test, it obtained an AUC of 0.9, specificity of 1, and sensitivity of 0.8. The proposed model provides the basis for the construction of a SIDS risk prediction computer tool, which will contribute to prevention, and proposes lines of research to deal with this pathology.

Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths.

Every year in the United States, approximately 3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Statistical Classification of Diseases and Related Health Problems 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths have remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. In addition, additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, which is included in this issue.

Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment.

Each year in the United States, ∼3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Classification of Diseases, 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths has remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. Additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is also included. The recommendations and strength of evidence for each recommendation are included in this policy statement. The rationale for these recommendations is discussed in detail in the accompanying technical report.

A proof-of-concept study to construct Bayesian network decision models for supporting the categorization of sudden unexpected infant death

Sudden infant death syndrome (SIDS) remains a leading cause of infant death in high-income countries. Supporting models for categorization of sudden unexpected infant death into SIDS/non-SIDS could reduce mortality. Therefore, we aimed to develop such a tool utilizing forensic data, but the reduced number of SIDS cases renders this task inherently difficult. To overcome this, we constructed Bayesian network models according to diagnoses performed by expert pathologists and created conditional probability tables in a proof-of-concept study. In the diagnostic support model, the data of 64 sudden unexpected infant death cases was employed as the training dataset, and 16 known-risk factors, including age at death and co-sleeping, were added. In the validation study, which included 8 new cases, the models reproduced experts’ diagnoses in 4 or 5 of the 6 SIDS cases. Next, to confirm the effectiveness of this approach for onset prediction, the data from 41 SIDS cases was employed. The model predicted that the risk of SIDS in 0- to 2-month-old infants exposed to passive smoking and co-sleeping is eightfold higher than that in the general infant population, which is comparable with previously published findings. The Bayesian approach could be a promising tool for constructing SIDS prevention models.

Positioning for acute respiratory distress in hospitalised infants and children.

Positioning for acute respiratory distress in hospitalised infants and children.

Maternal Smoking, Alcohol and Recreational Drug Use and the Risk of SIDS Among a US Urban Black Population.

BackgroundRates of sudden infant death syndrome (SIDS) are twice as high among Black infants compared to white infants in the US. While the contribution of sleep environment factors to this disparity is known, little is known about the risk of SIDS among Black infants in relation to maternal prenatal smoking, alcohol and drug use as well as infant smoke exposure.ObjectiveTo assess the contribution of maternal substance use during pregnancy and the potential interactions with infant bedsharing in a high-risk, urban Black population.MethodsThe Chicago Infant Mortality Study (CIMS) collected data on 195 Black infants who died of SIDS and 195 controls matched on race, age and birthweight. Risk of SIDS was calculated for maternal smoking, alcohol and drug use, adjusting for potential confounding variables and other risk factors for SIDS. Interactions between these substance use variables and bedsharing were also calculated.ResultsInfants were more likely to die from SIDS if the mother smoked during pregnancy (aOR 3.90, 95% CI 1.37–3.30) and post-pregnancy (aOR 2.49, 95% CI 1.49–4.19). There was a dose response seen between amount smoked during pregnancy and risk of SIDS. Use of alcohol (aOR 2.89, 95% CI 1.29–6.99), cocaine (aOR 4.78, 95% CI 2.45–9.82) and marijuana (aOR 2.76, 95% CI 1.28–5.93) were associated with increased risk of SIDS. In the final, multivariable model controlling for sociodemographic factors and covariates, maternal smoking (aOR 3.03, 95% CI 1.03–8.88) and cocaine use (aOR 4.65, 95% CI 1.02–21.3) during pregnancy remained significant. There were significant, positive interactions between bedsharing and maternal smoking during pregnancy and post-pregnancy, alcohol use and cocaine use.ConclusionMaternal use of tobacco, alcohol and cocaine during pregnancy is associated with significantly increased risk of SIDS in a Black, urban population. Reducing substance use and eliminating disparities in SIDS, sudden unexpected infant death (SUID) (also known as sudden unexpected death in infancy or SUDI) and infant mortality need to involve more than individual level education, but instead will require a comprehensive examination of the role of social determinants of health as well as a multi-pronged approach to address both maternal and infant health and wellbeing.

Birth anthropometry predicts neonatal and infant mortality in rural Bangladesh: a focus on circumferential measurements

ABSTRACTBackgroundLow birth weight predicts risk of infant death. However, several birth measurements may be equally predictive, for which cutoffs and associated risks are less explored.ObjectivesWe assessed and optimized population cutoffs of birth length, weight, and midupper arm circumference (MUAC), head circumference (HC), and chest circumference (CC) for predicting neonatal (≤28 d) and infant (≤365 d) mortality in northwest Bangladesh.MethodsAmong 28,026 singletons born in an antenatal micronutrient supplement trial, 21,174 received anthropometry ≤72 h after birth, among whom 583 died in infancy. Optimization for predicting mortality for each measurement was guided by the Youden Index (sensitivity + specificity – 1). Relative risk ratios (RRRs) and positive predictive values (PPVs) were calculated across cutoff ranges for individual and any pair of measurements.ResultsOptimal cutoffs, harmonized to 100-g or 0.5-cm readings, for neonatal and infant mortality were 44.5 cm for length, 2200 g for weight, 9.0 cm for MUAC, 31.0 cm for HC, and 28.5 cm for CC, below which all predicted mortality. However, a CC <28.5 cm, alone and combined with HC <31.0 cm, yielded the highest RRR [9.68 (95% CI: 7.84, 11.94) and 15.74 (95% CI: 12.54, 19.75), respectively] and PPV (11.3% and 10.7%) for neonatal mortality and highest RRR [6.02 (95% CI: 5.15, 7.02) and 9.19 (95% CI: 7.72, 10.95)] and PPV (16.3% and 14.5%) for infant mortality. Pairs of measurements revealed a higher RRR for neonatal and infant mortality than individual measurements of any one pair, although the ranges of PPV remained comparable.ConclusionsIn Bangladesh, multiple birth measurements alone or in combination, particularly chest circumference, predict neonatal and infant mortality.

Hyperthermia and Heat Stress as Risk Factors for Sudden Infant Death Syndrome: A Narrative Review.

Background and ObjectivesHeat stress and hyperthermia are common findings in sudden infant death syndrome (SIDS) victims. It has been suggested that thermal stress can increase the risk of SIDS directly via lethal hyperthermia or indirectly by altering autonomic functions. Major changes in sleep, thermoregulation, cardiovascular function, and the emergence of circadian functions occur at the age at which the risk of SIDS peaks—explaining the greater vulnerability at this stage of development. Here, we review the literature data on (i) heat stress and hyperthermia as direct risk factors for SIDS, and (ii) the indirect effects of thermal loads on vital physiological functions.ResultsVarious situations leading to thermal stress (i.e., outdoors temperatures, thermal insulation from clothing and bedding, the prone position, bed-sharing, and head covering) have been analyzed. Hyperthermia mainly results from excessive clothing and bedding insulation with regard to the ambient thermal conditions. The appropriate amount of clothing and bedding thermal insulation for homeothermia requires further research. The prone position and bed-sharing do not have major thermal impacts; the elevated risk of SIDS in these situations cannot be explained solely by thermal factors. Special attention should be given to brain overheating because of the head's major role in body heat losses, heat production, and autonomic functions. Thermal stress can alter cardiovascular and respiratory functions, which in turn can lead to life-threatening events (e.g., bradycardia, apnea with blood desaturation, and glottal closure). Unfortunately, thermal load impairs the responses to these challenges by reducing chemosensitivity, arousability, and autoresuscitation. As a result, thermal load (even when not lethal directly) can interact detrimentally with vital physiological functions.ConclusionsWith the exception of excessive thermal insulation (which can lead to lethal hyperthermia), the major risk factors for SIDS appears to be associated with impairments of vital physiological functions when the infant is exposed to thermal stress.

SIDS is associated with prenatal drug use: a meta-analysis and systematic review of 4 238 685 infants

ObjectiveTo conduct a meta-analysis to determine the association between prenatal drug exposure and risk of sudden infant death syndrome (SIDS).DesignStudies were searched using PubMed, Medline and Embase and restricted to...

Cerebrospinal Fluid Histamine Levels in Healthy Children and Potential Implication for SIDS: Observational Study in a French Tertiary Care Hospital.

ObjectiveA defect of the waking systems could constitute a factor of vulnerability for sudden infant death syndrome (SIDS). A decrease in orexin levels, which promotes wakefulness and activates histaminergic neurons (another hypothalamic wake-promoting system) has already been demonstrated between 2 and 6 months. This work aims to study the levels of histamine (HA), tele-methylhistamine (t-MeHA), its direct metabolite, and t-MeHA/HA ratio in the cerebrospinal fluid (CSF) of healthy children, to evaluate the maturation of the histaminergic system and its possible involvement in SIDS.MethodsSeventy Eight French children between 0 and 20 years (48.7% boys) were included, all of whom had a clinical indication for lumbar puncture, but subsequently found to be normal. Measurements of HA and t-MeHA in CSF were performed by reverse phase liquid chromatography coupled to mass spectrometry detection. Statistical analyses were performed using Spearman correlations and Non-parametric pairwise ranking tests.ResultsA negative correlation was found between age and CSF HA (r = −0.44, p < 10−4) and t-MeHA (r = −0.70, p < 10−4) levels. In pairwise comparisons, no difference in CSF HA and t-MeHA levels was observed between youngest age groups (i.e., 0–2 mo vs. 3–6 mo), but CSF HA and t-MeHA levels were significantly lower in older children (i.e., >6 mo vs. 0–6 mo). The CSF HA decrease with age was only observed in boys, who also presented global lower CSF HA levels than girls.ConclusionCSF HA and t-MeHA levels decrease with age in boys, and global levels are lower in boys than in girls. These results reveal changes in histaminergic transmission and metabolism during maturation. Whether lower CSF histamine values in boys compared to girls could contribute to their higher risk of SIDS warrants further research.

Infant mortality and death clustering at the district level in India: A Bayesian approach

This study assessed the clustering of and spatial variations in infant mortality between districts in selected states of India using a Bayesian geoadditive model. The study utilized 10 years of retrospective birth history of women from the fourth round of NFHS-4 (2015–16). Findings suggest, except Kerala, there was a significant amount of clustering of infant deaths in families in the selected Indian states. The maximum impact of clustering was observed in Assam, followed by Madhya Pradesh, Bihar, Uttarakhand, and Uttar Pradesh. The estimated residual spatial effect was statistically significant in all the states, with the maximum effect being in Assam and Chhattisgarh. The risk of infant death in Assam was higher in the north-eastern districts and lower in the southern districts of the state. Mother's age at child birth had a nonlinear effect on infant death in all the states, although significant effects were observed only in Bihar and Assam. In both of these states, mother's age at child birth had a “U-shape,” showing that the risk of infant death was higher at both earlier and later ages of mother's reproductive period. With the exception of Kerala, all the other selected states in the study had an “elongated L shaped” pattern, showing that in the early ages of the reproductive period, the risk of infant death was very high and that it gradually decreased with age and remained constant thereafter. In Kerala, mother's age at child birth was a straight line, implying that the risk of infant death was constant across the reproductive age of women. In order to keep infant mortality at a low level and to achieve better maternal and child health outcomes, the government needs to target families experiencing multiple infant deaths. In addition, programs must take into consideration the prevailing state-specific spatial heterogeneity in infant deaths and factors like mother's age at child birth.

Accelerating Upstream Together: Achieving Infant Health Equity in the United States by 2030.

Accelerating Upstream Together: Achieving Infant Health Equity in the United States by 2030.

Mothers' Decision Making Concerning Safe Sleep for Preterm Infants: What Are the Influencing Factors?

Parental decisions regarding infant sleep practices vary widely, resulting in a lack of adherence to the American Academy of Pediatrics safe sleep recommendations (SSR) and consequently an increased risk of sudden infant death syndrome (SIDS). Preterm infants are among those at a highest risk for SIDS, yet few studies focus on parental decision-making surrounding sleep practices for preterm infants. The purpose of this study was to identify factors influencing decisions concerning infant sleep practices of mothers of preterm infants. This study used a mixed-methods design. Recruitment was through social media messaging by 2 parent support organizations. An online survey was used to assess factors influencing mothers' decisions regarding sleep practices for preterm infants. Survey participants (n = 98) were from across the United States. Mothers of preterm infants (mean gestational age at birth = 29.42 weeks) most often reported positioning infants on their back to sleep (92.3%) and a low (15.4%) use of a pacifier at sleep time. Three themes emerged for the decisions made: adherence to SSR; nonadherence to SSR; and infant-guided decisions. Regardless of the decision, mothers indicated that anxiety over the infant's well-being resulted in a need for sleep practices that facilitated close monitoring of the infant. The findings of this study indicate the need for understanding the underlying anxiety preventing mothers from adhering to SSR despite knowing them, along with tailoring infant sleep messaging and education to improve safety of sleep practices for preterm infants. Research is needed to examine decision making in more diverse populations.