Sudden Infant Death Research Articles

Preterm infants experience a nadir in cerebral oxygenation during sleep three months after hospital discharge.

Preterm infants are at increased risk of Sudden Infant Death Syndrome (SIDS) and frequently experience short central apnoeas which can occur in isolation or a repetitive pattern (periodic breathing). We investigated the relationship between central apnoeas experienced before and over the 6 months after hospital discharge and cerebral oxygenation. Preterm infants born between 28 and 32 weeks gestational age (GA) were studied during supine daytime sleep at 32-36 weeks post menstrual age (PMA) (n = 40), 36-40 weeks PMA (n = 27), 3-months corrected age (CA) (n = 20) and 6-months CA (n = 26). Cerebral tissue oxygenation (TOI), peripheral oxygenation (SpO2) and heart rate were recorded continuously. The percentage total sleep time (%TST) spent having central apnoeas at each study and cerebral fractional oxygen extraction (SpO2-TOI/SpO2) were calculated. %TST spent with central apnoeas decreased with increasing age in both active sleep (AS) and quiet sleep (QS). TOI tended to be lower and cerebral fractional oxygen extraction higher at 3 months compared to the other studies and this reached statistical significance compared to 32-36 weeks in QS. The nadir in cerebral tissue oxygenation at 3 months of age coincides with the peak risk period for SIDS and this may contribute to increased risk in these infants.

Characteristics of Sudden Unexpected Infant Deaths on Shared and Nonshared Sleep Surfaces.

Describe characteristics of sudden unexpected infant deaths (SUID) occurring on shared or nonshared sleep surfaces. We examined SUID among residents of 23 US jurisdictions who died during 2011 to 2020. We calculated frequencies and percentages of demographic, sleep environment, and other characteristics by sleep surface sharing status and reported differences of at least 5% between surface sharing and nonsharing infants. Of 7595 SUID cases, 59.5% were sleep surface sharing when they died. Compared with nonsharing infants, sharing infants were more often aged 0 to 3 months, non-Hispanic Black, publicly insured, found supine, found in an adult bed or chair/couch, had a higher number of unsafe sleep factors present, were exposed to maternal cigarette smoking prenatally, were supervised by a parent at the time of death, or had a supervisor who was impaired by drugs or alcohol at the time of death. At least 76% of all SUID had multiple unsafe sleep factors present. Among surface-sharing SUID, most were sharing with adults only (68.2%), in an adult bed (75.9%), and with 1 other person (51.6%). Surface sharing was more common among multiples than singletons. Among SUID, surface sharing and nonsharing infants varied by age at death, race and ethnicity, insurance type, presence of unsafe sleep factors, prenatal smoke exposure, and supervisor impairment. Most SUID, regardless of sleep location, had multiple unsafe sleep factors present, demonstrating the need for comprehensive safe sleep counseling for every family at every encounter.

Using the C14:1/Medium-Chain Acylcarnitine Ratio Instead of C14:1 to Reduce False-Positive Results for Very-Long-Chain Acyl-CoA Dehydrogenase Deficiency in Newborn Screening in Japan.

Very-long-chain acyl-CoA dehydrogenase (VLCAD) deficiency is a long-chain fatty acid oxidation disorder that manifests as either a severe phenotype associated with cardiomyopathy, a hypoglycemic phenotype, or a myopathic phenotype. As the hypoglycemic phenotype can cause sudden infant death, VLCAD deficiency is included in newborn screening (NBS) panels in many countries. The tetradecenoylcarnitine (C14:1) level in dried blood specimens is commonly used as a primary marker for VLCAD deficiency in NBS panels. Its ratio to acetylcarnitine (C2) and various other acylcarnitines is used as secondary markers. In Japan, tandem mass spectrometry-based NBS, initially launched as a pilot study in 1997, was introduced to the nationwide NBS program in 2013. In the present study, we evaluated levels of acylcarnitine with various chain lengths (C18 to C2), free carnitine, and their ratios in 175 infants who tested positive for VLCAD deficiency with C14:1 and C14:1/C2 ratios. Our analyses indicated that the ratios of C14:1 to medium-chain acylcarnitines (C10, C8, and C6) were the most effective markers in reducing false-positive rates. Their use with appropriate cutoffs is expected to improve NBS performance for VLCAD deficiency.

Community infant safe sleep and breastfeeding promotion and population level-outcomes: A mixed methods study

ProblemIn the U.S., sudden unexpected infant deaths due to accidental suffocation and strangulation in bed are increasing. Though breastfeeding is a protective factor against sudden unexpected infant death, motivations to breastfeed often couple with unsafe infant sleep practices. Racial/ethnic disparities are present in sudden unexpected infant death, accidental suffocation and strangulation in bed, and breastfeeding. BackgroundPromoting infant safe sleep and breastfeeding through community-level initiatives could address disparities in related outcomes. AimInvestigate the relationship between community-level strategies and associated state-level outcomes for infant safe sleep and breastfeeding. MethodsWe employed an intervention mixed methods framework and exploratory sequential design. The qualitative component entailed a hermeneutical phenomenological framework to analyze key informant interview data from seven U.S. community-level providers participating in a practice improvement initiative. The quantitative component entailed descriptively analyzing infant safe sleep and breastfeeding indicators from the 2019 Pregnancy Risk Assessment Monitoring System and Ohio Pregnancy Assessment Survey. Qualitative and quantitative data were linked through embedded integration. FindingsWe identified two mixed insights: gaps in promotion and outcomes, and persistent disparities between infant safe sleep and breastfeeding promotion and outcomes. DiscussionOur findings indicate conversational approaches could improve infant safe sleep and breastfeeding promotion, outcomes, and relative disparities. We find that community collaboration is needed to address organizational capacity limitations in promoting infant safe sleep and breastfeeding. ConclusionCommunity-level organizations and providers should consider tailoring program offerings and care delivery to include conversational approaches and community collaboration to promote infant safe sleep and breastfeeding and decrease relative disparities in outcomes.

Infant death from accidental suffocation and strangulation in bed in England and Wales: rare or unrecognised events?

BackgroundMandatory joint police and healthcare investigations of sudden unexpected death in infancy (SUDI) have been in place since 2008 in England. These include death scene examination with cause of death...

The study of the microbiome in forensic investigations on pediatric deaths.

Sudden infant death syndrome (SIDS) is a tragic and devastating condition whose causes remain largely unknown. Recent studies have shown that the composition of a child's gut flora can play a significant role in the development of SIDS. This work aims to research those factors that influence the composition of the intestinal flora, the role they have in the development of SIDS and the new strategies for preventing SIDS showing a new interpretation through a detailed review of the literature. The gut in physiological conditions is mainly composed of Bacteroidetes, Firmicutes, Actinobacteria, and Proteobacteria, but when there is the presence of dysbiotic or different microbial communities, the onset of the disease is more likely as an altered microbial community can lead to an interruption of the gut-brain axis and an increased risk of SIDS. All this implies that the composition of the microbiome can be modified to reduce the risk of sudden death in newborns. The results of the literature provide valuable information on the potential role of the intestinal microbiome in SIDS even if not all mechanisms are yet clear, especially in the mechanisms of death. Therefore, it is necessary in cases of SIDS when carrying out an autopsy to also investigate this area; to this end, we suggest a questionnaire to be administered to family members to understand the eating habits of the newborn and the family and integrate with microbiological investigations to explore every possible hypothesis.

Detecting central apneas using multichannel signals in premature infants.

Objective. Monitoring of apnea of prematurity, performed in neonatal intensive care units by detecting central apneas (CAs) in the respiratory traces, is characterized by a high number of false alarms. A two-step approach consisting of a threshold-based apneic event detection algorithm followed by a machine learning model was recently presented in literature aiming to improve CA detection. However, since this is characterized by high complexity and low precision, we developed a new direct approach that only consists of a detection model based on machine learning directly working with multichannel signals.Approach. The dataset used in this study consisted of 48 h of ECG, chest impedance and peripheral oxygen saturation extracted from 10 premature infants. CAs were labeled by two clinical experts. 47 features were extracted from time series using 30 s moving windows with an overlap of 5 s and evaluated in sets of 4 consecutive moving windows, in a similar way to what was indicated for the two-step approach. An undersampling method was used to reduce imbalance in the training set while aiming at increasing precision. A detection model using logistic regression with elastic net penalty and leave-one-patient-out cross-validation was then tested on the full dataset.Main results. This detection model returned a mean area under the receiver operating characteristic curve value equal to 0.86 and, after the selection of a FPR equal to 0.1 and the use of smoothing, an increased precision (0.50 versus 0.42) at the expense of a decrease in recall (0.70 versus 0.78) compared to the two-step approach around suspected apneic events.Significance. The new direct approach guaranteed correct detections for more than 81% of CAs with lengthL≥ 20 s, which are considered among the most threatening apneic events for premature infants. These results require additional verifications using more extensive datasets but could lead to promising applications in clinical practice.

Multiomic Analysis of Neuroinflammation and Occult Infection in Sudden Infant Death Syndrome

Antemortem infection is a risk factor for sudden infant death syndrome (SIDS)-the leading postneonatal cause of infant mortality in the developed world. Manifestations of infection and inflammation are not always apparent in clinical settings or by standard autopsy; thus, enhanced resolution approaches are needed. To ascertain whether a subset of SIDS cases is associated with neuroinflammation and occult infection. In this case-control study, postmortem fluids from SIDS cases and controls collected between July 2011 and November 2018 were screened for elevated inflammatory markers, specifically cerebrospinal fluid (CSF) neopterin and CSF and serum cytokines. CSF, liver, and brain tissue from SIDS cases with elevated CSF neopterin were subjected to metagenomic next-generation sequencing (mNGS) to probe for infectious pathogens. Brainstem tissue from a subset of these cases was analyzed by single-nucleus RNA sequencing (snRNAseq) to measure cell type-specific gene expression associated with neuroinflammation and infection. All tissue and fluid analyses were performed from April 2019 to January 2023 in a pathology research laboratory. Included was autopsy material from infants dying of SIDS and age-matched controls dying of known causes. There were no interventions or exposures. CSF neopterin levels were measured by high-performance liquid chromatography. Cytokines were measured by multiplex fluorometric assay. mNGS was performed on liver, CSF, brain, and brainstem tissue. snRNAseq was performed on brainstem tissue. A cohort of 71 SIDS cases (mean [SD] age, 55.2 [11.4] postconceptional weeks; 42 male [59.2%]) and 20 controls (mean [SD] age, 63.2 [16.9] postconceptional weeks; 11 male [55.0%]) had CSF and/or serum available. CSF neopterin was screened in 64 SIDS cases and 15 controls, with no exclusions. Tissues from 6 SIDS cases were further analyzed. For CSF neopterin measures, SIDS samples were from infants with mean (SD) age of 54.5 (11.3) postconceptional weeks (38 male [59.4%]) and control samples were from infants with mean (SD) age of 61.5 (17.4) postconceptional weeks (7 male [46.7%]). A total of 6 SIDS cases (9.3%) with high CSF neopterin were identified, suggestive of neuroinflammation. mNGS detected human parechovirus 3 (HPeV3) in tissue and CSF from 1 of these 6 cases. snRNAseq of HPeV3-positive brainstem tissue (medulla) revealed dramatic enrichment of transcripts for genes with predominately inflammatory functions compared with 3 age-matched SIDS cases with normal CSF neopterin levels. Next-generation molecular tools in autopsy tissue provide novel insight into pathogens that go unrecognized by normal autopsy methodology, including in infants dying suddenly and unexpectedly.

Brainstem Encephalitis as a Cause of Sudden Infant Death Syndrome

Brainstem Encephalitis as a Cause of Sudden Infant Death Syndrome

Effetti neonatali del fumo di sigaretta in gravidanza: descrizione di un caso clinico

The paper describes the case of a second child born by iterative caesarean section at 38 weeks + 5 days after pregnancy complicated by maternal smoking (20 ciga-rettes/day) and gestational diabetes on dietary therapy. At birth, regular adaptation to extrauterine life. Neonatal weight 4,150 g (LGA > 97°pct). On the second day of life, limbs tremors, masticatory clonus and hyperexcitability were observed. After excluding metabolic causes (hypoglycaemia, dyselectrolythemia), sepsis and seizures, in the suspicion of neonatal abstinence syndrome, a urine dosage of the most common substances of abuse, nicotine and its metabolites, was carried out. The high value of Trans-3-OH-Cotinine, the main metabolite of nicotine, together with the negativity for other substances, confirmed the suspicion of nicotine withdrawal syndrome. The newborn was kept under strict parametric monitoring in a low sensory stimulation environment. Hyperexcitability, increased tone, acute crying and tremors continued through the fifth day of life: Finnegan score 9, 8 and 5 respectively on the second, third and fifth day of life. Subsequently, there was a progressive improvement and the patient was discharged on the ninth day of life. Currently, at the paediatric and neuropsychiatric follow-up at the first month of life, the newborn is in regular growth and their neurological examination is normal and age-appropriate. The use of tobacco products during pregnancy is one of the most important modifiable risk factors associated with adverse maternal, foetal and ne-onatal outcomes. In utero tobacco exposure is associated with increased risk of placental abruption, prematurity, low birth weight, foetal malformations, stillbirths and sudden unexpected infant death (SUID). Studies on infants born to mothers who smoke have reported an in-crease in signs of stress such as irritability and hypertonicity compared to those born to mothers who do not smoke.

Need for Repeat-Hospitalization in Very Low Birth Weight or Very Preterm Infants: A Prospective Cohort Study.

To determine the incidence of repeat-hospitalization amongst neonates with gestation <32 wk or birth weight <1500g within 6 mo of birth. All live births with gestation <32 wk or birth weight <1500g born at a level-III NICU were prospectively enrolled and followed up through routine visits, multimedia and telephonically, fortnightly for re-hospitalization details till 6 mo of postnatal age. Main outcome measures were incidence, causes and risk factors for repeat-hospitalization. Of the 131 neonates enrolled, incidence and incidence density ofrepeat-hospitalization were 16% (95% CI 10.2-23.4) and 3.6 per 100 person-months, respectively. The most common causes for repeat-hospitalizations were pneumonia (n = 8; 29.6%), sepsis (n = 5, 18.5%), gastroenteritis (n = 3, 11.1%) and severe anemia (n = 2, 7.4%). Majority of repeat-hospitalizations (92.6%; 95% CI 74.1-98.5) occurred within 2 mo of discharge. The median hospital stay during repeat-hospitalizations was 4 d (IQR 1-21). On multivariate analysis, lower socioeconomic status was significantly associated with repeat-hospitalization (aOR 5.9, 1.3-23). Death after discharge occurred in 3 (2.3%) infants and were due to sudden infant death syndrome, complex cyanotic heart disease and pneumonia with multiple co-morbidities (one each). All deaths occurred at home. Nearly one-sixth of very low birth weight (VLBW) or very preterm infants required repeat-hospitalization after discharge, primarily within 2 mo of discharge. Infections, especially pneumonia, being the most common reason. A comprehensive follow-up package of post-discharge care for prevention of morbidities and timely hospital care for ongoing morbidities is required for optimal long-term survival of these infants.

A study of Samoan, Tongan, Cook Island Māori, and Niuean infant care practices in the Growing Up in New Zealand study

BackgroundDespite a low rate of infant mortality, Aotearoa New Zealand has a high rate of Sudden Unexpected Death in Infants (SUDI), with disproportionate impact for Pacific infants. This study explored the infant care practices, factors and relationships associated with increased risk of SUDI amongst Tongan, Samoan, Cook Islands Māori, and Niuean mothers in New Zealand, to inform evidence-based interventions for reducing the incidence of SUDI for Pacific families and their children.MethodsAnalysis comprised of data collected in 2009–2010 from 1089 Samoan, Tongan, Cook Islands Māori and Niuean mothers enrolled in the Growing Up in New Zealand longitudinal cohort study. The sleeping environment (bed-sharing and sleep position) of the infants was assessed at 6 weeks. Multivariable logistic regression analysis were conducted, controlling for sociodemographic factors to explore the association between selected maternal and pregnancy support and environment factors and the sleeping environment for infants.ResultsMothers who converse in languages other than English at home, and mothers who consulted alternative practitioners were less likely to follow guidelines for infant sleeping position. Similarly language, smoking, alcohol, household dwelling, crowding and access to a family doctor or GP were associated with mothers following guidelines for bed-sharing.ConclusionThe impact of SUDI on Pacific infants may be lessened or prevented if communication about risk factors is more inclusive of diverse ethnic, cultural worldviews, and languages. Societal structural issues such as access to affordable housing is also important. This research suggests a need for more targeted or tailored interventions which promote safe sleeping and reduce rates of SUDI in a culturally respectful and meaningful way for Pasifika communities in Aotearoa, New Zealand.

Interventional Safety Program about Sudden Infant Death Syndrome among Egyptian Infants&amp;#039; Mothers

Interventional Safety Program about Sudden Infant Death Syndrome among Egyptian Infants&amp;#039; Mothers

Sudden Infant Death Syndrome (SIDS): State of the Art and Future Directions.

Sudden infant death syndrome (SIDS) is a type of death that occurs suddenly and without any apparent explanation, affecting infants between 28 days of life and up to a year. Recognition of this entity includes performing an autopsy to determine if there is another explanation for the event and performing both an external and internal examination of the different tissues to search for possible histopathological findings. Despite the relative success of awareness campaigns and the implementation of prevention measures, SIDS still represents one of the leading causes of death among infants worldwide. In addition, although the development of different techniques has made it possible to make significant progress in the characterization of the etiopathogenic mechanisms underlying SIDS, there are still many unknowns to be resolved in this regard and the integrative consideration of this syndrome represents an enormous challenge to face both from a point of view scientific and medical view as humanitarian. For all these reasons, this paper aims to summarize the most relevant current knowledge of SIDS, exploring from the base the characterization and recognition of this condition, its forensic findings, its risk factors, and the main prevention measures to be implemented. Likewise, an attempt will be made to analyze the causes and pathological mechanisms associated with SIDS, as well as potential approaches and future paths that must be followed to reduce the impact of this condition.

Knowledge about sudden infant death syndrome prevention among postpartum women in Southern Brazil, 2019: a cross-sectional survey.

To assess knowledge on sudden infant death syndrome (SIDS) prevention among postpartum women who received prenatal care in public and private services in Rio Grande, Rio Grande do Sul, Brazil, in 2019. A cross-sectional study was conducted with postpartum women who gave birth in that municipality in 2019; the outcome was the indication of incorrect sleeping position (side/supine position) to prevent SIDS; the chi-square test was used to compare proportions between those who underwent prenatal care in public and private services. Among all 2,195 postpartum women, 67.7% (95%CI 65.7;69.6) were unaware of the position that prevents SIDS, 71.6% were public care service users; 77.8% of them feared choking/suffocation; 1.9% were informed about SIDS during prenatal care; doctors/nurses (70.5%) and grandmothers (65.1%) were influential regarding the baby's sleeping position. Most postpartum women were unaware of the sleeping position that prevents SIDS, especially those receiving care in the public sector; in general, this subject is not discussed in prenatal care. Two out of three mothers believed the newborn should sleep in the side or prone position, which does not prevent but rather facilitates sudden infant death syndrome (SIDS); lack of knowledge was significantly greater when prenatal care took place in public services. SIDS should be addressed in prenatal care. Guidance from a doctor/nurse during consultations can be essential for mothers to change their mind and adopt a safe sleeping position (supine position) for their child. SIDS prevention campaigns are relevant in the context of prenatal care, as is conducting research that aims to evaluate potential impacts of interventions on the correct sleeping position for babies.

Sudden infant death syndrome - a community intervention project.

To capacitate pregnant women to comply with measures designed to prevent sudden infant death syndrome. A quasi-experimental study was conducted before and after the intervention that included pregnant women attending the Course of Preparation for Childbirth and Parenthood of Health Centers Cluster. Six training sessions were given in the context of preventing this syndrome. Three questionnaires were applied, one to evaluate the knowledge of pregnant women before classes, other was submitted after the sessions, and another, one month after the birth of the babies, to identify what skills were acquired and which were practiced. Among 77 studied pregnant women, 70 answered pre-session questionnaire and the proportion of correct answers varied from from 60.0% to 84.3%. After the intervention, 64 women answered the questionnaire and the proportion of correct answers varied between 79.7% and 100% . Prior to the intervention, the most wrong answers were related to the role of smoking as a risk factor for sudden infant death syndrome and to the use of pacifiers as a protective measure. After the sessions, all women answered correctly to the questions concerning where the baby should sleep and the safest way to lay the baby in the cradle. Health education with the aim of establishing measures may have a significant impact in terms of care delivery and mortality rate caused by sudden infant death syndrome.

Синдром внезапной детской смерти: классификация, факторы риска, влияние пандемии COVID-19

This review is devoted to sudden infant death syndrome (SIDS), an urgent problem of modern pediatrics. In this exclusion diagnosis, a significant part of cases of sudden death of an infant under one year of age (more often during sleep) of unknown etiology, coded by the International Classification of Diseases X revision as R95 (sudden infant death). The review details the epidemiologic, etiologic, and terminologic aspects of SIDS. Special attention is paid to the different levels of diagnostic capabilities of health care systems in different countries, differences in classifications and discrepancies in their application, as well as the possible role of viral infections (including coronavirus) in the possible mechanisms of development and onset of sudden infant death. Attraction of attention of a wide range of specialists, both fundamental and clinical, to this important problem, according to the authors, will allow developing and implement modern measures of prevention and preventive diagnosis of SIDS in practical pediatrics. Key words: coronavirus infection, smoking, infant mortality rate, sudden infant death syndrome

Sudden Infant Death Syndrome (SIDS): Known Risk Factors and the Need for Continued Education

Sudden Infant Death Syndrome (SIDS): Known Risk Factors and the Need for Continued Education

Evaluation of mothers' knowledge about infant sudden death syndrome and its risk factors.

Sudden infant death syndrome is the third leading cause of infant death in the first year of life and is one of the most important health problems around the world. The exact etiology of this phenomenon is not clear yet, but some risk factors, especially prone sleep positions, have been described. Fortunately, by modifying some environmental factors, the SIDS incidence might be decreased. Mothers' and caregivers' knowledge about this neglected event could be an important factor in determining SIDS prevalence. This cross-sectional study was conducted in the pediatric and neonatal specialty clinic of Bahar Shahroud Hospital in 2020. Five hundred and twenty-seven pregnant women of reproductive age (18 to 45 years) were included in the study. Assessment of mothers' knowledge was done using a sudden infant death syndrome risk questionnaire. Statistical analysis of data was performed using independent t-test, Chi-square, and logistic regression. The number of 527 pregnant women of childbearing age participated in our study. 81.9% were under 35 years old. According to the study, factors such as maternal age, mother's level of education, number of pregnancies, and history of previous infant death syndrome had a significant relationship with the mother's level of knowledge about infant death syndrome. The findings showed that the mother's age is over 35 years old during pregnancy (CI: 0.95-0.46-OR: 1.53) and the level of education under a diploma (CI: 3.13-1.6: 06, OR: 1.86), and increasing parity is associated with a lower level of knowledge about infant death syndrome. According to mothers' lack of knowledge about SIDS and the availability of simple and cost-effective methods to prevent SIDS, improving mothers' knowledge about this important event in pregnancy and postpartum, educational sessions are crucial.

Risk factors for small for gestational age as defined by a birthweight z-score below minus one: A prospective observational study

Objective: To determine the maternal risk factors for small-for-gestational-age newborns as defined by a birthweight z-score (BWZS) &lt; -1.0 Design: A prospective cohort study with recruitment from August 2007 to January 2015. Setting: Recruitment at a community health centre with assessments at Tygerberg Academic Hospital, Cape Town, South Africa. Population: A largely homogeneous population in a low socioeconomic residential area in Cape Town. Methods: This study is a further analysis of the data of the Safe Passage Study which investigated whether exposure to alcohol and tobacco was associated with increased risk of stillbirth and sudden infant death syndrome (SIDS). Main outcome measures: Birthweight z-score &lt; -1.0 Results: Individual odds ratios (ORs), in descending order, were associated with smoking, drinking, and preeclampsia (2.45), previous stillbirth (1.85), smoking (including smokers only and drinkers who also smoked) (1.55), preeclampsia (1.52), smoking and drinking (does not include smokers only or drinkers only)(1.43), hypertension (1.28), drug use (1.24), drinking during pregnancy (including drinkers only and drinkers who also smoked) (1.18), thoughts of self-harm (1.13), and crowding (1.10). After multiple logistic regression, highly significant ORs were found for previous stillbirth (1.89), cigarette smoking (1.84), hypertension (1.40), education (0.94) and body mass index (BMI) (0.95). Thoughts of self-harm then had an OR of 1.08 (95% confidence interval (CI) 1.00-1.18). Conclusion: Previous stillbirth, cigarette smoking, hypertension, lesser education, and a lower BMI were associated with the highest risks for low BWZS.