November 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 comment on this issue, 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 or through Powerline at 1-800-822-2539.

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 2006 – 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 2 - Issue Number 11, November 2006

1. Georgia SIDS Project Georgia SIDS continues to offer risk reduction training on a fee scale basis. CEU’s for nurses and child care workers available. New information and recommendations are making updated training a must. For information or to schedule a training contact Georgia SIDS Project at 678-342-3360.

2. Predicting Antepartum Stillbirth Study shows simple educational interventions can lower stillbirth rate by up to 30%.

3. SIDS Risk factors for infants found face down differ from other SIDS cases

4. Sleep Environment, Positional, Lifestyle, and Demographic Characteristics Associated With Bed Sharing in SIDS Cases: A Population-Based Study.

5. Survey of sleeping position recommendations for prematurely born infants on neonatal intensive care unit discharge

6. Association between sleep position and early motor development studied

7. National Institutes Of Health Launches "Health Information Rx Program" On Newborn Screening And Related Genetic Disorders Physicians Can Direct Patients to Consumer-Friendly Online Information

8. Level of traumatic stress disorders following first-trimester spontaneous abortion (miscarriage) studied.

9. Study confirms association between SIDS, smoking and brainstem abnormalities

10. New Technology For Monitoring Fetal Oxygen During Labor May Offer No Additional Benefit.

11. Save these dates in 2007 for upcoming conferences

1. Georgia SIDS Project has training available on a sliding fee scale. Be sure your SIDS training includes updated information like results from the studies below – stay current with new findings and recommendations! See our training options at www.sidsga.org

2. Predicting Antepartum Stillbirth, Curr Opin Obstet Gynecol. 2006 Dec;18 Smith GC. Purpose of Review: Rates of stillbirth in the developed world have been static or rising in recent years. Clinical prediction of stillbirth risk may allow interventional studies. Recent Findings: The most prevalent independent risk factors are nulliparity, advanced age and obesity. These are increasingly prevalent in the developed world. Obesity is particularly associated with stillbirth at term and after term. Pregestational diabetes is a major risk factor for stillbirth and these women are usually offered intensive surveillance during pregnancy. Despite this, a recent national study in the UK demonstrated a fourfold excess of stillbirth, with 80% unrelated to congenital abnormality. Studies of association between previous caesarean section and subsequent stillbirth risk are inconsistent, although in data sources with detailed information, the association has been confirmed. Global analyses of stillbirth risk demonstrate that 98% occur in the developing world and that many are due to potentially preventable causes. A randomized controlled trial of very simple educational interventions was associated with a 30% lower risk of stillbirth. Relatively simple interventions may be successful in reducing the global burden of stillbirth. Further biological understanding of the causes of stillbirth is required to reduce the burden of the disease in the developed world.

3. Sudden infant death syndrome: Risk factors for infants found face down differ from other SIDS cases. Thompson JM, Thach BT, et al. J Pediatr. 2006 Nov; The goal of the study was to test the hypothesis that infants with sudden infant death syndrome (SIDS) found face down (FD) would have SIDS risk factors different from those found in other positions (non-face-down position, NFD). Study Design: We used the New Zealand Cot Death Study data, a 3-year, nationwide (1987 to 1990), case-control study. Odds ratios (univariate and multivariate) for FD (n = 154) and NFD SIDS (n = 239) were estimated separately, and statistical differences between the two groups were assessed. Results: Of 12 risk factors for SIDS, there were 8 with a statistically significant difference between FD and NFD infants. After adjustment for the potential confounders, younger infant age, Maori ethnicity, low birth weight, prone sleep position, use of a sheepskin, and pillow use were all associated with a greater risk of SIDS in the FD than the NFD group. Sleeping during the nighttime, maternal smoking, and bed-sharing were associated with a risk of SIDS only in the NFD group. Pacifier use was associated with a decreased risk for SIDS only in the NFD group, whereas being found with the head covered was associated with a decreased risk for SIDS for the FD group. Conclusions: Infants with SIDS in the FD position appear to be a distinct subgroup of SIDS. These differences in risk factors provide clues to mechanisms of death in both SIDS subtypes.

4. Sleep Environment, Positional, Lifestyle, and Demographic Characteristics Associated With Bed Sharing in Sudden Infant Death Syndrome Cases: A Population-Based Study. Ostfeld BM, Esposito L, et al. Pediatrics, 2006 Nov; In 2005, the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome recommended that infants not bed share during sleep. Our goal was to characterize the profile of risk factors associated with bed sharing in sudden infant death syndrome cases. Design/Methods: We conducted a population-based retrospective review of sudden infant death syndrome cases in New Jersey (1996–2000) dichotomized by bed-sharing status and compared demographic, lifestyle, bedding-environment, and sleep-position status. Results: Bed-sharing status was reported in 239 of 251 cases, with sharing in 39%. Bed-sharing cases had a higher percentage of bedding risks (44.1% vs 24.7%), exposure to bedding risks in infants discovered prone (57.1% vs 28.2%), and lateral sleep placement (28.9% vs 17.8%). The prone position was more common for bed-sharing and non–bed-sharing cases at placement (45.8% and 51.1%, respectively) and discovery (59.0% and 64.4%, respectively). In multivariable logistic-regression analyses, black race, mother <19 years, gravida >2, and maternal smoking were associated with bed sharing. There was a trend toward less breastfeeding in bed-sharing cases (22% vs 35%). In bed-sharing cases, those breastfed were younger than those who were not and somewhat more exposed to bedding risks (64.7% vs 45.1%) but less likely to be placed prone (11.8% vs 52.9%) or have maternal smoking (33% vs 66%). Conclusions: Bed-sharing cases were more likely to have had bedding-environment and sleep-position risks and higher ratios of demographic and lifestyle risk factors. Bed-sharing subjects who breastfed had a risk profile distinct from those who were not breastfed cases. Risk and situational profiles can be used to identify families in greater need of early guidance and to prepare educational content to promote safe sleep.

5. Survey of sleeping position recommendations for prematurely born infants on neonatal intensive care unit discharge. Rao H, et al. Eur J Pediatr. 2006 Nov 14; Prematurely born infants are at an increased risk of sudden infant death syndrome (SIDS), particularly when sleeping prone. Parents are strongly influenced in their choice of sleeping position for their infant by practitioners. The aim of this study was to determine the neonatal units' recommendations regarding the sleeping position for premature infants prior to and after discharge and ascertain whether there had been changes from those recorded in a survey performed in 2001-2002. Materials And Methods: A questionnaire survey was sent to all 229 neonatal units in the United Kingdom; 80% responded. Results And Discussion: The majority (83%) of units utilized the supine sleep position for infants at least 1-2 weeks prior to discharge, but after discharge, only 38% of the units actively discouraged prone sleeping and 17% additionally recommended side sleeping. Compared to the previous survey, significantly more units started infants with supine sleeping 1-2 weeks prior to discharge (p < 0.0001) and fewer recommended side sleeping after discharge (p = 0.0015). However, disappointingly, less actively discouraged prone sleeping after discharge (p = 0.0001). Conclusion: Recommendations regarding sleeping position for prematurely born infants after neonatal discharge by some practitioners remain inappropriate. Evidence-based guidelines are required as these would hopefully inform all neonatal units' recommendations.

6. Association between sleep position and early motor development. Majnemer A

, Barr RGJ Pediatr. 2006 Nov; The goal of the study was to compare motor performance in infants sleeping in prone versus supine positions. Healthy 4-month-olds (supine: n = 71, prone: n = 12) and 6-month olds (supine: n = 50, prone: n = 22) were evaluated with the Alberta Infant Motor Scale (AIMS) and Peabody Developmental Motor Scale (PDMS), and parents completed a positioning diary. Infants were reassessed at 15 months. At 4 months, motor scores were lower in the supine group and were less likely to achieve prone extension (P < .05). At 6 months, there were wide discrepancies on the AIMS (supine: 44.5 +/- 21.6, prone: 60.0 +/- 18.8, P = .005) and the gross motor PDMS (supine: 85.7 +/- 7.6, prone: 90.2 +/- 9.5, P = .03). Motor delays were documented in 22% of babies sleeping supine. Prone sleep-positioned infants were more likely to sit and roll. Daily exposure to awake prone positioning was predictive of motor performance in infants sleeping supine. (reinforcing the importance of “tummy time”) At 15 months, sleep position continued to predict motor performance. Conclusions: Infants sleeping supine may exhibit early motor lags, associated with less time in prone while awake. This has implications for accurate interpretation of assessment of infants at risk and prevention of inappropriate referrals. Rate of infant motor development appears influenced by extrinsic factors such as positioning practices.

7. National Institutes Of Health Launches "Health Information Rx Program" On Newborn Screening And Related Genetic Disorders Physicians Can Direct Patients to Consumer-Friendly Online Information with the NIH Seal of Approval. After a doctor sees a patient, he or she often prescribes medications. But what if such a doctor also wants to direct a patient to up-to-date, reliable, consumer-friendly information about a genetic condition, or an explanation of the basics of genetic science? Under a new program launched today, practitioners are being encouraged to refer their patients to Genetics Home Reference, a free, patient-friendly Web site of the National Institutes of Health (NIH), at <http://ghr.nlm.nih.gov>. Under this program, doctors can request free "Information Rx" pads, which will enable them to write "prescriptions," pointing patients to the Genetics Home Reference site and to the wealth of information it contains. Obstetricians can direct their patients to the site's explanation of newborn screening, so expectant mothers will better understand why this testing will be important for their baby. Pediatricians and family physicians who see new moms and dads often provide good advice on newborn or child care concerns. If there happens to be a problem detected in a screening, where should this doctor direct the concerned parents for reliable, easy-to-read information at a stressful time? NIH's Genetics Home Reference can be an invaluable resource.

8. Traumatic stress disorders following first-trimester spontaneous abortion (miscarriage). Bowles SV, et al J Fam Pract. 2006 Nov; Research indicates that many women will talk with their physician about their emotional distress and that physicians provide good information after the spontaneous abortion. Evaluate women for acute stress disorder (ASD) after a spontaneous abortion. Research found that women reporting physical, emotional, or sexual abuse are more likely to experience ASD. Patients should be assessed for post-traumatic stress disorder in follow-up visits 1 month after the initial visit. Research has found that up to 25% of women meet criteria for PTSD 1 month post the spontaneous abortion and 7% met criteria at 4 months. Physicians should refer women who are experiencing traumatic stress to a behavioral health professional and provide counsel and support to all women after a spontaneous abortion (miscarriage)

9. Maternal smoking and sudden infant death syndrome: epidemiological study related to pathology. Matturri L, et al. Virchows Arch. 2006 Nov 8; Various risk factors have been postulated to be related to sudden infant death syndrome (SIDS). Despite its reduction, thanks to the "Back to Sleep" campaign, SIDS is still a major cause of infant mortality in the first year of life. The purpose of this study was to correlate the different risk factors with the autopsy results and thus to determine if one or more of these variables is really specific for SIDS. We collected 128 sudden infant death victims with clinical diagnosis of SIDS and performed a complete autopsy with in-depth histology on serial sections, particularly of the brainstem, in accordance with our necropsy protocol. Histopathologic and immunohistochemical examination of the central autonomic nervous system revealed, in 78 cases of the SIDS group, the following anomalies: hypodevelopment of the arcuate nucleus, somatostatin positive hypoglossus nucleus, tyrosine hydroxylase negativity in the locus coeruleus, gliosis, and hypoplasia of the hypoglossus nucleus. A significant relation was found between maternal smoke and brainstem alterations.

10. New Technology For Monitoring Fetal Oxygen During Labor May Offer No Additional Benefit. A new technology “fetal oxygen saturation monitoring” for measuring blood oxygen levels of a baby during labor -- expected to provide information useful for preventing birth complications -- offers no apparent benefit, report researchers in a National Institutes of Health research network., The technology was designed for use along with electronic fetal monitoring, which tracks the fetal heart rate, to measure changes in fetal oxygen levels. Designers of the new technology hoped that knowing the oxygen status of the baby during labor would provide information on the health of the baby, especially when there were disturbances in the fetal heart rate during labor. "The results of this study show that while a new technology may appear to be very promising, it's not possible to know how effective it will be until it can be fully tested under clinical conditions," said Duane Alexander, M.D., Director of NICHD The study, appeared in the 11/23 "New England Journal of Medicine,". "Fetal oxygen saturation monitoring offered no apparent advantage in interpreting the meaning of abnormal fetal heart rates," said Catherine Spong, M.D., an author of the study "Abnormal oxygen readings were common among babies showing abnormal heart rates but they were also common among babies with normal heart rates." The study authors noted that a technology developed earlier, electronic fetal heart rate monitoring, was adopted for use in delivery rooms without prior testing. Although electronic fetal heart rate monitoring is in widespread use, the study authors added, there is controversy about the technique's effectiveness. The authors of the current study undertook their research to try to find if there was sufficient reason to warrant introducing fetal oxygen saturation monitoring into the delivery room. A previous study of the technology was inconclusive. That study found no overall change in Caesarean delivery rates when fetal oxygen saturation monitoring was undertaken. However, the study found different rates of Caesarean deliveries for two different categories of births. For cases in which the fetal heart rate pattern was abnormal, there were fewer Caesarean deliveries than normal. But there was a higher-than-normal rate of Caesarean deliveries from cases involving dystocia -- failure of the baby to move down the birth canal. (Dystocia can result from such causes as the baby being improperly positioned in the birth canal, or from the baby simply being too large.) The U.S. Food and Drug Administration granted approval of the OxiFirst Fetal Oxygen Saturation Monitoring System on May 12, 2000. As a condition of the approval, FDA required that the manufacturer of the device conduct additional studies to resolve questions on the device's effectiveness and its potential influence on the rate of Caesarean deliveries.

11. Save the Date for the CJ Foundation for SIDS 2nd National Conference Plenary sessions, workshop presentations, and panel discussions addressing: SIDS, Sudden Unexplained Death in Childhood (SUDC) Sudden Unexpected Infant Death (SUID) Numerous sessions and other activities specifically for families and siblings. September 27 - 30, 2007 St. Louis, Missouri. More information, including the specific location will be available soon at www.cjsids.com.

Save the date for the Georgia Child Abuse, Injury and fatality Prevention Conference April 3-5, 2007. Information at http://www2.state.ga.us/departments/dhr/ohrmd/Training/conferences.html

www.sidsga.org
2300 Henderson Mill Rd., Suite 410

Atlanta, Georgia 30345
678-342-3360 or Powerline 1-800-822-2539 FAX 770-451-2466

-mail: gasids@mindspring.com