Sudden Unexplained Infant Death Research Articles

Cardiac rhabdomyoma: an uncommon culprit in sudden infant death.

Sudden death in infants remains a common and poorly understood cause of childhood mortality in the USA. Pediatric cardiac tumors, although rare, may underlie some cases of unexplained sudden infant death. Autopsy is a crucial diagnostic step in these cases, as both gross and microscopic examination of the heart may uncover occult cardiac tumors. Rhabdomyomas are the most common cardiac tumors in childhood and may result in arrythmia and sudden death. We present a case of sudden death in a healthy 5-month-old infant which initially appeared "SIDS-like" until thorough histological analysis revealed an underlying cardiac rhabdomyoma. The case is of particular importance in that the gross examination of the heart was considered completely normal, and the tumor only involved certain portions of the heart microscopically. Had a single random section of myocardium been the only heart section examined microscopically, the diagnosis might have been missed. This case emphasizes the importance of thorough microscopic examination in infant cases, especially in cases where the heart appears grossly normal.

Exploring the Relationship between Psychosocial Risk Factors and Sudden Unexplained Infant Death: A Study of Autopsy Cases from a Perspective of Child Welfare

Infants who are born between 24 hours and 1 year of age require extreme caution in their care due to their fragility. However, if there are multiple risk factors associated with the infant, caretaker, household, and surrounding circumstances, providing proper and appropriate care becomes problematic. This difficulty in caring for infants can contribute to abuse, neglect, or even death. This study investigates unexplained infant deaths that occur in the presence of multiple psychosocial risk factors. This study aimed to explore the relationship between various psychosocial risk factors and sudden, unexplained infant deaths. We examined nine cases from the autopsy archive of the National Forensic Service using a statistical approach. Among these cases, three were subject to legal action, while six were closed without further legal process. Although it was difficult to establish a clear relationship between death and abuse or neglect in the six cases, all were found to have experienced a harsh environment that was similar to abuse or neglect. We discuss the implications of our findings for understanding infant deaths and legal outcomes and propose a new framework to understand the deaths of infants.

Qualitative assessment of infant sleep practices and other risk factors of sudden infant death syndrome (SIDS) among mothers in Lusaka, Zambia

BackgroundThere is very little information on the beliefs and perceptions of mothers about SIDS and its related risk factors in Africa. To better understand parental decisions about infant sleep practices and other risk factors for SIDS, we conducted focus group discussions (FGDs) with mothers of infants in Lusaka, Zambia.MethodsFGDs involved 35 purposively sampled mothers aged 18–49 years. FGDs were conducted using a semi-structured interview guide in the local language, Nyanja. These were translated, transcribed verbatim into English, and then coded and analyzed using thematic analysis in NVivo 12.ResultsSix FGDs were conducted with 35 mothers in April-May 2021 across two study sites. FGD Participants were generally aware of sudden unexplained infant deaths, with several describing stories of apparent SIDS in the community. The side sleeping position was preferred and perceived to be safer for the infant with most believing the supine position posed an aspiration or choking risk to the infant. Bedsharing was also preferred and perceived to be convenient for breastfeeding and monitoring of the infant. Experienced family members such as grandmothers and mothers-in-law, and health care workers were frequently cited as sources of information on infant sleep position. A heightened awareness of the infant’s sleeping environment was suggested as a mechanism to prevent SIDS and smothering.ConclusionsDecisions about bedsharing and infant sleep position were guided by maternal beliefs and perceptions about what is convenient for breastfeeding and safer for the infant. These concerns are vital to designing tailored interventions to address sleep-related sudden infant losses in Zambia. Public health campaigns with tailored messages that address these concerns are likely to be effective at ensuring optimal uptake of safe sleep recommendations.

Perceptions and Use of Safe Sleep Baby Boxes at Hospital Discharge by New Mothers.

A large community hospital in South Texas began distributing safe sleep baby boxes to reduce sudden unexplained infant death (SUID) in 2017. To describe safe sleep practices among new mothers who received a safe sleep baby box at hospital discharge. An information sheet containing a link to an online survey was mailed to all women who received a safe sleep baby box prior to discharge from the hospital from January 2018 to January 2019. N = 84 women participated. Most reported using the safe sleep baby box only during nap time (n = 62, 88.6%). Only 70.2% of participants reported that baby always slept their back (n = 59). Most reported their baby did not use a pacifier (n = 62, 73.8%), and many reported they were not breastfeeding their baby (n = 38, 45.2%). Many women were not using the safe sleep baby box as intended and were not following many of the other safe sleep guidelines. Nurses should ask their patients about plans for infant safe sleep after discharge to provide individualized education or recommend specific resources to address the family's needs.

The added value of molecular-based diagnostics in the African forensic medical setting.

Sudden unexpected infant death (SUDI) is reported to be an extraordinarily high burden in sub-Saharan Africa, with the incidence rate in South Africa among the highest in the world. It is common for the cause of many such infant deaths to remain unexplained even after a full medico-legal death investigation, and then to be categorised as a sudden unexplained infant death (SUID). Fortunately, advances in molecular-based diagnostics allow researchers to identify numerous underlying inherited cardiac arrhythmogenic disorders in many SUDI cases, with a predominance of variants identified in the SCN5A gene. Such cardiac arrhythmogenic-related sudden deaths generally present with no structural alterations of the heart that are macroscopically identifiable at autopsy, therefore highlighting the importance of post mortem genetic testing. We report on a significant genetic finding that was made on a SUDI case in which the cause was ascribed to an acute bacterial pneumonia but it was still subjected to post mortem genetic testing of the SCN5A gene. The literature shows that many SUDI cases diagnosed with inherited cardiac arrhythmogenic disorders have demonstrated a viral prodrome within days of their death. It is therefore not uncommon for these cardiac disorders in infants to be mistaken for flu, viral upper respiratory tract infection or pneumonia, and without the incorporation of post mortem genetic testing, any other contributory causes of these deaths are often disregarded. This study highlights the need for research reporting on the genetics of inherited cardiac disorders in Africa.

Intervention during the Perinatal Period: Synthesis of the Clinical Practice Guidelines from the French National College of Midwives.

These clinical practice guidelines from the French National College of Midwives (CNSF) are intended to define the messages and the preventive interventions to be provided to women and co-parents by the different professionals providing care to women or their children during the perinatal period. These guidelines are divided into 10 sections, corresponding to 4 themes: 1/ the adaptation of maternal behaviors (physical activity, psychoactive agents); 2/ dietarybehaviors; 3/ household exposure to toxic substances (household uses, cosmetics); 4/ promotion of child health (breastfeeding, attachment and bonding, screen use, sudden unexplained infant death, and shaken baby syndrome). We suggest a ranking to prioritize the different preventive messages for each period, to take into account professionals' time constraints.

Survey of Korean daycare personnel on safe sleep practices related to sudden unexplained infant death: a cross-sectional exploratory study.

Safe sleep practices (SSP) are among the main strategies to reduce sleep-related sudden unexplained infant death (SUID). Daycare personnel must be knowledgeable and trained in SSP related to SUID. This study explored the experience, knowledge, and confidence regarding SSP associated with SUID of daycare personnel. A cross-sectional survey was conducted with 395 staff members at 61 daycare centers to measure their experience related to SSP (10 items), related to sleep position and location, bedding materials, and other topics; knowledge of SSP (18 items); and confidence in SSP (1 item) related to SUID. A substantial proportion (23.6%) of respondents used the lateral or prone positions for infant sleep. On average, 4.5 bedding materials were used for infant sleep. Participants showed a lack of knowledge about SSP as indicated by a 56.6% knowledge of SSP related to SUID correct answer rate. Personnel who received SUID education were more knowledgeable and had more confidence regarding SSP than those who did not. More knowledge and confidence related to SSP were associated with better adherence to SSP. Standard SSP guidelines should be developed based on South Korea's culture of childcare for educating both childcare professionals and parents at home.

Using a Community Approach to Address Sudden Unexplained Infant Death

Using a Community Approach to Address Sudden Unexplained Infant Death

Using a Community Approach to Address Sudden Unexplained Infant Death

Using a Community Approach to Address Sudden Unexplained Infant Death

The disparity in infant mortality outcomes based on duration of tobacco smoke in pregnancy

Smoking is an important public health burden. In pregnancy, it has been linked to fetal growth restriction, preterm birth, and sudden unexplained infant death. The objective of this study is to determine whether the duration of smoking in pregnancy results in differences in risk of infant mortality.

Understanding the Obstacles and Influences in Adopting Infant Safe Sleep Practices

Background About 3,500 infants die annually within their first year of life from Sudden Unexplained Infant Death (SUID) and its subset Sudden Infants Death Syndrome (SIDS), making it the single leading cause of infant mortality in the U.S. Evidence indicates adherence to infant Safe Sleep Guidelines developed by the American Academy of Pediatrics (AAP) reduces these mortality rates. Still, since an initial decline following the 1994 guidelines introduction, SIDS rates have leveled, and SUID rates have increased. In addition, SUID rates per 100,000 live births are twice as high among Black and Native American infants than white. The AAP last updated the guidelines in 2016 and is scheduled to issue the next updated guidelines in late 2021. Objective To examine perceptions of the AAP guidelines held by parents and health care providers as they relate to guidelines comprehension and compliance, and to share this information with the AAP 2021 guidelines task force. Methods First Candle commissioned a qualitative research study in 2020, consisting of three online focus groups in three different states to identify perceptions and potential barriers to guidelines adoption by family members and providers, the outcomes of which were shared with the AAP for review as its guidelines task force develops the updated version to be released in 2021. Results Regarding how the AAP guidelines were viewed, there were responses across geographic and sociocultural variation regarding varying levels of general comprehension and trust in them, depending on the resource and acceptance of the language used. Additional factors were the emotional and practical realities of parenting, cultural and family traditions, and the belief that parental volition in decision-making is important. Conclusion Evidence-based protocols regarding infant safe sleep practices and their impact on reducing infant mortality rates may have proven value. Still, professional caregivers and family members feel that more cultural context and personal relevance are needed in presentation and communication if families are to trust and consider them for adoption and compliance.

A Retrospective Study of Parent’s First-Hand Experience of Premonitions and Other Anomalous Aspects of the SIDS Phenomenon: A potential “SIDS early warning system?”

Introduction The main purpose of this study is to determine the incidence of premonition in SIDS parents vs. Non-SIDS/Control Group parents and to test for a number of other anomalous "markers" noted anecdotally by decades of in the field observation. Evidence of premonition and these other "markers" as consistent elements of the SIDS phenomenon could serve as an "early warning system" for a future SIDS event if confirmed by larger studies. Methodology Both groups of SIDS parents and Control parent participants completed electronic questionnaires on the SurveyMonkey platform for statistical analysis. Results The results of this pilot study indicated statistically significant differences between the SIDS parent and Non-SIDS control study groups for premonition and a set of other anomalous markers. Conclusion The authors believe that this pilot study of premonition and other markers may provide an "early-warning" system for an impending SIDS event if confirmed with future larger studies. Importance: This pilot study confirms results of the value of premonition as well as other anomalous observations by parents whose infants may be at risk for a SIDS event. This study deserves to be confirmed by larger studies and, if so, confirmed indicates a reliable "early warning system" for an impending SIDS event. We face the problem if this SIDS event represents the small percentage of infants who will die of SIDS, even if a diagnostic evaluation and management, including hospital admission and monitoring, may not prevent death from SIDS. However, if this premonition is predictive of Sudden Unexplained Infant Death (SUID) secondary to a potentially preventable etiology, this infant death may be preventable.

Spectral motherhood and maternal grieving: language and sudden unexplained death in infancy in Australian juvenile fiction

ABSTRACT Written by adults for children, children’s literature plays a significant role in shaping readers’ identities and worldviews, including those relating to gender and death. In two Australian children’s novels, The Shape (2000) by Diane Bates and The Naming of Tishkin Silk (2003) by Glenda Millard, the generic depiction of motherhood meets new representational agendas relating to sudden unexplained death in infancy and grieving at a politically charged price. Primarily drawing on an Irigarayian theory relating to motherhood, and patriarchal language and discourse, this paper argues that the depressed mothers in these two novels function as spectral figures, whose absent presence and present absence haunt both the child protagonists and the texts. Moreover, the fictional mothers’ healing is dependent on their relationship to their surviving children, which ensures that ideologies of motherhood are contained within patriarchal discourses in these texts for children.

On Adapting to Remote Learning for Healthcare Professionals

The article focuses on COVID-19 pandemic has changed and continues to change our health outlook, risk behaviors, and daily activities and for clinicians and health education professionals, it has forced us to be open to new ways of working with each other and with those we serve Topics include the mission is to reduce the rate of infant mortality due to Sudden Unexplained Infant Death (SUID), which includes Sudden Infant Death Syndrome and Accidental Strangulation and Suffocation in Bed

Vaccines and sudden infant death: An analysis of the VAERS database 1990-2019 and review of the medical literature.

Although there is considerable evidence that a subset of infants has an increased risk of sudden death after receiving vaccines, health authorities eliminated "prophylactic vaccination" as an official cause of death, so medical examiners are compelled to misclassify and conceal vaccine-related fatalities under alternate cause-of-death classifications. In this paper, the Vaccine Adverse Event Reporting System (VAERS) database was analyzed to ascertain the onset interval of infant deaths post-vaccination. Of 2605 infant deaths reported to VAERS from 1990 through 2019, 58 % clustered within 3 days post-vaccination and 78.3 % occurred within 7 days post-vaccination, confirming that infant deaths tend to occur in temporal proximity to vaccine administration. The excess of deaths during these early post-vaccination periods was statistically significant (p < 0.00001). A review of the medical literature substantiates a link between vaccines and sudden unexplained infant deaths. Several theories regarding the pathogenic mechanism behind these fatal events have been proposed, including the role of inflammatory cytokines as neuromodulators in the infant medulla preceding an abnormal response to the accumulation of carbon dioxide; fatal disorganization of respiratory control induced by adjuvants that cross the blood-brain barrier; and biochemical or synergistic toxicity due to multiple vaccines administered concurrently. While the findings in this paper are not proof of an association between infant vaccines and infant deaths, they are highly suggestive of a causal relationship.

Improving infant sleep safety via electronic health record communication: a randomized controlled trial

BackgroundWith increased use of telehealth, interventions to improve infant sleep environments have not been explored. This study sought to assess the feasibility and efficacy of using electronic health record patient portals to transmit photographs of infant sleep between mothers and healthcare professionals as part of an intervention to promote sleep environments consistent with AAP guidelines.MethodsOne hundred eighty-four mother-newborn dyads consented to participate in a randomized trial requiring patient portal registration within 1 month of delivery. We first assessed feasibility as measured by a) the proportion of consented mothers enrolling in the portal and b) maternal adherence to prompts to submit photographs of their infant sleeping to the research team through the patient portal. Intervention group mothers were prompted at 1 and 2 months; controls were prompted only at 2 months. Efficacy was determined via research assistant review of submitted photographs. These assistants were trained to detect sudden unexplained infant death risk factors utilizing AAP guidelines. Standardized feedback was returned to mothers through the patient portal. We used Fisher’s Exact test to assess group differences in guideline adherence at 2 months.ResultsOne hundred nine mothers (59%) enrolled in the patient portal and were randomized to intervention (N = 55) and control (N = 54) groups. 21 (38, 95% CI 25–52%) intervention group participants sent photographs at 1 month and received personalized feedback. Across both groups at 2 months, 40 (37, 95% CI 28–46%) sent photographs; 56% of intervention group participants who submitted photographs met all safe sleep criteria compared with 46% of controls (difference 0.10, 95% CI − 0.26 to 0.46, p = .75). Common reasons for guideline non-adherence were sleeping in a room without a caregiver (43%), loose bedding (15%) and objects (8%) on the sleep surface.ConclusionsUtilizing the patient portal to individualize safe infant sleep is possible, however, we encountered numerous barriers in this trial to assess its effects on promoting safe infant sleep. Photographs of infants sleeping showed substantial non-adherence to AAP guidelines, suggesting further needs for improvement to promote safe infant sleep practices.Trial registrationName: Improving Infant Sleep Safety With the Electronic Health Record; Clinicaltrials.gov: NCT03662048; Date of Registration: September 7, 2018;Data Sharing Statement: None

Sudden Unexplained Infant Deaths: New Study Findings Related to Day of Life.

Sudden Unexplained Infant Deaths: New Study Findings Related to Day of Life.

Mother-Infant Co-Sleeping and Maternally Reported Infant Breathing Distress in the UK Millennium Cohort.

Mother–infant co-sleeping or bed sharing is discouraged by health organisations due to evidence that it is associated with unexplained sudden infant death. On the other hand, there is evidence that it should theoretically be beneficial for infants. One line of this evidence concerns breathing regulation, which at night is influenced by the rocking movement of the mother’s chest as she breathes. Here, the hypothesis that mother–infant co-sleeping will be associated with a lower probability of infant breathing distress is tested in the UK Millennium Cohort Study (n = 18,552 infants). Maternal, infant, family, and socio-economic covariates were included in logistic regression analysis, and in a machine learning algorithm (Random Forest) to make full use of the number of variables available in the birth cohort study data. Results from logistic regression analysis showed that co-sleeping was associated with a reduced risk of breathing difficulties (OR = 0.69, p = 0.027). The Random Forest algorithm placed high importance on socio-economic aspects of infant environment, and indicated that a number of maternal, child, and environmental variables predicted breathing distress. Co-sleeping by itself was not high in the Random Forest variable importance ranking. Together, the results suggest that co-sleeping may be associated with a modest reduction in risk of infant breathing difficulties.

Sudden Unexplained Infant Deaths and Day of Life 0.

* Abbreviations: SIDS — : sudden infant death syndrome SUID — : sudden unexplained infant death Fifty years ago, an extraordinary group of pathologists, pediatricians, and epidemiologists met to address the limited research and numerous diagnoses applied to unexplained, largely sleep-related pediatric deaths. Their efforts led to the identification of a new category of disease, sudden infant death syndrome (SIDS). Among the observations fueling the creation of the category was the relative sparing of neonates despite what should be increased vulnerability in the early days of life. When Dr Bruce Beckwith, the conference’s leader, asked whether anyone doubted this age-related sparing, not a single objection was raised.1 Yet, humility about what was not yet known led to broader diagnostic criteria of “any infant or young child.” Years later, SIDS was redefined as pertaining to infants <1 year of age.2 Still later, when classification practices scattered because of objections about the concept of SIDS and the varied use of alternative terminologies, the composite of sudden unexplained infant death (SUID) came to stand in.3 In this issue of Pediatrics , big data concur with the pioneering thinkers and draw the demarcation at 1 week. In “Distinct … Address correspondence to Richard D. Goldstein, MD, Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail: richard.goldstein{at}childrens.harvard.edu

Intensive Care Neonates and Evidence to Support the Elimination of Hats for Safe Sleep

Although the incidence of sudden unexplained infant deaths has decreased over time with the use of safe sleep practices, one area that remains unclear is the safety of hats during infant sleep. Decrease the risk of overheating or suffocation by removing NICU infants' hats during sleep without increasing the relative risk of hypothermia during transition to an open crib. Removal of hats for routine thermoregulation, beyond the initial infant resuscitation and stabilization of NICU infant was implemented in 2015. Retrospective chart audits were conducted on all NICU infants between February 2015 and December 2016. Hypothermia (≤ 97.6°F) data during transition to an open crib was collected. Exclusion criteria included concurrent diagnosis of: sepsis, hyperbilirubinemia, congenital anomaly inhibiting infants thermoregulation and noncompliance with unit guideline for weaning infant to open crib. Over 18 months, 2.7% of infants became hypothermic (≤ 97.6°F) during transition to open crib, requiring return to isolettes. Hats were found to be unnecessary in maintaining thermoneutrality after weaning infants toan open crib in our NICU. By avoiding the use of hats in an open crib, it's possible infants will avoid overheating and a risk of suffocation, creating a safer sleep environment. The removal of hats during sleep to promote infant health should be considered for all infants.