Recent Study

Women who breastfeed evidently lower the chances that their baby might die of sudden infant death syndrome or SIDS, according to a German study.
Dr. M. M. Vennemann, from the University of Munster, and colleagues therefore recommend that public health messages aimed at SIDS risk-reduction should encourage women to breastfeed their infant through 6 months of age.
At present, some countries include breastfeeding recommendations in their SIDS prevention campaigns, while others do not, the investigator point out in their report in the medical journal Pediatrics. The goal of the current study was to confirm that breastfeeding is, in fact, tied to a reduced risk of SIDS.
The study included 333 infants who died of SIDS and 998 age-matched "control" infants.
At 2 weeks of age, 83 percent of controls were being breastfed compared to only 50 percent of SIDS infants. At 1 month of age, corresponding rates were 72 percent versus 40 percent
Exclusive breastfeeding at 1 month cut the risk of SIDS in half. Partial breastfeeding at this point was also tied to a reduced risk, although that could have been a chance finding.
These results add "to the body of evidence showing that breastfeeding reduces the risk of SIDS, and that this protection continues as long as the infant is breastfed," the investigators conclude.

Sudden infant death through history - a glance

A look at sudden infant death through history.
1000 B.C. - In Egypt, women found to have accidentally smothered a baby as they slept together are condemned to hold the dead infant for three days as punishment.
600 B.C. - In the Bible's First Book of Kings, the prophet Jeremiah tells of how King Solomon settles a dispute between two women over custody of a baby boy after the other one had lost her baby "when she laid on him in her sleep."
1800s - After centuries of alternating suspicion that parents either accidentally or deliberately "stifled" their babies in their sleep and sympathy for the seemingly mysterious deaths of healthy infants, a few doctors in Britain and the United States attempt to record patterns in infant deaths.
Circa 1900 - A small group of doctors begin to suspect that some breathing defect kills many infants, but most babies with no apparent illness are still presumed to have suffocated.
1934 - Dr. Sidney Farber publishes a report on "fulminating streptococcus infections in infancy as a cause of sudden death" in the New England Journal of Medicine, the first major medical journal report to suggest an alternative cause to suffocation.
1944 - Dr. Harold Abramson in New York City analyzes infant deaths attributed to "accidental mechanical suffocation" in the previous four years, and finds 68 percent were sleeping on their stomachs and almost half were discovered with their nose and mouth in contact with bedding.
1947-1953 - Drs. Jacob Werne and Irene Garrow, pathologists in Queens, N.Y., publish a refutation of Abramson's findings, saying claims of accidental suffocation increased "the feeling of culpable negligence experienced by the mother." They find possible medical causes, mainly related to infections, for most deaths previously blamed on suffocation.
1949 - Parents who have lost infants to sudden death press the Children's Bureau of the National Institutes of Health to fund a conference on the topic in Washington, chaired by Farber.
1956 - Dr. Lester Adelson, a pathologist who was deputy coroner for Cuyahoga County in Ohio, working under a contract from the Children's Bureau, reports on autopsies of 126 infants, finding that "in the majority of infants and children who die suddenly and unexpectedly there is an inflammatory process in some portion of the respiratory tract."
1962-68 - Families of sudden infant death victims in several cities organize the Guild for Infant Survival and the National SIDS Foundation, to support other grieving parents and to back research.
1963 - The first international conference on causes of sudden infant death is held in Seattle, and experts suggest labeling the cause a "syndrome" that implies a constellation of possible causes.
1967 - Dr. Marie Valdes-Dapena, a pathologist at St. Christopher's Children's Hospital in Philadelphia, publishes a landmark paper that downplays the risk of suffocation by bed clothing, and examines various possible physical causes, while noting "great numbers of these deaths remain inexplicable."
1969 - During a second international conference, the term SIDS is formally coined and defined as the sudden death of an infant or young child that is unexpected by history and in which a thorough postmortem examination fails to demonstrate an adequate cause of death.
1970 - The Guild for Infant Survival surveys chief medical officers of each state and finds that 16 different names were used for SIDS, that no uniform classification system exists for reporting SIDS deaths nationally, and that as a result, only 1,155 cases were reported in 1970, about a tenth the number researchers thought were actually dying.
1969-1973 - Parental groups put increasing pressure on the NIH to fund more research and on Congress to hold hearings on SIDS.
1974 - Congress passes the Sudden Infant Death Syndrome Act, which assigns research responsibility to the National Institute of Child Health and Human Development, and the Maternal and Child Health Bureau to set up educational and counseling programs about SIDS.
1979 - The World Health Organization formally recognizes SIDS as a cause of death.
1980s - By the end of the decade, the federal government has devoted tens of millions of dollars to SIDS research, and a growing database of results based on infant autopsies and other research suggests congenital defects may be responsible for many of the deaths.
1992-94 - Extensive international research finds that babies who sleep on their stomachs are at significantly increased risk from SIDS. U.S. agencies, medical groups and parent-advocates launch the "Back to Sleep" campaign encouraging all new parents to have the infants sleep on their backs exclusively during the first six months of life.
1995 - SIDS Network launched as an online information site for SIDS. A number of new SIDS support and educational groups spring up in the next decade, linked by the Web.
1996 -The federal Centers for Disease Control and Prevention issues national guidelines for the investigation of sudden unexplained infant deaths. Standard autopsy and death scene investigation forms are published.
1998 - By some estimates, the back sleeping program reduces SIDS deaths by 30 percent to 50 percent. But the overall number of unexplained infant deaths begins to level off, even as the SIDS death rate declines, prompting many experts to wonder if stricter investigative guidelines are "code-shifting" the causes of infant deaths.
2001 - More infant deaths are being classified as "unexplained" or "undetermined" because investigators are finding evidence that doesn't allow for a SIDS diagnosis. In many jurisdictions investigators are finding that many infants are dying in adult beds or on soft bedding.
2005 - The American Academy of Pediatrics issues a new policy on SIDS that recognizes shifts in coding and additional risks from infants' sleep environments, including the need to avoid soft bedding, the hazards of adults sleeping with an infant, and the need to reinforce the "back-to-sleep" message to all caregivers. The SIDS Alliance begins spreading similar messages.
2006 - Concerned about the quality of data on infant deaths, the CDC releases the new Sudden, Unexplained Infant Death Investigation Reporting Form and begins efforts to train and encourage investigators and death certifiers to collect more accurate data.

A host of theories on syndrome's cause

The Centers for Disease Control and Prevention defines SIDS as: "The sudden death of an infant less than 1 year of age that remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history."
SIDS is frequently described as a diagnosis of exclusion. If no other cause of death can be determined for an infant, medical authorities are advised by the CDC to issue a diagnosis of SIDS.
The syndrome is still a mystery, although it follows many important patterns. It almost always strikes when infants are thought to be sleeping. Sleeping on the stomach rather than on the back raises a baby's risk for SIDS by as much as twelvefold. SIDS occurs in boys more frequently than girls and is most common in the first and second months of life.
SIDS rates are about three times higher among black and American Indian infants compared with Caucasian babies, but the rate among Latino infants in the United States is about a third lower than that seen among white infants.
Most experts now think that babies who die of the syndrome are born with one or more physical conditions affecting their respiratory or metabolic functions that make them more vulnerable to conditions such as prone sleeping or parents who smoke.
Here are some of the possible causes of the syndrome that have been discussed and researched over the years:
Arrhythmia: Loss of rhythm in the heart, perhaps brought on by changes in the autonomic nervous system during sleep.
Brain stem defect: Infants have some abnormality or immaturity in the brain stem, which controls breathing and waking reflexes. This defect may not allow a baby to rouse when challenged by not getting enough oxygen or too much carbon dioxide.
Carbon dioxide rebreathing: A baby rebreathing exhaled air over an extended period of time could result in oxygen deprivation.
Developmental disorders: This theory suggests that some critical part of the brain or respiratory system does not develop properly from birth, leaving the baby susceptible to SIDS.
Environmental challenges or stress: Some extra challenge to the body, from passive tobacco smoke to excess carbon dioxide or overheating or a viral or bacterial infection, triggers the breakdown in function of the central nervous system that controls heartbeat and respiration.
Immune system flaw: Some research has shown that the immune systems of babies with SIDS have a higher-than-normal number of white blood cells and proteins, which could interact with the brain to affect heart rate, breathing or arousal function during sleep.
Kidney disorder: A disorder called nephron deficiency, which affects the organ's ability to excrete, has been linked to a number of infants who died of no known cause.
Metabolic disorder: This is the theory that SIDS babies lack a certain enzyme that processes fatty acids. They experience a buildup of those acids that causes a fatal breakdown in breathing and heart function.
Toxic gas: The notion that either chemicals in bedding or a common household fungus in bedding produces a toxic gas that shuts down the central nervous system.
Toxic infection: This suggests that SIDS may be linked to infection by a common bacterium, such as E. coli, which can produce a shock-inducing byproduct. The toxin was found in the blood of SIDS babies in a 2002 Italian study.

Brain Stem Defect May Be Cause of SIDS – Serotonin Regulation Could Help Explain Sudden Infant Death Syndrome

New research suggests that an abnormality in the brainstem which regulates breathing, blood pressure, body heat, and arousal, may be the cause of sudden infant death syndrome (SIDS). The American SIDS Institute says placing babies to sleep on their back even though they sleep more soundly on their stomach and the use of firm mattresses can reduce SIDS risk.
Researchers examined brain autopsy specimens from 31 infants who had died from SIDS and 10 who had died acutely from other causes. After examining the lowest part of the brainstem, known as the medulla oblongata, they found abnormalities in nerve cells that make and use serotonin, one of over 100 chemicals in the brain that transmit messages from one nerve cell to another.
In the central nervous system, serotonin is believed to play an important role in the regulation of mood, sleep, emesis (vomiting), sexuality and appetite. Low levels of Serotonin have been associated with several disorders, notably depression, migraine, bipolar disorder and anxiety.
When placed face down, babies re-breathe exhaled carbon dioxide, therefore breathing in less oxygen. Typically, this rise in carbon dioxide activates nerve cells in the brainstem, which in turn stimulate respiratory and arousal centers in the brain so that the baby doesn't asphyxiate.
Doctor Hannah Kinney says “A normal baby will wake up, turn its head, and start breathing faster when carbon dioxide levels rise.” They believe that defects in the serotonin system may impair this reflex. Kenny is a neuroscientist at the Children’s Hospital Boston and Harvard Medical School.
It is hoped that babies with this defect can be identified early. Kenny’s colleague David Paterson, PhD said “We provide strong evidence that SIDS is a biological problem, and that the brainstem serotonin system is a good place to focus continued research efforts.”
The findings also provide a biological explanation for why SIDS occurs twice as often in males than females – male SIDS infants had significantly fewer 5-HT1A receptors than female SIDS infants.
In addition, serotonin abnormalities help explain why infants under 6 months are most vulnerable to SIDS. At birth, babies must adjust from being totally dependent on their mother to breathing on their own and maintaining their own blood pressure. If the brainstem serotonin system is defective or still immature, this transition to total independence in the control of vital functions may be impaired during the crucial first six months of life.
By Marsha QuinnBest Syndication Health Writer

Sharing Beds?

(WebMD) Babies who die of sudden infant death syndrome, or SIDS, while sharing beds may have a risky sleep profile, a new study shows. SIDS is the sudden and unexplained death of an infant under 1 year of age. Its exact cause isn't known. The new study, published in Pediatrics, comes a year after the American Academy of Pediatrics issued its latest SIDS prevention recommendations. Take a moment to review those recommendations:
Put infants to sleep on their backs.
Put babies to sleep on a firm sleep surface (a crib mattress covered by a sheet).
Don't put soft objects such as pillows, quilts, or comforters under a sleeping baby.
Keep soft objects, including pillows, quilts, blankets, and stuffed animals, out of babies' sleeping environment.
Don't smoke during pregnancy.
Infants shouldn't share beds or couches with grown-ups or other kids during sleep.
Babies may sleep in a safe crib, bassinet, or cradle in the same room as the mother.
Don't bring the baby to the bed of a parent who's overtired or using medications or other substances that could impair their alertness.
Consider offering the baby a pacifier at nap time and bedtime.
Dress babies in light clothing for sleep to avoid overheating.
Don't overbundle the baby.
The baby's bedroom temperature should be comfortable for a lightly-clothed adult.
Avoid commercial devices marketed to reduce SIDS risk.
Don't use home monitors as a strategy to reduce SIDS risk.
Encourage "tummy time" for babies who are awake and are being watched.
Continue the "Back to Sleep" campaign to promote putting babies to sleep on their backs. The new study doesn't prove that bed-sharing causes SIDS. But it links bed sharing to several SIDS risk factors. The study focuses on 239 New Jersey babies who died of SIDS between 1996 and 2000. Data came from the SIDS Center of New Jersey at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School. That's where researcher Barbara Ostfeld, Ph.D., works. Ostfeld's team found that 39% of the babies died of SIDS while sharing a bed or couch. "Bed-sharing with respect to SIDS is a controversial topic," write the researchers. They didn't try to explain why the babies died of SIDS. Instead, they looked for patterns among bed-sharing babies who died of SIDS. Those babies were more likely to have been put to sleep on their sides. That's an "unstable sleep position," the researchers note. The bed-sharing babies who died of SIDS were also more likely to have sleep risks like sleeping with soft, loose bedding (such as pillows, quilts, or blankets), or to have slept in the same bed as other kids. Those babies were also more likely to be black, have a mother less than 19 years of age, and a mother who smoked. The study doesn't show whether household income affected SIDS risk, or whether the findings apply to other babies who die of SIDS.
http://www.cbsnews.com/video/watch/?id=2141407n

What is SIDS?

The Centers for Disease Control and Prevention defines SIDS as: “The sudden death of an infant less than 1 year of age that remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history.”
SIDS is frequently described as a diagnosis of exclusion. If no other cause of death can be determined for an infant, medical authorities are advised by the CDC to issue a diagnosis of SIDS.
The syndrome is still a mystery, although it follows many important patterns.
It almost always strikes when infants are thought to be sleeping.
Sleeping on the stomach rather than on the back raises a baby’s risk for SIDS by as much as 12-fold.
SIDS occurs in boys more frequently than girls and is most common in the first and second months of life.
SIDS rates are about three times higher among black and American-Indian infants compared with Caucasian babies, but the rate among Hispanic infants in the United States is about a third lower than that seen among white infants.
While dozens of possible causes for SIDS have been proposed and researched for more than 60 years, most experts now believe that babies who die from the syndrome are born with one or more physical conditions affecting their respiratory or metabolic functions that make them more vulnerable to conditions such as prone sleeping or parents who smoke.JUST What is SIDS?
http://www.projo.com/health/content/lb_sids_bar1_10-21-07_4S7G8PJ.1b8d91b.html

Study Shows Bedroom Fans May Help Cut Risk of Sudden Infant Death Syndrome

Study Shows Bedroom Fans May Help Cut Risk of Sudden Infant Death Syndrome
Oct. 6, 2008 — Young infants who sleep in bedrooms with fans have a lower risk of sudden infant death syndrome than babies who sleep in less well-ventilated rooms, new research shows.
Investigators concluded that sleeping with a fan lowers SIDS risk by more than 70%.
Sleeping in a room with an open window was also found to lower risk, although the association was not significant.
The intriguing findings must be confirmed, and researchers say fan use is no substitute for interventions known to lower SIDS risk, such as placing babies to sleep on their backs, avoiding soft bedding in cribs, and putting babies to sleep with pacifiers.
SIDS deaths have dropped by more than half in the U.S. since 1992, when parents were first told to put babies to sleep on their backs.
“This is one more thing that parents can do for peace of mind,” De-Kun Li, MD, PhD, tells WebMD.
Sleeping and SIDS
It is now clear that sleep environment plays a big role in SIDS, Li says, but the reasons for this are not completely understood.
SIDS deaths are most likely to occur when babies are between the ages of 2 months and 4 months, and deaths tend to peak in winter months. It is the leading cause of death in babies 1 month to 1 year old.
One theory is that SIDS is caused by the buildup of carbon dioxide when infants with inadequate sleep arousal responses re-breathe exhaled air trapped by bedding or proximity to other sleeping family members.
With this idea in mind, Li and colleagues from the research division of the California-based managed health care group Kaiser Permanente hypothesized that increasing airflow near a sleeping baby would help protect against sudden infant death syndrome.
To test the theory, they interviewed the mothers of 185 babies who died of SIDS in Northern California and Los Angeles County from 1997 to 2000. The average length of time between the SIDS death and the interview was 3.8 months.
The mothers of 312 children matched for age, area of residence, and socioeconomic and ethnic background to the SIDS victims were also interviewed.
Sleeping in a room with an open window was found to reduce the risk of SIDS by 36%, while sleeping with a fan in the room was associated with a 72% reduction in risk.
The risk reduction with fan use was even greater in babies who were put to bed on their stomachs or had other sleep-related SIDS risk factors.
Funded by the National Institutes of Health, the study appears in the October issue of Archives of Pediatric & Adolescent Medicine.
Back Sleeping Still Important
Pediatrician and SIDS researcher Fern Hauck, MD, tells WebMD that the observation that better ventilation may lower the risk of sudden infant death is an important one.
Hauck directs the Internal Family Medicine Clinic of the University of Virginia Health System.
“We have no way of knowing which children will die of SIDS, so anything we can tell parents that might lower risk is important,” she says.
She called the findings “exciting,” but also expressed concern that some parents might get the message that all they need to do to keep their baby safe is put a fan in the baby’s bedroom.
Hauck led the American Academy of Pediatrics task force that wrote the group’s most recent recommendations for lowering SIDS risk.
In addition to putting babies to sleep on their backs, the task force recommended that babies be offered a pacifier at night or at nap time if they will take one.
Other recommendations include:
Although babies can be brought into their parents’ bed for nursing or comforting, they should not share the bed when parents are sleeping.
Infants should be put to sleep on a firm mattress covered by nothing more than a sheet.
Keep soft objects and loose bedding out of the crib: stuffed toys, pillows, and quilts should be removed from the bed when the baby is sleeping.
Avoid overheating. Babies should be lightly clothed during sleep, and the room they sleep in should not be too hot.
Mothers-to-be should not smoke during pregnancy, and babies should not be exposed to secondhand smoke.
“ Smoking during pregnancy is one of the strongest risk factors for SIDS,” Hauck says.