January E-zine

The Georgia SIDS Project E-Zine is an on-line educational update offered monthly by the Georgia Sudden Infant Death Information, Referral and Support Project,

an affiliate of First Candle/SIDS Alliance. To request additional information, refer families in need of support, make a donation

or be added or removed from the list please contact us at gasids@mindspring.com or call 678-342-3360

This publication is made available through a generous donation from the Columbus Community Foundation.

Through the State Charitable Campaign Program state employees can select and donate to the Georgia SIDS Project. Help us support bereaved families, increase risk reduction education, make safe cribs available to low-income high-risk infants through your donations. Select Georgia SIDS Project  # 160000.

As you consider your Charitable Donations for 2007 – Please be sure to remember the Georgia SIDS Project.

The support materials we offer to bereaved families is ENTIRELY dependent on donations.

Your contribution could make an enormous difference to a family.

All Donations are tax-deductible.

Volume 3 - Issue Number 1, January 2007

1. Georgia SIDS Office changes location and hours – but keeps the same e-mail and phone.
2. Georgia SIDS Project supports NICU nurse training project and additional research program
3. Infant Deaths Associated with Cough and Cold Medications – new CDC report
4. Risk of preterm delivery in relation to vaginal bleeding in early pregnancy studied
5. Maternal-Infant bed sharing: Risk factors for bed sharing in a population-based survey of new mothers and implications for SIDS risk reduction
6. Contexts and evolution of women's responses to miscarriage during the first year after loss
7. Factors Influencing Childbearing Decisions and Knowledge of Perinatal Risks among Canadian Men and Women
8. Health Care Costs Attributable to Prenatal Smoking: Past and Current Research conference call February 28.
9. Pertinent Issues in the SIDS/ Bed-sharing Debate One-Day Conference March 28,2007 in Dalton, Georgia
10. A new study finds women who take folic acid supplements early in their pregnancy can substantially reduce their baby's chances of cleft lip and/or palate
11. Differences in neonatal mortality in Asian American subgroups: evidence from California with clinical implications
12. Legal and ethical considerations: risks and benefits of postpartum depression screening at well-child visits
13. Consumer Report indicates that most infant seats did not perform adequately in more severe car crash tests AAP makes recommendations.

1. The Georgia SIDS Project has changed locations and is staffing the office on a part-time basis only. Please know that the phone and e-mail (which remain the same) are being checked regularly, but the office will be open by appointment only. Our new fax number is 404-501-9744. Our new location and mail address is:

Georgia SIDS Project

4112 - 2 E. Ponce de Leon

Clarkston, Georgia 30021

Office 678-342-3360 24-hour Support 1-800-221-SIDS

www.sidsga.org e-mail: gasids@mindspring.com

2. On January 11, 2007 with the support from the Morehouse School of Medicine Center of Excellence on Health Disparities, the Georgia SIDS Project offered training to 39 NICU nurses representing 16 Neonatal Intensive Care Units in Georgia. The training was offered to hospitals across the state. The project was an expanded effort of the third phase of a study begun under the auspices of an American Academy of Pediatrics grant. The training was conducted by Chris Aris, CNNP from Syracuse, NY whose published article about NICU nurse knowledge, attitudes and behaviors was recently published, the abstract of which was highlighted in our November 2006 E-zine. Hospitals participating in the training are being recruited to help GSP continue the study in conjunct with Chris Aris related to the impact of nurse training on in-hospital practice and discharge instruction. For more information about the next study phase for the NICU and your institutions interest in participation please contact Diane Manheim at 678-468-8023 cell or 678-342-3360 office.

3. NEW Report from the CDC: Infant Deaths Associated with Cough and Cold Medications --- Two States, 2005 CDC and the National Association of Medical Examiners (NAME) investigated deaths in U.S. infants aged <12 months associated with cough and cold medications. This report describes the results of that investigation, which identified deaths of three infants aged <6 months in 2005, for which cough and cold medications were determined by medical examiners or coroners to be the underlying cause. The dosages at which cough and cold medications can cause illness or death in children aged <2 years are not known. Food and Drug Administration (FDA)-approved dosing recommendations for clinicians prescribing cough and cold medications do not exist for this age group. Because of the risks for toxicity, absence of dosing recommendations, and limited published evidence of effectiveness of these medications in children aged <2 years, CDC recommends that parents and other caregivers should not administer cough and cold medications to children in this age group without first consulting health-care provider and should follow the provider's instructions precisely. Clinicians should use caution when prescribing cough and cold medications to children aged <2 years. Moreover, clinicians should always ask caregivers about their use of over-the-counter combination medications to avoid overdose in children from multiple medications that contain the same ingredient. Whole report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5601a1.htm

4. Risk of preterm delivery in relation to vaginal bleeding in early pregnancy. Hossain R, et al Eur J Obstet Gynecol Reprod Biol. 2007 Jan 3;

The objective of the study was to examine the relationship between vaginal bleeding during early pregnancy and preterm delivery. Study subjects (N=2678) provided information regarding socio-demographic, biomedical, and lifestyle characteristics. Any vaginal bleeding in early pregnancy was associated with a 1.57-fold increased risk of preterm delivery (95% CI: 1.16-2.11). Vaginal bleeding was most strongly related with spontaneous preterm labor (OR=2.10) and weakly associated with preterm premature rupture of membrane (OR=1.36) and medically induced preterm delivery (OR=1.32). As compared to women with no bleeding, those who bled during the first and second trimesters had a 6.24-fold increased risk of spontaneous preterm labor; and 2-3-fold increased risk of medically induced preterm delivery and preterm premature rupture of membrane, respectively. Conclusion: Vaginal bleeding, particularly bleeding that persists across the first two trimesters, is associated with an increased risk of preterm delivery. 

5. Maternal-Infant bedsharing: Risk factors for bedsharing in a population-based survey of new mothers and implications for SIDS risk reduction. Lahr MB, Rosenberg KD, Lapidus JA. Matern Child Health J. 2006 Dec 29;

Maternal-infant bedsharing is a common but controversial practice. Little has been published about who bedshares in the United States. This information would be useful to inform public policy, to guide clinical practice and to help focus research. The objective was to explore the prevalence and determinants of bedsharing in Oregon. Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) surveys a population-based random sample of women after a live birth. Women were asked if they shared a bed with their infant "always," "almost always," "sometimes" or "never." 1867 women completed the survey in 1998-99. Of the respondents, 20.5% reported bedsharing always, 14.7% almost always, 41.4% sometimes, and 23.4% never. In multivariable logistic regression, Hispanics, blacks and Asians/Pacific Islanders women who breastfed more than 4 weeks, had annual family incomes less than $30,000 or were single were more likely to bedshare frequently (always or almost always). Among Hispanic and black women, bedsharing did not vary significantly by income level. Bedsharing black, American Indian/Alaska Native and white infants were much more likely to be exposed to smoking mothers than Hispanic or Asian/Pacific Islander infants Conclusions: Bedsharing is common in Oregon. The women most likely to bedshare are non-white, single, breastfeeding and low-income. Non-economic factors are also important, particularly among blacks and Hispanics. Campaigns to decrease bedsharing by providing cribs may have limited effectiveness if mothers are bedsharing because of cultural norms.

6. Contexts and evolution of women's responses to miscarriage during the first year after loss. Swanson KM, et al Res Nurs Health. 2007 Jan 22; Descriptions of 85 women's feelings about miscarriage at 1, 6, 16, and 32 weeks were inductively coded, rank-ordered, and clustered into 3 responses: healing, actively grieving, and overwhelmed. Women who were actively grieving or overwhelmed at 1 week experienced significantly less distress from 6 weeks on. Responses at 1 week differed with regards to those who had a history of perinatal loss or went on to experience negative life events or sexual distance after loss. One year responses differed based on who was pregnant or gave birth, miscarried again, lived through a higher number of post-loss negative life events, or experienced interpersonal or sexual distance from their mate. Responses were not influenced by gestational age at loss or having other children.

7. Factors Influencing Childbearing Decisions and Knowledge of Perinatal Risks among Canadian Men and Women. Tough S,et al Child Health J. 2007 Jan 20; Women age 35 and older account for an increasing proportion of births and are at increased risk of having difficulties conceiving and of delivering a multiple birth, low birth weight infant, and/or preterm infant. Little is known about men's and women's understanding of the maternal age related risks to pregnancy. An age-stratified random sample of individuals, aged 20-45 years and without children, completed a computer-assisted telephone interview from two urban regions of Alberta, Canada (1006 women and 500 men). Factors that influenced timing of childbearing for both men and women included: financial security (85.8%) and partner suitability to parent (80.2%). Over 70% of men and women recognized the direct relationship between older maternal age and conception difficulties. Less than half knew that advanced maternal age increased the risk of stillbirth, caesarean delivery, multiple birth and preterm delivery. Conclusions: Poor understanding of the links between childbearing after age 35, pregnancy complications and increased risk of adverse infant outcomes limits adults' ability to make informed decisions about timing of childbearing. 

8. National Center for Chronic Disease Prevention and Health Promotion Presents: Health Care Costs Attributable to Prenatal Smoking: Past and Current Research Speaker: E. Kathleen Adams, Ph.D. February 28^th 1:00-2:00pm The conference call in number is 1-877-636-9249. The participant pass code is 227809#. The health effects of prenatal smoking on the mother and infant are well known. Previous estimates of the smoking attributable neonatal costs exceed $350 million nationally and over $700 per mother (1996 dollars). Dr. Adams will report on efforts to update these smoking attributable costs based on 2001/2002 Pregnancy Risk Assessment Monitoring System (PRAMS) data and 2003 state birth certificates. Findings indicate that smoking may not lead to increased NICU admission but to longer hospital stays for the infant and, hence to significant neonatal costs. She will discuss current estimates of these costs in the context of her earlier work on the costs of counseling-based smoking cessation programs such as the 5A's. The quit rates needed to 'break even' in terms costs will be discussed. Other work on health care costs attributable to exposure to smoke in the first year of life and through age 12 will also be discussed.For additional information, please contact: Van Tong, Public Health Advisor, ASB, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, 770-488-6309.

9. Pertinent Issues in the SIDS/Bedsharing Debate One-Day Conference – March 28, 2007 7:45 am – 4:45 pm Dalton Georgia. This program features Jim McKenna, PHD. For more information and registration forms call Theresa Brown 706-217-2229.

10. A new study finds that women who take folic acid supplements early in their pregnancy can substantially reduce their baby's chances of being born with a facial cleft. Researchers at the National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health, found that 0.4 milligrams (mg) a day of folic acid reduced by one third the baby's risk of isolated cleft lip (with or without cleft palate). Folic acid is a B vitamin found in leafy vegetables, citrus fruits, beans, and whole grains. It can also be taken as a vitamin supplement, and it is added to flour and other fortified foods. The recommended daily dietary allowance for folate for adults is 400 micrograms or 0.4 mg. "These findings provide further evidence of the benefits of folic acid for women," said Allen J. Wilcox, M.D., Ph.D., lead NIEHS author on the new study published online in the "British Medical Journal." "We already know that folic acid reduces the risk of neural tube defects, including spina bifida. Our research suggests that folic acid also helps prevent facial clefts, another common birth defect." In the United States, about one in every 750 babies is born with cleft lip and/or palate.

11. Differences in neonatal mortality among whites and Asian American subgroups: evidence from California. Baker LC, Arch Pediatr Adolesc Med. 2007 Jan; Objective: To obtain information about health outcomes in neonates in 9 subgroups of the Asian population in the United States. A comparison of outcomes for births to mothers of Cambodian, Chinese, Filipino, Indian, Japanese, Korean, Laotian, Thai, and Vietnamese origin and for births to non-Hispanic white mothers. Study reviewed all California births between January 1,1991, and December 31, 2001. which included more than 2.3 million newborn infants. The unadjusted mortality rate for births to non-Hispanic white mothers was 2.0 per 1000. The unadjusted mortality rate for births to Chinese and Japanese mothers was significantly lower (Chinese: 1.2 per 1000 Japanese: 1.2 per 1000,), and for births to Korean mothers the rate was significantly higher (2.7 per 1000,). For infants of Chinese mothers, observed risk factors explain the differences observed in unadjusted data. For infants of Cambodian, Japanese, Korean, and Thai mothers, differences persist or widen after risk factors are considered. After risk adjustment, infants of Cambodian, Japanese, and Korean mothers have significantly lower neonatal mortality rates compared with infants born to non-Hispanic white mothers (adjusted odds ratios, 0.58 for infants of Cambodian mothers, 0.67 for infants of Japanese mothers, and 0.69 for infants of Korean mothers; all P<.05); infants of Thai mothers have higher neonatal mortality rates (adjusted odds ratio, 1.89; P<.05). There are significant variations in neonatal mortality between subgroups of the Asian American population that are not entirely explained by differences in observable risk factors. Efforts to improve clinical care that treat Asian Americans as a homogeneous group may miss important opportunities for improving infant health in specific subgroups.

12. Legal and ethical considerations: risks and benefits of postpartum depression screening at well-child visits. Chaudron LH, et al Pediatrics. 2007 Jan; Pediatric professionals are being asked to provide an increasing array of services during well-child visits, including screening for psychosocial and family issues that may directly or indirectly affect their pediatric patients. One such service is routine screening for postpartum depression at pediatric visits. Postpartum depression is an example of a parental condition that can have serious negative effects for the child. Because it is a maternal condition, it raises a host of ethical and legal questions about the boundaries of pediatric care and the pediatric provider's responsibility and liability. In this article the authors discuss the ethical and legal considerations of, and outline the risks of screening or not screening for, postpartum depression at pediatric visits. They make recommendations for pediatric provider education and for the roles of national professional organizations in guiding the process of defining the boundaries of pediatric care.

13. AAP says that the Consumers Union has reported on frontal and side-impact crash tests it conducted on rear-facing infant-only car safety seats in the February issue of Consumer Reports. The results of these crash tests are alarming to parents and pediatricians. The Consumers Union tested infant-only seats in crash tests that were more severe than the tests that are required for car safety seats. The Consumers Union tests included frontal crashes at a speed higher than required for car safety seats and side-impact crashes, which are not required for car safety seats. The standards used in these tests are the same as those that are used in crash-testing most new vehicles. The report indicates that most infant seats did not perform adequately in these more severe crash tests. In light of this report, and in consideration of the concerns parents and pediatricians may have about protecting infant passengers, the American Academy of Pediatrics offers the following guidance:

* Parents should continue to use car safety seats on every trip for every child.

* Parents should read and follow the car safety seat and vehicle manufacturers* instructions for their car safety seat.

* Car safety seats have been shown to be highly effective in reducing death and injury due to motor vehicle crashes.

* The best seat is one that fits your child, fits your vehicle and that you will use correctly on every trip.

* The Academy believes that current standards for testing of car safety seats are useful and rigorous but that the standards can and should be improved continually. * Certified Child Passenger Safety Techs are trained properly and can help parents make sure their children are as safe as possible on the road.

To find an inspection station, visit http://www.seatcheck.org or call toll-free at 866/SEATCHECK (866/732-8243).

www.sidsga.org
4112-2 Ponce de Leon

Clarkston, Georgia 30021

678-342-3360 or 24-hour support 1-800-221-SIDS

gasids@mindspring.com