Risk Of Sudden Infant Death Syndrome Research Articles

The Institution of a Standardized Investigation Protocol for Sudden Infant Death in the Eastern Metropole, Cape Town, South Africa,.

The rate for the sudden infant death syndrome (SIDS) in Cape Town, South Africa, is estimated to be among the highest in the world (3.41/1000 live births). In several of these areas, including those of extreme poverty, only sporadic, nonstandardized infant autopsy, and death scene investigation (DSI) occurred. In this report, we detail a feasibility project comprising 18 autopsied infants with sudden and unexpected death whose causes of death were adjudicated according to the 1991 NICHD definitions (SIDS, n = 7; known cause of death, n = 7; and unclassified, n = 4). We instituted a standardized autopsy and infant DSI through a collaborative effort of local forensic pathology officers and clinical providers. The high standard of forensic investigation met international standards, identified preventable disease, and allowed for incorporation of research. We conclude that an effective infant autopsy and DSI protocol can be established in areas with both high sudden unexpected infant death, and elsewhere. (SUID)/SIDS risk and infrastructure challenges.

Environmental risk factors for sudden infant death syndrome in Japan.

Most parents already avoid laying infants in the prone position, and parental smoking is still a SIDS risk concern in Japan. Smoking cessation programs should be further implemented for parents to decrease risks of SIDS in Japan. What is Known: • The prevalence of sudden infant death syndrome (SIDS) has decreased worldwide, however, this decline has plateaued recently. What is New: • Most infants were laid sleeping in the supine position (96.7%) and were fed breast milk or a mix of expressed milk and formula (92.7%), and 2.1% of mothers smoked at the one-month medical checkup. • Maternal smoking prevalence significantly increased from the one-month medical checkup to one year later, and smoking mothers were more likely to feed infants by formula rather than breast milk. • Independent risk factors for new or continued maternal smoking habits included younger maternal age, maternal smoking habits at one month, and paternal smoking habits one year later.

Gastroschisis: mortality risks with each additional week of expectant management

Prior studies have evaluated the overall risk of stillbirth in pregnancies with fetal gastroschisis. However, the gestational age at which mortality is minimized, balancing the risk of stillbirth against neonatal mortality, remains unclear. We sought to evaluate the gestational age at which prenatal and postnatal mortality risk is minimized for fetuses with gastroschisis. This was a retrospective cohort study of singleton pregnancies delivered between 24 0/7 and 39 6/7 weeks, using 2005 through 2006 US national linked birth and death certificate data. Among pregnancies with fetal gastroschisis, prospective risk of stillbirth and risk of infant death were determined for each gestational age week. Risk of infant death with delivery was further compared to composite fetal/infant mortality risk with expectant management for 1 additional week. Among 2,119,049 pregnancies, 860 cases (0.04%) of gastroschisis were identified. The overall stillbirth rate among gastroschisis cases was 4.8%, and infant death occurred in 8.3%. Prospective risk of stillbirth became more consistently elevated beginning at 35 weeks, rising to 13.9 per 1000 pregnancies (95% confidence interval, 10.8-17.1) at 39 weeks. Risk of infant death concurrently nadired in the third trimester, ranging between 62.4-66.8 per 1000 live births between 32-39 weeks. Comparing mortality with expectant management vs delivery, relative risk was significantly greater with expectant management between 37-39 weeks, reaching 1.90 (95% confidence interval, 1.73-2.08) at 39 weeks with a number needed to deliver of 17.49 (95% confidence interval, 15.34-20.32) to avoid 1 excess death. Risk of prenatal and postnatal mortality for fetuses with gastroschisis may be minimized with delivery as early as 37 weeks.

Nocturnal Video Assessment of Infant Sleep Environments.

Reports describing factors associated with sleep-related infant death rely on caregiver report or postmortem findings. We sought to determine the frequency of environmental risk factors by using nocturnal sleep videos of infants. Healthy, term newborns were recruited for a parent study examining the role of parenting in the development of nighttime infant sleep patterns. For 1 night at ages 1, 3, and 6 months, video recordings were conducted within family homes. Videos were coded for sudden infant death syndrome risk factors in post hoc secondary analyses after the parent study was completed. Among 160 one-month-olds, initially 21% were placed to sleep on nonrecommended sleep surfaces and 14% were placed nonsupine; 91% had loose/nonapproved items on their sleep surface, including bedding, bumper pads, pillows, stuffed animals, and sleep positioners. Among 151 three-month-olds, 10% were initially placed on a nonrecommended sleep surface, 18% were placed nonsupine, and 87% had potentially hazardous items on their sleep surface. By 6 months, 12% of the 147 infants initially slept on a nonrecommended surface, 33% were placed to bed nonsupine, and 93% had loose/nonrecommended items on their surface. At 1, 3, and 6 months, 28%, 18%, and 12% changed sleep locations overnight, respectively, with an increased likelihood of bed-sharing and nonsupine position at the second location at each time point. Most parents, even when aware of being recorded, placed their infants in sleep environments with established risk factors. If infants were moved overnight, the second sleep environment generally had more hazards.

Hypoxia and hypercapnia inhibit hypothalamic orexin neurons in rats

Evidence of impaired function of orexin neurons has been found in individuals with cardiorespiratory disorders, such as obstructive sleep apnea (OSA) and sudden infant death syndrome (SIDS), but the mechanisms responsible are unknown. Individuals with OSA and SIDS experience repetitive breathing cessations and/or rebreathing of expired air, resulting in hypoxia/hypercapnia (H/H). In this study, we examined the responses of fluorescently identified rat orexin neurons in the lateral hypothalamus to acute H/H to test if and how these neurons alter their activity and function during this challenge. Experiments were conducted in an in vitro slice preparation using voltage-clamp and current-clamp configurations. H/H (10 min) induced hyperpolarization, accompanied by rapid depression, and finally, cessation of firing activity in orexin neurons. Hypoxia alone had similar but less potent effects. H/H did not alter the frequency of inhibitory glycinergic postsynaptic currents. The frequency of GABAergic currents was diminished but only at 8-10 min of H/H. In contrast, the frequency of excitatory glutamatergic postsynaptic events was diminished as early as 2-4 min of H/H. In the presence of glutamatergic receptor blockers, the inhibitory effects of H/H on the firing activity and membrane potential of orexin neurons persisted but to a lesser extent. In conclusion, both direct alteration of postsynaptic membrane properties and diminished glutamatergic neurotransmission likely contribute to the inhibition of orexin neurons by H/H. These mechanisms could be responsible for the decreased function of orexin in individuals at risk for OSA and SIDS.

Swaddling and Infant Sleeping Practices.

Swaddling promotes quiet sleep and may be a useful strategy to encourage infant safe sleep practices. We explored the effect of a swaddling education intervention on infant sleep practices in an urban minority community. We compared a cohort of postpartum mothers who were given education about swaddling to a historical group. Breastfeeding and pacifier use were similar in both groups. Compared to the historical group (n=121), mothers in the swaddling group (n=40) were more likely to swaddle infants to sleep (52.5 vs. 23.1%, p=.001) and less likely to bedshare (15.4 vs. 33.1%, p=.042). No significant effect was reported on infant supine sleep (81.6 vs. 69.4%, p=.212). A postpartum swaddling education intervention had a limited impact on infant safe sleeping practices in an urban minority community. A recent metaanalysis demonstrated an increased risk of sudden infant death in infants swaddled for sleep and recommended the need to avoid the prone and side sleep position, especially for swaddled infants, and to set an age and developmentally appropriate limit for the use of swaddling. Ongoing studies are needed to monitor the safety and effectiveness of swaddling as a tool to promote safe sleeping in infants.

Messaging Affects the Behavior of African American Parents with Regards to Soft Bedding in the Infant Sleep Environment: A Randomized Controlled Trial

To evaluate the impact of specific health messages on the decisions of African American parents regarding soft bedding use, specifically related to the high degree of self-efficacy that African American parents have with regards to preventing infant suffocation vs low self-efficacy with regards to sudden infant death syndrome (SIDS) risk reduction. We conducted a randomized, controlled clinical trial of African American mothers of infants. The control group received standard messaging emphasizing safe sleep practices recommended by the American Academy of Pediatrics for the purposes of SIDS risk reduction. The intervention group received enhanced messaging emphasizing safe sleep practices for both SIDS risk reduction and suffocation prevention. Participants completed interviews at 2-3weeks, 2-3months, and 5-6months after the infant's birth. Of 1194 mothers enrolled, 637 completed all interviews. The use of soft bedding both in the past week and last night declined with age (P<.001). Infants in the enhanced group had a lower rate of use of soft bedding in the past week (P=.006) and last night (P=.013). Mothers who received the enhanced message were more likely to state that they avoided soft bedding to protect their infant from suffocation. African American mothers who receive an enhanced message about SIDS risk reduction and suffocation prevention are less likely to use soft bedding in their infant's sleep environment. ClinicalTrials.gov: NCT01361880.

Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis.

Swaddling is a traditional practice of wrapping infants to promote calming and sleep. Although the benefits and risks of swaddling in general have been studied, the practice in relation to sudden infant death syndrome remains unclear. The goal of this study was to conduct an individual-level meta-analysis of sudden infant death syndrome risk for infants swaddled for sleep. Additional data on sleeping position and age were provided by authors of included studies. Observational studies that measured swaddling for the last or reference sleep were included. Of 283 articles screened, 4 studies met the inclusion criteria. There was significant heterogeneity among studies (I(2) = 65.5%; P = .03), and a random effects model was therefore used for analysis. The overall age-adjusted pooled odds ratio (OR) for swaddling in all 4 studies was 1.58 (95% confidence interval [CI], 0.97-2.58). Removing the most recent study conducted in the United Kingdom reduced the heterogeneity (I(2) = 28.2%; P = .25) and provided a pooled OR (using a fixed effects model) of 1.38 (95% CI, 1.05-1.80). Swaddling risk varied according to position placed for sleep; the risk was highest for prone sleeping (OR, 12.99 [95% CI, 4.14-40.77]), followed by side sleeping (OR, 3.16 [95% CI, 2.08-4.81]) and supine sleeping (OR, 1.93 [95% CI, 1.27-2.93]). Limited evidence suggested swaddling risk increased with infant age and was associated with a twofold risk for infants aged >6 months. Heterogeneity among the few studies available, imprecise definitions of swaddling, and difficulties controlling for further known risks make interpretation difficult. Current advice to avoid front or side positions for sleep especially applies to infants who are swaddled. Consideration should be given to an age after which swaddling should be discouraged.

Role of antibiotics in reducing childhood mortality in resource-poor settings.

A recent article ‘A quiet revolution in the treatment of childhood diarrhea’ in the New York Times[1] highlights childhood diarrhea, a ‘silent’ killer of infants and children in resource-poor settings, second in magnitude only to pneumonia. Diarrhea treatment guidelines in such settings rely on oral rehydration and reserve antibiotics for the presence of blood in the stool. These guidelines were developed more than 30 years ago. Newer evidence points to the higher than previously thought frequency of bacterial causes, even in the absence of visible blood in the stool [1]. Some experts argue that empiric antibiotic treatment of childhood diarrhea in resource-poor settings is a more cost-effective option than microbiologic testing to determine the cause. Others argue that such use of antibiotics will lead to widespread resistance. Several lines of recent evidence have shown a benefit of administering antibiotics to children in resource-poor settings in which malaria is also prevalent. Use of daily cotrimoxazole prophylaxis in HIV-exposed, uninfected infants in Malawi significantly reduced the risk of infant pneumonia, diarrhea, and malaria, and halved the risk of infant death [2]. Another study in Malawi compared the combination of chloroquine with azithromycin to chloroquine alone as treatment for symptomatic malaria episodes in children [3]; the combination with azithromycin not only treated malaria, but also decreased the incidence of subsequent respiratory infections by 33% and gastrointestinal tract infections by 26%. These data complement those of yet another study in Malawi, which demonstrated a 40% reduction in mortality in children by adding amoxicillin or cefdinir to ready-to-use food for the outpatient treatment of acute severe malnutrition [4], and those of a study of mass treatment for trachoma with azithromycin in Ethiopia [5], which demonstrated a decrease in childhood mortality. These benefits of antibiotics for children in resource-poor settings likely stem from the fact that bacterial diseases are very frequent and the etiologic pathogens are still susceptible to them [6]. We know that resistance can follow indiscriminate use of antibiotics. On the contrary, saving young children's lives cannot wait, and the evidence that antibiotics can help reduce child mortality is compelling. We urgently need to know when and how to treat common childhood infections in resource-poor settings, and whether and how to utilize prophylactic approaches for such infections. Such knowledge stems from finding out the etiologic pathogens of diarrhea and respiratory infections of infants and children in different resource-poor settings using newer methods adaptable to such settings. Based on that knowledge, creative and novel approaches to treatment and prevention can be quickly developed and clinically tested. Such studies need to give us accurate measurements of the effectiveness of each approach, their side-effects, resistance, and also the efficiency and cost-effectiveness of their administration. Pneumonia and diarrhea kill millions of young children, and stunt their growth and development. The time to dedicate efforts on this is now, so updated diagnostic, treatment, and prevention algorithms can be built. Acknowledgements Conflicts of interest The findings and conclusions in this letter are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. .

Grandmothers' Beliefs and Practices in Infant Safe Sleep.

Background Sudden infant death syndrome (SIDS) and suffocation are leading causes of infant mortality. Supine sleep position and use of appropriate sleep surfaces reduce SIDS risk but are not universally practiced. Mothers' decisions about sleep position and environment may be influenced by guidance provided by infants' grandmothers and other caregivers. Methods A survey was conducted of a convenience sample of grandmothers aged 30-70years who provide care at least weekly for an infant grandchild <6months old. The survey was distributed through community partners of a university-based research team. Respondents received home safety items as compensation. Analyses focused on the relationship of grandmother demographic characteristics and beliefs on their reported practices related to infant sleep. Results Among the 239 grandmothers, 45% reported placing infants to sleep supine on an appropriate sleep surface at the grandmother's house, while 58% reported doing so when the infant was sleeping in the mother's house. After adjusting for other factors, respondents were less likely to adhere to recommended guidelines when they believed supine position increased choking risk (OR 0.34, 95% CI 0.18-0.62) or believed infants are more comfortable or sleep longer when on their stomachs (OR 0.51, 95% CI 0.28-0.93). Discussion Grandmothers do not universally observe evidence-based safe sleep practices, particularly if the infant is not sleeping in the home of the parent. Interventions for senior caregivers focused on perceived choking risk, infant comfort in the supine position, and other recent changes in recommended safety practices are warranted.

Down syndrome: perinatal mortality risks with each additional week of expectant management.

To evaluate the gestational age (GA) at which perinatal mortality risk is minimized for fetuses with Down syndrome (DS). Retrospective cohort of singleton pregnancies delivered between 24 and 41 weeks, using 2005-2006 United States linked birth and death certificate data. Among fetal DS cases, prospective risk of intrauterine fetal demise (IUFD) and risk of infant death were calculated for each week, and composite risk of fetal/infant mortality with expectant management was compared to delivery. Of 3,113,098 pregnancies, 1766 had fetal DS (0.06%). IUFD occurred in 7.4% with DS, and infant death in 6.5%. Prospective risk of IUFD increased from 37 weeks onward to reach 50.7 per 1000 pregnancies (95% CI 33.2-68.3) at 42 weeks. Comparing mortality with expectant management to delivery, expectant management carried increasing risk from 38 (RR 1.18; 95% CI 1.05-1.33) to 41 weeks (RR 1.84; 95% CI 1.66-2.05). Further, number needed to deliver to avoid one excess death decreased from 38 (109.17; 95% CI 64.52-344.83) to 41 weeks (24.08; 95% CI 20.59-29.04). Although further research is needed to clarify risk factors for fetal and neonatal death in cases of DS, risk of perinatal mortality appears to be minimized with delivery at 38 weeks.

SIDS Risk: It's More Than Just the Sleep Environment.

* Abbreviations: ICD-10 — : International Classification of Diseases, 10th Revision SIDS — : sudden infant death syndrome It is widely acknowledged that dramatic declines in the rate of sudden infant death syndrome (SIDS) in the United States resulted from recommendations that infants not be placed prone to sleep, first by the American Academy of Pediatrics in 1992,1 followed by the national Back to Sleep campaign 2 years later.2 Other recommendations, such as room-sharing without bed-sharing and avoidance of soft bedding, were introduced and reinforced over the next 2 decades and, with supine positioning, have been the mainstay of SIDS risk reduction guidelines.3,4 However, there has been much concern in recent years because the rate of SIDS (International Classification of Diseases, 10th Revision [ICD-10] R95) has plateaued and rates of other sleep-related infant deaths, such as accidental suffocation and strangulation in bed (ICD-10 W75) and ill-defined deaths (ICD-10 R99), have increased.2 Indeed, the rate of postneonatal mortality, which encompasses all of these diagnoses, has not declined since the late 1990s.2 The risk factors for these different categories of death are strikingly similar,5 and researchers have documented a diagnostic shift, ie, deaths that were previously classified as SIDS 2 to 3 decades … Address correspondence to Rachel Y. Moon, MD, Division of General Pediatrics, PO Box 800386, University of Virginia, Charlottesville, VA 22908. E-mail: rym4z{at}virginia.edu

Meta-analysis of the Association between Serotonin Transporter Polymorphisms and Sudden Infant Death Syndrome

The serotonin transporter (5-HTT) gene has been considered one of the risk factors for sudden infant death syndrome (SIDS), but the association remains unconfirmed. This meta-analysis was performed to quantitatively summarize the evidence for such a relationship. PubMed, EMBASE, and China National Knowledge Infrastructure databases were searched for eligible studies within a range of published years from 1990 to December 2015. The odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the different associations. A total of 8 studies with 624 cases and 796 controls were included for 5-HTT promoter polymorphism, 5 studies with 418 cases and 542 controls for intron 2, and 3 studies with 253 cases and 334 controls for haplotype. The pooled examinations showed an overall increased SIDS risk for the 5-HTT promoter polymorphism (OR = 1.65, 95% CI = 1.03–2.63, P = 0.035 for LL vs. LS and SS; OR = 1.46, 95% CI = 1.04–2.04, P = 0.028 for L vs. S), but no association (OR = 1.00, 95% CI = 0.75–1.33, P = 0.994 for 10 + 9 carriers vs. 12/12; OR = 0.97, 95% CI = 0.79–1.19, P = 0.753 for 10 + 9 vs. 12) for intron 2 polymorphism, and an unreliable association (OR = 0.52, 95% CI = 0.31–0.87, P = 0.013) for S-9 and S-10 haplotypes. This meta-analysis suggests that the L allele or LL homozygote of 5-HTT promoter polymorphism has an increased risk for SIDS, while intron 2 polymorphism has no association with SIDS.

Prevalence and the Relationship between Characteristics and Parental Conditions with Risk Factors for Sudden Infant Death Syndrome (SIDS)

Introduction Sudden Infant Death Syndrome (SIDS) is a disease which causes unexpected death of infants aged less than 1 year. Given the undeniable role of parents in the presence or absence of SIDS risk factors, the present study aimed to studythe prevalence and the relationship between characteristics and conditions of parent’s infants with SIDS risk factors. Materials and Methods In this cross-sectional descriptive-analytic study, 1,021 infants aged 1 to 12 months in the health centers in Qom-Iran in 2014 were selected as the sample by stratified random sampling method. The required data were collected using an author-made questionnaire on SIDS risk factors. The obtained data were analyzed by descriptive and inferential statistics in SPSS 18 at a significance level of 95%. Results 4.5% of mothers were younger than 20 years, 92.3% infants had a co-sleeping with their parents, and 35.7% of infants had a bed-sharing with their parents. 19% of infants used Soft pillow. Study findings showed that there is no significant relationship between the age of mothers and using a shared bedroom (P>0.05), while such a relationship exists between education backgrounds of parents and sharing a bedroom (P<0.05). Conclusion The results showed that socioeconomic and educational status of parents play a significant role in the development of SIDS risk factors. Therefore, the incidence of such factors can be reduced through improving parental awareness and education.

Maternal obesity and gestational weight gain are risk factors for infant death.

Assessment of the joint and independent relationships of gestational weight gain and prepregnancy body mass index (BMI) on risk of infant mortality was performed. This study used Pennsylvania linked birth-infant death records (2003-2011) from infants without anomalies born to mothers with prepregnancy BMI categorized as underweight (n = 58,973), normal weight (n = 610,118), overweight (n = 296,630), grade 1 obesity (n = 147,608), grade 2 obesity (n = 71,740), and grade 3 obesity (n = 47,277). Multivariable logistic regression models stratified by BMI category were used to estimate dose-response associations between z scores of gestational weight gain and infant death after confounder adjustment. Infant mortality risk was lowest among normal-weight women and increased with rising BMI category. For all BMI groups except for grade 3 obesity, there were U-shaped associations between gestational weight gain and risk of infant death. Weight loss and very low weight gain among women with grades 1 and 2 obesity were associated with high risks of infant mortality. However, even when gestational weight gain in women with obesity was optimized, the predicted risk of infant death remained higher than that of normal-weight women. Interventions aimed at substantially reducing preconception weight among women with obesity and avoiding very low or very high gestational weight gain may reduce risk of infant death.

Place of Residence Moderates the Risk of Infant Death in Kenya: Evidence from the Most Recent Census 2009.

BackgroundSubstantial progress has been made in reducing childhood mortality worldwide from 1990–2015 (Millennium Development Goal, target 4). Achieving target goals on this however remains a challenge in Sub-Saharan Africa. Kenya’s infant mortality rates are higher than the global average and are more pronounced in urban areas as compared to rural areas. Only limited knowledge exists about the differences in individual level risk factors for infant death among rural, non-slum urban, and slum areas in Kenya. Therefore, this paper aims at 1) assess individual and socio-ecological risk factors for infant death in Kenya, and at 2) identify whether living in rural, non-slum urban, or slum areas moderated individual or socio-ecological risk factors for infant death in Kenya.MethodologyWe used a cross-sectional study design based on the most recent Kenya Population and Housing Census of 2009 and extracted the records of all females who had their last child born in 12 months preceding the survey (N = 1,120,960). Multivariable regression analyses were used to identify risk factors that accounted for the risk of dying before the age of one at the individual level in Kenya. Place of residence (rural, non-slum urban, slum) was used as an interaction term to account for moderating effects in individual and socio-ecological risk factors.ResultsIndividual characteristics of mothers and children (older age, less previously born children that died, better education, girl infants) and household contexts (better structural quality of housing, improved water and sanitation, married household head) were associated with lower risk for infant death in Kenya. Living in non-slum urban areas was associated with significantly lower infant death as compared to living in rural or slum areas, when all predictors were held at their reference levels. Moreover, place of residence was significantly moderating individual level predictors: As compared to rural areas, living in urban areas was a protective factor for mothers who had previous born children who died, and who were better educated. However, living in urban areas also reduced the health promoting effects of better structural quality of housing (i.e. poor or good versus non-durable). Furthermore, durable housing quality in urban areas turned out to be a risk factor for infant death as compared to rural areas. Living in slum areas was also a protective factor for mothers with previous child death, however it also reduced the promoting effects of older ages in mothers.ConclusionsWhile urbanization and slum development continues in Kenya, public health interventions should invest in healthy environments that ideally would include improvements to access to safe water and sanitation, better structural quality of housing, and to access to education, health care, and family planning services, especially in urban slums and rural areas. In non-slum urban areas however, health education programs that target healthy diets and promote physical exercise may be an important adjunct to these structural interventions.

Exploring Safe Sleep and SIDS Risk Perception in an African‐American Community: Focused Ethnography

Explore the cultural influences of safe sleep practices by African-American caregivers of children under 2years old. Explore the role of health care professionals in promoting safe sleep. A focused ethnography was used to understand the contextual cultural meaning and experiences of safe sleep practices of African-American caregivers of children under 2years. Nineteen African-Americans participated in this study. Demographic data were collected and semi-structured interviews were conducted with individuals and small groups. Saturation of the data occurred after 17 interviews. Data were analyzed using Leininger's four Phases of qualitative data analysis. (Themes): (1) The informants expressed both accurate and inaccurate knowledge of Sudden Infant Death Syndrome (SIDS) and safe sleep practices influenced by personal experiences, hospital education, family, extended family and television; (2) Sleeping with infants and children was viewed as a cultural caring behavior promoting comfort, closeness and protection for infants, children, parents and caregivers; (3) The informants want and are seeking collaboration with nurses and health care professionals who are viewed as important in promoting accurate information about SIDS and safe sleep practices. The role of the nurse can impact accurate outcomes about SIDS and safe sleep practices.

The Effect of Gestational Age at Birth on Post-Term Maturation of Heart Rate Variability.

Preterm birth delays maturation of autonomic cardiovascular control, reflected in reduced heart rate variability (HRV) in preterm compared to term infants at term-equivalent age. It has been suggested that immature cardiovascular control contributes to the increased risk for the sudden infant death syndrome (SIDS) in preterm infants. However, the effects of prone sleeping, the major SIDS risk factor, and of gestational age (GA) at birth on HRV have not been assessed in preterm infants beyond term-equivalent age. Very preterm (n = 21; mean GA 29.4 ± 0.3 weeks), preterm (n = 14; mean GA 33.5 ± 0.3 weeks), and term (n = 17; mean GA 40.1 ± 0.3 weeks) infants were recruited and underwent daytime polysomnography at 2-4 weeks, 2-3 months, and 5-6 months post-term corrected age (CA). Infants slept both supine and prone. HRV was assessed in the low frequency (LF) and high frequency (HF) ranges. There was no effect of prone sleeping on HRV parameters in either preterm group. In term infants LF/HF was significantly elevated in the prone position in AS at 2-4 weeks (P < 0.05). HF HRV was significantly reduced (P < 0.05) and LF/HF increased (P < 0.05) in very preterm compared to both preterm and term infants at 2-3 months CA. Prone sleeping did not significantly impact on heart rate variability (HRV) in preterm infants. However, reduced maturation of high frequency HRV in very preterm infants resulted in significantly altered sympathovagal balance at 2-3 months corrected age, the age of peak sudden infant death syndrome (SIDS) risk. This may contribute to the increased risk of SIDS in infants born at earlier gestational age.

Infant Mortality and SIDS Perceptions Among Key Healthcare Professional Informants in Sedgwick County, KS.

Sedgwick County, KS, has one of the highest infant mortality rates (IMR) in the USA, of which sudden infant death syndrome (SIDS) is a large component. The purpose of this study was to assess local key informants' awareness of the high IMR overall, their knowledge and beliefs about SIDS risk factors specifically, and their recommendations for ways to increase physician and community awareness of SIDS within Sedgwick County, KS. Structured interviews were conducted with key informants from Sedgwick County, KS. Four themes emerged from key informant interviews: low level of awareness of infant mortality and SIDS, target population most at risk for SIDS/infant mortality, and barriers to and importance of SIDS education. Key informants were in consensus that there was a lack of general community awareness surrounding the high IMR in Sedgwick County. Strategies were identified to address this issue, including consistent SIDS education of medical providers and parents, social support to moms, use of social media, and involving the faith community in educating target populations about risk factors. Health and public health key informants provided an overall view of their perception of the SIDS problem in Sedgwick County, KS. Based on collected interviews, the consensus was there are significant problems within Sedgwick County around the issue of SIDS awareness (severity of the problem), SIDS risk, and barriers to increasing SIDS education among professional and community members. African-Americans were identified as the population with the highest infant mortality and SIDS rates in Sedgwick County by health and public health key informant participants. A concerted, educational approach was recommended as the best way forward to reduce SIDS risk within this community.

Survival of Preterm Singleton Deliveries: A Population-Based Retrospective Study

Aim. To identify sociodemographic and medical characteristics associated with preterm birth survival.Methods. A retrospective study of singleton births was performed using Missouri linked data for the years 1978 to 2005. We computed hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional hazards model.Results. High rates of infant, neonatal, and postneonatal mortality were observed among preterm as compared to term births. White are at low risk for postneonatal (HR = 0.77, CI: 0.65, 0.90) and infant mortality (HR = 0.90, CI: 0.81, 0.99) compared to blacks. We observed increased risks of all mortality types for preterm deliveries by caesarean section (neonatal HR = 1.53, CI: 1.40, 1.68; postneonatal HR = 1.39, CI: 1.22, 1.58; infant HR = 1.37, CI: 1.27, 1.48). As compared to nonsmokers, preterm singletons born to smoking mothers are 69% more likely to experience postneonatal mortality and have a 17% increased risk for infant death.Conclusions. Caesarean section is associated with increased risk of all types of mortality. Racial disparity is still a concern. Further research is required to identify the detailed differences in structure and procedures that result in the disadvantage associated with preterm birth especially with respect to caesarean section and race.