Risk Of Sudden Infant Death Syndrome Research Articles

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.

Nrf2-driven CD36 and HO-1 gene expression in circulating monocytes correlates with favourable clinical outcome in pregnancy-associated malaria.

BackgroundPregnancy-associated malaria (PAM) constitutes one of the most severe forms of malaria infection leading to fetal growth restriction and high risk of infant death. The severity of the pathology is largely attributed to the recruitment of monocytes and macrophages in the placenta which is evidenced by dysregulated inflammation found in placental blood. Importantly, CD36+ monocytes/macrophages are also thought to participate in the tight control of the pro- and anti-inflammatory responses following Plasmodium detection through elimination of apoptotic cells and malaria-infected erythrocytes, internalization and recycling of oxidized forms of low-density lipoprotein and collaboration with TLR2 in pro-inflammatory response. Interestingly, previous work demonstrated that CD36 expression was upregulated on inflammatory macrophages following stimulation of the Nrf2 transcription factor, whilst the PPARγ pathway was inhibited and non-functional in the same inflammatory conditions. This current study examined the possible role of Nrf2-driven gene expression, CD36 and Haem-Oxygenase-1 (HO-1), in PAM clinical outcomes.MethodsClinical data and biological samples including peripheral blood mononuclear cells were collected from 27 women presenting PAM. Polychromatic flow cytometry was used to characterize innate immune cell subpopulations and quantify CD36 protein expression level on monocytes. mRNA levels of CD36, PPARγ, Nrf2 and HO-1 were determined by qPCR and related to clinical outcomes. Finally, the capacity of monocytes to modulate CD36 expression upon rosiglitazone or sulforaphane treatment, two respective PPARγ or Nrf2 activators, was also investigated.ResultsThe CD36 receptor, mostly expressed by CD14+ circulating monocytes, statistically correlated with increased infant birth weights. Interestingly, mRNA levels of the transcription factor Nrf2 and the enzyme HO-1 also correlated with lower parasitaemia and increased infant birth weight, while PPARγ mRNA levels did not. Finally, monocytes isolated from low infant birth weight pregnant women were capable of up-regulating CD36 via the Nrf2 pathway ex vivo.ConclusionsAltogether these results suggest that Nrf2-driven CD36 and HO-1 expression on innate immune cells could contribute to a protective and detoxifying mechanism during PAM. More powered and mechanistical studies are however needed to strengthen the conclusions of this study.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0888-8) contains supplementary material, which is available to authorized users.

Differences in African-American Maternal Self-Efficacy Regarding Practices Impacting Risk for Sudden Infant Death.

Sudden Infant Death Syndrome (SIDS) and other sleep-related deaths, including accidental suffocation, account for ~4000 US deaths annually. Parents may have higher self-efficacy with regards to preventing accidental suffocation than SIDS. The objective of this study was to assess self-efficacy in African-American mothers with regards to safe sleep practices and risk for SIDS and accidental suffocation. As part of randomized clinical trial in African-American mothers of newborn infants, mothers completed a baseline survey about knowledge of and attitudes towards safe sleep recommendations, current intent, self-efficacy, and demographics. Tabular and adjusted, regression-based analyses of these cross-sectional data evaluated the impact of the message target (SIDS risk reduction vs. suffocation prevention) on perceived self-efficacy. 1194 mothers were interviewed. Mean infant age was 1.5 days. 90.8 % of mothers planned to place their infant supine, 96.7 % stated that their infant would sleep in the same room, 3.6 % planned to bedshare with the infant, and 72.9 % intended to have soft bedding in the crib. Mothers were more likely to believe that prone placement (70.9 vs. 50.5 %, p < 0.001), bedsharing (73.5 vs. 50.1 %, p < 0.001), and having soft bedding in the sleep area (78.3 vs. 59.5 %, p < 0.001) increased their infant's risk for suffocation than it did for SIDS. Mothers had higher self-efficacy, viz. increased confidence that their actions could keep their infant safe, with regards to suffocation than SIDS (88.0 vs. 79.4 %, p < 0.001). These differences remained significant when controlled for sociodemographics, grandmother in home, number of people in home, and breastfeeding intention. Maternal self-efficacy is higher with regards to prevention of accidental suffocation in African-Americans, regardless of sociodemographics. Healthcare professionals should discuss both SIDS risk reduction and prevention of accidental suffocation when advising African-American parents about safe sleep practices.

An analysis of attitude toward infant sleep safety and SIDS risk reduction behavior among caregivers of newborns and infants.

To explore beliefs and attitude toward infant sleep safety and sudden infant death syndrome (SIDS) risk reduction behaviors among caregivers of newborns and infants. A convenience sample comprised of 121 caregivers of newborns at Staten Island University Hospital completed a questionnaire. Despite an overall favorable attitude toward safe sleep practices, a majority disagreed with use of pacifiers (53%) and believed that swaddling (62%) as well as the use of home monitors (59%) are acceptable practices. The caregivers who recalled being taught about safe sleep had higher perception of infant vulnerability (P<0.001), more confidence in their ability to implement safe sleep behaviors (P<0.0006) and stronger belief that safe sleep behaviors are effective (P<0.01). Active caregiver education may result in more effective demonstration of safe sleep and SIDS risk reduction behaviors. Further study is needed to assess if favorable attitudes toward safe sleep practices correlate with actual demonstrated behaviors.

Breastfeeding and dummy use have a protective effect on sudden infant death syndrome.

We conducted a literature review on the effect of breastfeeding and dummy (pacifier) use on sudden infant death syndrome (SIDS). From 4343 abstracts, we identified 35 relevant studies on breastfeeding and SIDS, 27 on dummy use and SIDS and 59 on dummy use versus breastfeeding.ConclusionWe found ample evidence that both breastfeeding and dummy use reduce the risk of SIDS. There has been a general reluctance to endorse dummy use in case it has a detrimental effect of breastfeeding. However, recent evidence suggests that dummy use might not be as harmful to breastfeeding as previously believed.

Preterm Infants Exhibit Greater Variability in Cerebrovascular Control than Term Infants.

Sudden infant death syndrome (SIDS) remains an important cause of infant death, particularly among infants born preterm. Prone sleeping is the major risk factor for SIDS and this has recently been shown to alter cerebrovascular control in term infants. As preterm infants are at greater risk for SIDS than those born at term, we hypothesized that their cerebrovascular control in the prone position would be reduced compared to term infants. There were 35 preterm (mean gestation 31.2 ± 0.4 w) and 17 term (mean gestation 40.1 ± 0.3 w) infants. Infants underwent daytime polysomnography at 2-4 w, 2-3 mo, and 5-6 mo postterm age. Infants slept both prone and supine and were presented with cardiovascular challenges in the form of 15° head-up tilts (HUT). Cerebral tissue oxygenation index (TOI) was recorded using near-infrared spectroscopy (NIRO-200 spectrophotometer, Hamamatsu Photonics KK, Japan) and mean arterial pressure (MAP) was recorded using a Finometer cuff (Finapres Medical Systems, Amsterdam, The Netherlands). In the prone position TOI increased following the HUT (P < 0.05), whereas no change was seen in the supine position. The overall pattern of response was similar in both groups, but more variable in preterm than term infants (P < 0.05). Cerebrovascular control differs between the prone and supine positions in preterm infants. Although overall the responses to head-up tilts were similar between term and preterm infants, greater variability of responses in preterm infants suggests persisting immaturity of their cerebrovascular control in the first year of life, which may contribute to their increased risk of sudden infant death syndrome.

Hazard Patterns Associated With Co-sleepers.

We conducted a retrospective review of incidents associated with co-sleepers. A total of 26 incidents (6 deaths and 20 injuries) were reported to the Consumer Product Safety Commission. Of these, 5 deaths were caused by asphyxia, and 1 was attributed to sudden infant death syndrome (SIDS). The mean age at death was 3.1 months. Two-thirds of deaths had known risk factors for SIDS. Of the 20 injuries, entrapment (60%) and suffocation (35%) hazards were most common. Almost half of the injuries occurred after the co-sleeper was improperly assembled. Infant deaths and injuries associated with co-sleepers are infrequent. Most deaths were associated with other SIDS risk factors. Many deaths and injuries were associated with improper use or assembly of the co-sleeper. It is important for pediatricians to advise parents not to use previously owned co-sleepers or to use co-sleepers in any way other than what is specifically stated in the product instructions to avoid infant injury or death.

Escherichia coli and Sudden Infant Death Syndrome.

This review examines the association of strains of Escherichia coli with sudden infant death syndrome (SIDS) and the possible role these bacteria play in this enigmatic condition. The review addresses evidence for E. coli in SIDS infants, potential sources of E. coli in the environment, colonization by commensal and pathogenic strains, the variety of currently accepted pathotypes, and how these pathotypes could compromise intestinal integrity and induce inflammation. Both intestinal and extraintestinal pathotypes are compared in relation to the apparent liability in which virulence traits can be gained or lost by strains of E. coli. The way in which E. coli infections fit with current views on infant sleeping position and other SIDS risk factors is highlighted.

Sudden infant death syndrome and residential altitude.

Theories of sudden infant death syndrome (SIDS) suggest hypoxia is a common pathway. Infants living at altitude have evidence of hypoxia; however, the association between SIDS incidence and infant residential altitude has not been well studied. We performed a retrospective cohort study by using data from the Colorado birth and death registries from 2007 to 2012. Infant residential altitude was determined by geocoding maternal residential address. Logistic regression was used to determine adjusted association between residential altitude and SIDS. We evaluated the impact of the Back to Sleep campaign across various altitudes in an extended cohort from 1990 to 2012 to assess for interaction between sleep position and altitude. A total of 393 216 infants born between 2007 and 2012 were included in the primary cohort (51.4% boys; mean birth weight 3194 ± 558 g). Overall, 79.6% infants resided at altitude <6000 feet, 18.5% at 6000 to 8000 feet, and 1.9% at >8000 feet. There were no meaningful differences in maternal characteristics across altitude groups. Compared with residence <6000 feet, residence at high altitude (>8000 feet), was associated with an adjusted increased risk of SIDS (odds ratio 2.30; 95% confidence interval 1.01-5.24). Before the Back to Sleep campaign, the incidence of SIDS in Colorado was 1.99/1000 live births and dropped to 0.57/1000 live births after its implementation. The Back to Sleep campaign had similar effect across different altitudes (P = .45). Residence at high altitude was significantly associated with an increased adjusted risk for SIDS. Impact of the Back to Sleep campaign was similar across various altitudes.

The risk of stillbirth and infant death by each additional week of expectant management in twin pregnancies

The objective of the study was to compare the fetal/infant mortality risk associated with each additional week of expectant management with the mortality risk of immediate delivery in women with twin gestations. A retrospective cohort study was performed utilizing 2006-2008 National linked birth certificate and death certificate data. The incidence of stillbirth and infant death were determined for each week of pregnancy from 32 0/7 weeks' through 40 6/7 weeks' gestation. Pregnancies complicated by fetal anomalies were excluded. These measures were combined to estimate the theoretic risk of remaining pregnant an additional week by adding the risk of stillbirth during the extra week of pregnancy with the risk of infant death encountered with delivery during the following week. This composite fetal/infant mortality risk was compared with the risk of infant death associated with delivery at the corresponding gestational age. The risk of stillbirth increased with increasing gestational age, for example, between 37 and 38 weeks' gestation (12.5 per 10,000 vs 22.5 per 10,000; P<.05). As expected, the risk of infant death following delivery gradually decreased as pregnancies approached term gestation. Week-by-week differences were statistically significant (P<.05) between 32 and 36 weeks with decreasing risk of infant death at advancing gestational ages. The composite risk of stillbirth and infant death associated with an additional week of pregnancy had a significant increase from 37 to 38 weeks' gestation (43.9 per 10,000 vs 59.2 per 10,000; P<.05). At 37 weeks' gestation, the relative risk of mortality was statistically significantly lower with immediate delivery as compared with expectant management (relative risk, 0.87; 95% confidence interval, 0.77-0.99). Our results suggest that fetal/infant death risk is minimized at 37 weeks' gestation; however, individual maternal and fetal characteristics must also be taken into account when determining the optimal timing of delivery for twin pregnancies.

Exploring the risk factors for sudden infant deaths and their role in inflammatory responses to infection.

The risk factors for sudden infant death syndrome (SIDS) parallel those associated with susceptibility to or severity of infectious diseases. There is no evidence that a single infectious agent is associated with SIDS; the common thread appears to be induction of inflammatory responses to infections. In this review, interactions between genetic and environmental risk factors for SIDS are assessed in relation to the hypothesis that many infant deaths result from dysregulation of inflammatory responses to “minor” infections. Risk factors are assessed in relation to three important stages of infection: (1) bacterial colonization (frequency or density); (2) induction of temperature-dependent toxins; (3) induction or control of inflammatory responses. In this article, we review the interactions among risk factors for SIDS for their effects on induction or control of inflammatory responses. The risk factors studied are genetic factors (sex, cytokine gene polymorphisms among ethnic groups at high or low risk of SIDS); developmental stage (changes in cortisol and testosterone levels associated with 2- to 4-month age range); environmental factors (virus infection, exposure to cigarette smoke). These interactions help to explain differences in the incidences of SIDS observed between ethnic groups prior to public health campaigns to reduce these infant deaths.

Undiagnosed metabolic dysfunction and sudden infant death syndrome--a case-control study.

Decades of research has yielded few clues about causes of sudden infant death syndrome (SIDS). While some studies have shown a link to inborn errors of metabolism (IEMs), few have examined the link in a large population-based sample. This population-based case-control study assessed the association between undiagnosed IEMs and SIDS. Children born in California during 2005-08 who died from SIDS were obtained from death records and linked to the newborn screening, birth certificate, and hospital discharge databases. Individuals with known chromosomal and neural tube defects, genetic disorders, and non-singleton births were excluded. Five controls were matched to each case on tandem mass spectrometry testing date and lab code. Rates of undiagnosed IEMs were compared between cases and controls using conditional logistic regression adjusting for known confounding factors. After adjusting for known confounding factors, SIDS cases had similar risk of having IEMs as controls (adjusted hazard ratio [HR] 1.3, 95% confidence interval [CI] 0.3, 5.5). Infants who were male, Black, and born preterm had higher risk of SIDS with the highest risk observed for those born preterm [adjusted HR = 1.7, 95% CI 1.3, 2.2]. Younger maternal age at delivery, mother being born in the US, parity after current birth >3, and delayed prenatal care were also significantly associated with higher risk of SIDS. While many maternal and infant factors are associated with an increased risk of SIDS, there is no evidence that undiagnosed IEMs are associated with increased risk.

Over Half of US Infants Sleep in Potentially Hazardous Bedding

Accidental suffocation deaths increased in the U.S. from 7 in every 100,000 live births in 2000 to 15.9 in 2010. TRENDS IN INFANT care practices can be identified by research that gives clinicians insight into caregiving practices and guides them in providing education on an individual as well as a community level. Beginning in 1993 studies have found that soft bedding under and over an infant increases the risk of sudden infant death syndrome (SIDS) and sleep-related suffocation. The American Academy of Pediatrics (AAP) has identified the use of potentially hazardous bedding (e.g., pillows, quilts, comforters, loose bedding) as a modifiable risk factor for SIDs and sleep-related suffocation because soft objects and loose bedding can obstruct an infant's airway, posing a suffocation risk and increasing risk for SIDS. The risk was so substantial that in 1996 the AAP issued recommendations that infants be placed to sleep on firm sleep surfaces without any soft or loose bedding. A recently published study by researchers at the National Institutes of Health and the Centers for Disease Control and Prevention is the first study to report on the trends in infant sleep practices (sleep position and sleep location) in the U.S. (Shapiro-Mendoza et al., 2015). The study analyzed data from the National Infant Sleep Position report which surveyed nearly 19,000 caregivers about infant sleep practices between 1993 and 2010. There were several disturbing findings from the study. The study found that although the prevalence of infant bedding use declined over the study period, the rate of decline had slowed markedly— from 86% in 1993 to 1995 to 55% in 2008–2010 and that over half of U.S. infants still sleep in hazardous situations. The researchers also noted that although the rate of SIDS

The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy by gestational age

The objective of the study was to characterize the risk of infant and fetal death by each additional week of expectant management vs immediate delivery in pregnancies complicated by cholestasis. This was a retrospective cohort study of 1,604,386 singleton, nonanomalous pregnancies of women between 34 and 40 weeks' gestation with and without intrahepatic cholestasis of pregnancy (ICP) in the state of California during the years of 2005-2008. International Classification of Diseases, 9th version, codes and linked hospital discharge and vital statistics data were utilized. For each week of gestation, the following outcomes were assessed: the risk of stillbirth, the risk of delivery (represented by the risk of infant death at a given week of gestation), and the composite risk of expectant management for 1 additional week. Composite risk combines the risk of stillbirth at this gestational age week plus the risk of infant death if delivered at the subsequent week of gestation. Among women with ICP, the mortality risk of delivery is lower than the risk of expectant management at 36 weeks' gestation (4.7 vs 19.2 per 10,000). The risk of expectant management remains higher than delivery and continues to rise by week of gestation beyond 36 weeks. The risk of expectant management in women with ICP reaches a nadir at 35weeks (9.1 per 10,000; 95% confidence interval, 1.4-16.9) and rises at 36 weeks (19.2 per 10,000; 95% confidence interval, 7.6-30.8). Among women with ICP, delivery at 36 weeks' gestation would reduce the perinatal mortality risk as compared with expectant management. For later diagnoses, this would also be true at gestational ages beyond 36 weeks. Timing of delivery must take into account both the reduction in stillbirth risk balanced with the morbidities associated with preterm delivery.

Improving infant sleep safety through a comprehensive hospital-based program.

We evaluated a comprehensive hospital-based infant safe sleep education program on parental education and safe sleep behaviors in the home using a cross-sectional survey of new parents at hospital discharge (HD) and 4-month follow-up (F/U). Knowledge and practices of infant safe sleep were compared to the National Infant Sleep Position Study benchmark. There were 1092 HD and 490 F/U surveys. Supine sleep knowledge was 99.8% at HD; 94.8% of families planned to always use this position. At F/U, 97.3% retained supine knowledge, and 84.9% maintained this position exclusively (P < .01). Knowledge of crib as safest surface was 99.8% at HD and 99.5% F/U. Use in the parents' room fell to 91.9% (HD) and 68.2% (F/U). Compared to the National Infant Sleep Position Study, the F/U group was more likely to use supine positioning and a bassinette or crib. Reinforcing the infant sleep safety message through intensive hospital-based education improves parental compliance with sudden infant death syndrome risk reduction guidelines.

Do nurses provide a safe sleep environment for infants in the hospital setting? An integrative review.

Sudden infant death syndrome (SIDS) may be the most preventable cause of death for infants 0 to 6 months of age. The American Academy of Pediatrics (AAP) first published safe sleep recommendations for parents and healthcare professionals in 1992. In 1994, new guidelines were published and they became known as the "Back to Sleep" campaign. After this, a noticeable decline occurred in infant deaths from SIDS. However, this number seems to have plateaued with no continuing significant improvements in infant deaths. The objective of this review was to determine whether nurses provide a safe sleep environment for infants in the hospital setting. Research studies that dealt with nursing behaviors and nursing knowledge in the hospital setting were included in the review. A search was conducted of Google Scholar, CINAHL, PubMed, and Cochrane, using the key words "NICU," "newborn," "SIDS," "safe sleep environment," "nurse," "education," "supine sleep," "prone sleep," "safe sleep," "special care nursery," "hospital policy for safe sleep," "research," "premature," "knowledge," "practice," "health care professionals," and "parents." The review included research reports on nursing knowledge and behaviors as well as parental knowledge obtained through education and role modeling of nursing staff. Only research studies were included to ensure that our analysis was based on rigorous research-based findings. Several international studies were included because they mirrored findings noted in the United States. All studies were published between 1999 and 2012. Healthcare professionals and parents were included in the studies. They were primarily self-report surveys, designed to determine what nurses, other healthcare professionals, and parents knew or had been taught about SIDS. Integrative review. Thirteen of the 16 studies included in the review found that some nurses and some mothers continued to use nonsupine positioning. Four of the 16 studies discussed nursing knowledge and noncompliance with AAP safe sleep recommendations. Eleven of the 16 studies found that some nurses were recommending incorrect sleep positions to mothers. Five of the 16 studies noted that some nurses and mothers gave fear of aspiration as the reason they chose to use a nonsupine sleep position. In the majority of the studies, the information was self-reported, which could impact the validity of the findings. Also, the studies used convenience sampling, which makes study findings difficult to generalize. The research indicates that there has been a plateau in safe sleeping practices in the hospital setting. Some infants continue to be placed in positions that increase the risk for SIDS. The research also shows that some nurses are not following the 2011 AAP recommendations for a safe sleep environment. Clearly, nurses need additional education on SIDS prevention and the safe sleep environment, and additional measures need to be adopted to ensure that all nurses and all families understand the research supporting the AAP recommendation that supine sleep is best. Further work is needed to promote evidence-based practice among healthcare professionals and families.

Does Breastfeeding Have an Effect on Infant Mortality in India? An Analysis of National Family Health Survey Data

Introduction: Sub-optimal infant and early childhood feeding practices in India contribute to the high burden of child under-nutrition and infant death. Objective: To study the effect of breast-feeding duration on the survival of infants along with other demographic, socioeconomic and service related factors and to compare the decadal changes in the association. Methods: A total of 36,754 and 26,782 births less than 3 years of age from two rounds of the National Family Health Survey (NFHS) carried out in India during 1992-1993 (NFHS-1), and 2005-2006 (NFHS-3) respectively comprised the sample. Infant mortality was examined against a set of variables and breastfeeding as a time dependent covariate using multivariate extended Cox regression model. Results: Hazard of infant death observed in NFHS-3 (2005-2006) was 18 percent less [HR = 0.82; 95% CI = 0.759 - 0.879] as compared to that observed in NFHS-1 (1992-1993). After adjustment of other factors, the risk of infant death was 97% less amongst children who were breastfed [HR = 0.03; 95% CI = 0.029 - 0.033] as compared to those who were not breastfed. In contrast to rural area, babies belonging to urban area had an 18 percent less hazard of death during the infancy period [HR = 0.82]. Hazard of infant death was less among births to mothers with higher maternal education levels [HR = 0.93] and in those who were in gainful occupation [HR = 0.91]. The risk of infant death was higher in babies perceived to be small at birth [HR = 1.40] and belonging to states with medium post neonatal mortality rate (PNMR) [HR = 1.23; 95% CI = 1.112 - 1.371] and high PNMR [HR = 1.46; 95% CI = 1.327 - 1.609] in contrast to those born to women belonging to states with low post neonatal mortality. Conclusion: Promotion and implementation of evidenced based strategies are needed in India to combat the high rates of child under-nutrition and infant and child mortality.

Newborn Electrocardiography as a Screening Method for Long-QT Syndrome

Prolongation of the QT interval is the cause of about 10% cases of sudden infant death syndrome (SIDS) in newborns but it is also responsible for about 5% of sudden deaths in adults. LQTS is associated with life threatening arrhythmias such us torsade de pointes ventricular tachycardia or ventricular fibrillation (VF) leading to sudden death. Congenital causes (channelopathies) of LQTS are associated to mutations with different hereditary pattern according affected gene but it has been proven that several drugs and electrolytic alterations can significantly increase the QT interval. However, the cost-effectiveness of neonatal electrocardiographic (EKG) screening has been questioned and despite studies made in newborns there is still no consensus about the best moment to make and electrocardiographic screening. Previous studies demonstrate that newborns with QTc values over 470 msec often normalize by themselves in the first month of life. However in some cases these values remain high after first months of life. These cases are more frequently in determinate ethnics (Maghreb, Morocco and India-Pakistan). These races could be linked to cardiac electrical alterations with a hereditary pattern of variable penetrance. An EKG performed in the first month of life will allow the early identification of still asymptomatic infants with LQTS and also infants with some correctable congenital heart defects (CHD) not recognized by routine neonatal examinations. Appropriate therapy will prevent unnecessary deaths in infants, children, and young adults. At the light of this literature review we could assess that neonatal electrocardiographic screening is highly cost-effective and it may permit the early identification of infants at risk for SIDS.

Infant Health and Longevity: Evidence from a Historical Trial in Sweden

This paper investigates the potential of an infant intervention to improve life expectancy, contributing to emerging interest in the early life origins of chronic disease. We analyse a pioneering program trialled in Sweden in the 1930s, which provided information, support and monitoring of infant care. Using birth certficate data from parish records matched to death registers, we estimate that the average duration of program exposure in infancy led to a 1.54% point decline in the risk of infant death (23% of baseline risk) and a 2.37% decline in the risk of dying by age 75 (6.5% of baseline risk).

Sudden unexpected death in infancy: a historical perspective.

Epidemiological, developmental and pathological research over the last 40 years has done much to unravel the enigma of sudden unexpected death in infancy (SUDI) and sudden infant death syndrome (SIDS) that has afflicted the human condition for millennia. Modifications in infant care practices based on the avoidance of risk factors identified from a consistent epidemiological profile across time and multiple locations have resulted in dramatic reductions in the incidence of SUDI and SIDS in particular. The definition of SIDS (or unexplained SUDI) has been continually refined allowing enhanced multidisciplinary research, results of which can be more reliably compared between investigators. These latter expanded definitions mandating death scene investigations, evaluation of the circumstances of death and more comprehensive autopsies including additional ancillary testing have illuminated the importance of life-threatening sleep environments. The triple-risk hypothesis for SIDS has been increasingly validated and formulates an inextricable relationship between an infant's state of development, underlying pathological vulnerability and an unsafe sleep environment for sudden infant death to occur. Today, the major risk factors for SUDI are maternal smoking and bed sharing, and the challenge is to implement effective strategies that will reduce the exposure to such risks as was done with prone sleeping position. The challenges ahead include development of clinical methods and/or laboratory testing that will accurately identify which infants are at particularly high risk of SIDS but also means by which their deaths can be prevented.