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OBJECTIVE: To describe pre-COVID-19 pandemic current practices in virological investigations, including type, frequency of samplings, and documented viruses, in sudden unexpected death in infancy (SUDI) and to compare results according to the cause of death. STUDY DESIGN: Between May 2015 and December 2019, infants under 2 years of age included in the French SUDI registry were classified in one of 4 groups by causes of death according to the classification by Goldstein et al. : unexplained (SIDS), infectious, explained but noninfectious, and undetermined. Sampling sites and viruses detected were described, and then SIDS and explained deaths (control group) were compared. RESULTS: Among 639 infants, 3.6% died of an established viral infection. From 23 sampling sites and 2238 samples, 19 virus species were detected. Overall, 43.3% of infants carried a virus, with no significant difference between SIDS infants and the control group (P = .06). We found wide variations in frequencies of samples by site (550 for nasopharynx to one for saliva). The highest positivity rate was from the nasopharynx (195/2238; 8.7%). Rhinovirus was the predominant virus detected (135/504; 26.8%), mostly in SIDS (83/254; 32.7%). We found no significant difference between positivity rates and distribution of viruses between the SIDS and control groups. At-autopsy virological analysis never contributed to determining the cause of death. CONCLUSION: Current practices in virological investigations in SUDI are heterogeneous, with wide variability despite published guidelines. Investigations should be limited to the most relevant sites, and systematic at-autopsy sampling should be reconsidered. We found no association between virus detection and SIDS.
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COVID-19 , Morte Súbita do Lactente , Humanos , Lactente , Morte Súbita do Lactente/epidemiologia , Morte Súbita do Lactente/etiologia , Fatores de Risco , Pandemias , COVID-19/complicações , DocumentaçãoRESUMO
Background: Sudden Infant Death Syndrome (SIDS) constitutes one of the main causes of mortality in children under one year of age in developed countries; it's frequency to varies geographically. In Mexico the real incidence of SIDS is not known. Methods: National databases of deaths in children under one year of age, from 2005 to 2020, were analyzed, due to Sudden Unexpected Infant Death (SUID) [SIDS (R95), accidental suffocation in a sleeping environment (W75), and other ill-defined and unspecified causes of mortality (R99), according to the International Classification of Diseases, tenth revision (ICD 10)]. Mortality rates per year of occurrence due to SUID and their subcategories were calculated. Simple frequencies of SIDS were obtained per year and month of occurrence, state of residence, age, place of death, and access to social security services. Results: In the study period 473,545 infant deaths occurred; 7,714 (1.62%) deaths were due to SUID; of these, 6,489 (84%) were due to SIDS, which is among the 10 leading causes of infant death in Mexico. The average mortality rate for SUID was 22.4/100,000 live births, for SIDS was 18.8/100,000 live births. Mortality rates within the states were variable, ranging from 2.4/100,000 to 105.1/100,000 live births. In 81% of SIDS records there was no autopsy; 38% of deaths due to SIDS occurred in infants under one month of age, up to 87% of deaths occurred in families without social security services or it was unknown, and 76.2% of deaths occurred at home. Deaths were more frequent during the last months of autumn and during winter. Conclusion: In Mexico there is an underregistry of SIDS as cause of death, along with other SUID categories. Health workers need to be trained to improve diagnosis and data registration, including the practice of autopsies; additionally, it is necessary to implement a public health campaign.
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Sudden infant death syndrome (SIDS) is defined as the death of a child under one year of age, during sleep, without apparent cause, after exhaustive investigation, so it is a diagnosis of exclusion. SIDS is the principal cause of death in industrialized countries. Inborn errors of metabolism (IEM) have been related to SIDS. These errors are a group of conditions characterized by the accumulation of toxic substances usually produced by an enzyme defect and there are thousands of them and included are the disorders of the ß-oxidation cycle, similarly to what can affect the metabolism of different types of fatty acid chain (within these, short chain fatty acids (SCFAs)). In this work, an analysis of postmortem SCFAs profiles of children who died due to SIDS is proposed. Initially, a set of features containing SCFAs information, obtained from the NIH Common Fund's National Metabolomics Data Repository (NMDR) is submitted to an univariate analysis, developing a model based on the relationship between each feature and the binary output (death due to SIDS or not), obtaining 11 univariate models. Then, each model is validated, calculating their receiver operating characteristic curve (ROC curve) and area under the ROC curve (AUC) value. For those features whose models presented an AUC value higher than 0.650, a new multivariate model is constructed, in order to validate its behavior in comparison to the univariate models. In addition, a comparison between this multivariate model and a model developed based on the whole set of features is finally performed. From the results, it can be observed that each SCFA which comprises of the SFCAs profile, has a relationship with SIDS and could help in risk identification.
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INTRODUCCIÓN: La Academia Americana de Pediatría recomienda que los lactantes menores de un año duerman en posición supina para prevenir el síndrome de muerte súbita en lactantes (SMSL). OBJETIVO: Describir la posición en que duermen un grupo de lactantes y factores de riesgo asociados al SMSL. SUJETOS Y MÉTODO: Estudio piloto, prospectivo concurrente, de lactantes < 45 días de vida en control sano en Centro Médico San Joaquín UC Christus. Criterios de exclusión: prematurez (edad gestacional < 37 semanas) y patología de base (respiratorias, metabólicas, cardiológicas). Se aplicó encuesta al cuidador principal respecto a datos demográficos y hábitos de sueño, basada en encuesta BISQ (Brief Screening Questionnaire for Infant Sleep Problems) validada en español, dado la inexistencia de instru mentos para < 3 meses. RESULTADOS: Se obtuvo muestra de 100 lactantes de edad 16,78 ± 12,88 días de vida, siendo 57% mujeres. La madre fue el principal informante (84%). El 79% de los lactantes dor mían en decúbito supino, 19% lo hacía de lado y 2% en prono. El 66% dormía en cuna en habitación de los padres, 31% en la cama de los padres. El 74% se quedaban dormidos durante la alimentación. El 28% de los lactantes estaban expuestos a tabaquismo pasivo. El 91% cuidadores estaba informa do sobre la posición segura de sueño, siendo el principal informante el pediatra (54%). CONCLUSIONES: En esta muestra se encontró alto porcentaje de lactantes < 45 días que duermen en posición no segura, siendo frecuente el colecho. Es importante implementar campañas locales de prevención del SMSL que refuercen el hábito de dormir seguro.
INTRODUCTION: The American Academy of Pediatrics recommends, through the implementation of the "Back to Sleep (BTS)" campaign, the supine sleeping position for infant sleeping since it prevents to prevent Sudden Infant Death Syndrome (SIDS). OBJECTIVE: To describe the sleeping position of a group of infants and the risk factors associated with sudden infant death syndrome (SIDS). SUBJECTS AND METHOD: Prospective pilot study, including infants < 45 days of life in well-child care visits at a medical center. Exclusion criteria: Preterm-born infant (gestational age < 37 weeks) and/or comorbidities (pulmonary, metabolic, cardiologic). A brief parental questionnaire was conducted regarding general demographic data and sleep habits. The questioner was based on the BISQ - Spanish version, due to the lack of validated instruments for infants < 3-month-old. RESULTS: We included a sample of 100 infants between 16.78 ± 12.88 days old (57% girls). Mothers were the main information source (84%). 79% of the infants slept in supine position, 19% slept on their sides, and 2% in prone position. Regarding the place where the infants slept, 66% did in their crib in the parents' room and 31% slept in parents' bed. 74% of infants fell asleep while being fed. 28% of infants were exposed to passive smoking at home. 91% of parents were informed about safe sleep positions, reporting that pediatricians were the main source of information (54%). CONCLUSION: We found a high percentage of infants < 45 days of life who slept in an unsafe position, and frequently co-sleep with their parents. Thus, it is important to implement local SIDS prevention campaigns to reinforce safe infant sleep.
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Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Sono , Morte Súbita do Lactente/etiologia , Morte Súbita do Lactente/prevenção & controle , Decúbito Dorsal , Cuidado do Lactente/métodos , Modelos Logísticos , Chile , Projetos Piloto , Estudos Prospectivos , Fatores de Risco , Guias de Prática Clínica como Assunto , Fatores de Proteção , Cuidado do Lactente/normas , Cuidado do Lactente/estatística & dados numéricosRESUMO
OBJECTIVE: To study recent epidemiologic trends of sudden unexpected death in infancy (SUDI) in Western Europe. STUDY DESIGN: Annual national statistics of death causes for 14 Western European countries from 2005 to 2015 were analyzed. SUDI cases were defined as infants younger than 1 year with the underlying cause of death classified as "sudden infant death syndrome," "unknown/unattended/unspecified cause," or "accidental threats to breathing." Poisson regression models were used to study temporal trends of SUDI rates and source of variation. RESULTS: From 2005 to 2015, SUDI accounted for 15 617 deaths, for an SUDI rate of 34.9 per 100 000 live births. SUDI was the second most common cause of death after the neonatal period (22.2%) except in Belgium, Finland, France, and the UK, where it ranked first. The overall SUDI rate significantly decreased from 40.2 to 29.9 per 100 000, with a significant rate reduction experienced for 6 countries, no significant evolution for 7 countries, and a significant increase for Denmark. The sudden infant death syndrome/SUDI ratio was 56.7%, with a significant decrease from 64.9% to 49.7% during the study period, and ranged from 6.1% in Portugal to 97.8% in Ireland. We observed between-country variations in SUDI and sudden infant death syndrome sex ratios. CONCLUSIONS: In studied countries, SUDI decreased during the study period but remained a major cause of infant deaths, with marked between-country variations in rates, trends, and components. Standardization is needed to allow for comparing data to improve the implementation of risk-reduction strategies.
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Morte Súbita do Lactente/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Modelos Lineares , Masculino , Distribuição de Poisson , Morte Súbita do Lactente/diagnósticoRESUMO
OBJECTIVE: To determine whether a monogenic basis explains sudden infant death syndrome (SIDS) using an exome-wide focus. STUDY DESIGN: A cohort of 427 unrelated cases of SIDS (257 male; average age = 2.7 ± 1.9 months) underwent whole-exome sequencing. Exome-wide rare variant analyses were carried out with 278 SIDS cases of European ancestry (173 male; average age = 2.7 ± 1.98 months) and 973 ethnic-matched controls based on 6 genetic models. Ingenuity Pathway Analysis also was performed. The cohort was collected in collaboration with coroners, medical examiners, and pathologists by St George's University of London, United Kingdom, and Mayo Clinic, Rochester, Minnesota. Whole-exome sequencing was performed at the Genomic Laboratory, Kings College London, United Kingdom, or Mayo Clinic's Medical Genome Facility, Rochester, Minnesota. RESULTS: Although no exome-wide significant (P < 2.5 × 10-6) difference in burden of ultra-rare variants was detected for any gene, 405 genes had a greater prevalence (P < .05) of ultra-rare nonsynonymous variants among cases with 17 genes at P < .005. Some of these potentially overrepresented genes may represent biologically plausible novel candidate genes for a monogenic basis for a portion of patients with SIDS. The top canonical pathway identified was glucocorticoid biosynthesis (P = .01). CONCLUSIONS: The lack of exome-wide significant genetic associations indicates an extreme heterogeneity of etiologies underlying SIDS. Our approach to understanding the genetic mechanisms of SIDS has far reaching implications for the SIDS research community as a whole and may catalyze new evidence-based SIDS research across multiple disciplines. Perturbations in glucocorticoid biosynthesis may represent a novel SIDS-associated biological pathway for future SIDS investigative research.
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Exoma , Predisposição Genética para Doença , Morte Súbita do Lactente/genética , Autopsia , Estudos de Casos e Controles , Criança , Pré-Escolar , Etnicidade , Feminino , Variação Genética , Humanos , Lactente , Masculino , Minnesota , Mutação , Morte Súbita do Lactente/epidemiologia , Morte Súbita do Lactente/etnologia , Reino UnidoRESUMO
OBJECTIVE: To compare risk factors for infant sleep-related deaths under the supervision of parents and nonparents. STUDY DESIGN: We conducted a secondary analysis of sleep-related infant deaths from 2004 to 2014 in the National Center for Fatality Review and Prevention Child Death Review Case Reporting System. The main exposure was supervisor at time of death. Primary outcomes included sleep position, location, and objects in the environment. Risk factors for parental vs nonparental supervisor were compared using χ2 and multivariable logistic regression models. Risk factors associated with different nonparental supervisors were analyzed using χ2. RESULTS: Of the 10 490 deaths, 1375 (13.1%) occurred under nonparental supervision. Infants who died under nonparental supervision had higher adjusted odds of dying outside the home (OR 12.87, 95% CI 11.31-14.65), being placed prone (OR 1.61, 95% CI 1.39-1.86) or on their side (OR 1.35, 95% CI 1.12-1.62), or being found prone (OR 1.74, 95% CI 1.50-2.02). Among infants who died under nonparental supervision, those supervised by relatives or friends were more often placed on an adult bed or couch for sleep and bed sharing (P < .0001), and to have objects in the sleep environment (P = .01). CONCLUSIONS: Infants who died of sleep-related causes under nonparental supervision were more likely to have been placed nonsupine. Among nonparental supervisors, relatives and friends were more likely to use unsafe sleep environments, such as locations other than a crib or bassinet and bed sharing. Pediatricians should educate parents that all caregivers must always follow safe sleep practices.
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Roupas de Cama, Mesa e Banho/efeitos adversos , Causas de Morte , Sono , Morte Súbita do Lactente/etiologia , Asfixia/complicações , Asfixia/mortalidade , Cuidadores/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To evaluate the epidemiology of sudden unexpected infant death (SUID) over a 20-year period in the US, to assess the potential frequency of sudden unexpected postnatal collapse in the early days of life, and to determine if SUID rates in the neonatal period (0-27 days) have changed in parallel with rates in the postneonatal periods, including the percentages attributed to codes that include accidental suffocation. STUDY DESIGN: Data from the US Centers for Disease Control and Prevention Linked Birth/Infant Death Records for 1995-2014 were analyzed for the first hour, day, week, and month of life. A comparison of neonatal and postneonatal data related to SUID, including accidental suffocation, was carried out. RESULTS: Death records for 1995-2014 indicate that, although SUID rates in the postneonatal period have declined subsequent to the 1992 American Academy of Pediatrics sleep position policy change, newborn SUIDs have failed to decrease, and the percentage of SUIDs attributed to unsafe sleep conditions has increased significantly in both periods; 29.2% of the neonatal cases occurred within the first 6 days of life. CONCLUSIONS: The frequency of SUIDs during the neonatal period warrants ongoing attention to all circumstances contributing to this category of deaths. The development of a standardized definition of sudden unexpected postnatal collapse and a national registry of these events is recommended. Ongoing research on the effects of early neonatal practices on postneonatal SUID should also be encouraged.
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Asfixia/complicações , Mortalidade Infantil/tendências , Morte Súbita do Lactente/etiologia , Causas de Morte , Atestado de Óbito , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pais , Educação de Pacientes como Assunto , Sistema de Registros , Análise de Regressão , Fatores de Risco , Sono , Fatores de Tempo , Estados UnidosAssuntos
Causas de Morte , Guias como Assunto , Cuidado do Lactente/normas , Sono/fisiologia , Morte Súbita do Lactente/prevenção & controle , Roupas de Cama, Mesa e Banho , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Masculino , Prevenção Primária/métodos , Decúbito Ventral/fisiologia , Medição de Risco , Gestão da Segurança , Sociedades Médicas/normas , Decúbito Dorsal/fisiologia , Estados UnidosRESUMO
OBJECTIVE: To assess the association between maternal birth country and adherence to the American Academy of Pediatrics safe sleep recommendations in a national sample of Hispanic mothers, given that data assessing the heterogeneity of infant care practices among Hispanics are lacking. STUDY DESIGN: We used a stratified, 2-stage, clustered design to obtain a nationally representative sample of mothers from 32 US intrapartum hospitals. A total of 907 completed follow-up surveys (administered 2-6 months postpartum) were received from mothers who self-identified as Hispanic/Latina, forming our sample, which we divided into 4 subpopulations by birth country (US, Mexico, Central/South America, and Caribbean). Prevalence estimates and aORs were determined for infant sleep position, location, breastfeeding, and maternal smoking. RESULTS: When compared with US-born mothers, we found that mothers born in the Caribbean (aOR 4.56) and Central/South America (aOR 2.68) were significantly more likely to room share without bed sharing. Caribbean-born mothers were significantly less likely to place infants to sleep supine (aOR 0.41). Mothers born in Mexico (aOR 1.67) and Central/South America (aOR 2.57) were significantly more likely to exclusively breastfeed; Caribbean-born mothers (aOR 0.13) were significantly less likely to do so. Foreign-born mothers were significantly less likely to smoke before and during pregnancy. CONCLUSIONS: Among US Hispanics, adherence to American Academy of Pediatrics safe sleep recommendations varies widely by maternal birth country. These data illustrate the importance of examining behavioral heterogeneity among ethnic groups and have potential relevance for developing targeted interventions for safe infant sleep.
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Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispânico ou Latino/estatística & dados numéricos , Cuidado do Lactente/métodos , Sono/fisiologia , Fumar/epidemiologia , Morte Súbita do Lactente/prevenção & controle , Adulto , Aleitamento Materno/tendências , Região do Caribe/etnologia , Estudos Transversais , Escolaridade , Feminino , Humanos , Lactente , Cuidado do Lactente/tendências , Recém-Nascido , Masculino , Comportamento Materno/etnologia , México/etnologia , Relações Mãe-Filho , Gravidez , Decúbito Ventral , Características de Residência , Medição de Risco , Sensibilidade e Especificidade , Fumar/efeitos adversos , América do Sul/etnologia , Morte Súbita do Lactente/etnologia , Inquéritos e Questionários , Estados Unidos , Adulto JovemRESUMO
Introducción. Las campanas públicas en países desarrollados con recomendaciones para el sueño seguro del lactante lograron aumentar la adherencia a la posición supina para dormir a más del 70% y generaron, simultáneamente, una reducción del 53% en la incidencia del síndrome de muerte súbita del lactante. Objetivo. Valorar el impacto a los 60 días de vida de una intervención educativa realizada en las maternidades para mejorar la adherencia a las recomendaciones sobre sueño seguro del lactante. Población, material y métodos. Estudio de intervención con control histórico entre el 1/2 y el 30/9 de 2014, realizado en la Maternidad Meisner y el Hospital Universitario Austral. Dicha intervención se denominó "tapeta cuna" y consistió en capacitar al equipo de salud y brindar información a las familias sobre sueño seguro a través de clases, adhesivos en las cunas y material escrito. Resultados. Fueron incluidos 550recién nacidos. Se observó un incremento del 35% en la posición supina al dormir tras la intervención (p < 0,0001); la lactancia materna exclusiva se incrementó un 11% (p= 0,01); se redujo el colecho de un 31% a un 18% (p < 0,0005). No se encontraron diferencias en la cohabitación, entre convivientes fumadores ni en la utilización del chupete a los 60 días. Conclusiones. La intervención educativa resultó útil para mejorar la adherencia a las recomendaciones sobre sueño seguro a los 60 días de vida: se evidenció una mejora en la posición supina, la lactancia materna y la reducción del colecho. No existieron cambios en la proporción de convivientes fumadores, la cohabitación y el uso del chupete.
Introduction. In developed countries, public campaigns promoting recommendations on safe infant sleep increased adherence to the supine sleeping position to more than 70% and, at the same time, reduced the incidence of sudden infant death syndrome by 53%. Objective. To determine the impact, at 60 days of life, of an educational intervention conducted in maternity centers aimed at improving adherence to the recommendations on safe infant sleep. Population, material and methods. Intervention study with historical control conducted between February 1st and September 30th of 2014 at the Maternity Center of Hospital Meisner and Hospital Universitario Austral. The intervention was called "crib card" and consisted in training health care team members and providing families with information on safe infant sleep by means of lessons, written material and using stickers on cribs. Results. Five hundred and fifty newborn infants were included. After the intervention, a 35% increase in the supine sleeping position (p < 0.0001) was observed; exclusive breastfeeding increased by 11% (p= 0.01); and co-sleeping decreased from 31% to 18% (p < 0.0005). No differences were observed in relation to bedroom sharing, living with tobacco users, or pacifier use at 60 days of life. Conclusions. The educational intervention was useful to improve adherence to the recommendations on safe sleep at 60 days of life: using the supine position and breastfeeding improved, and the rate of co-sleeping decreased. No changes were observed in the number of household members who smoke, bedroom sharing, and pacifier use.
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Humanos , Recém-Nascido , Sono , Morte Súbita do Lactente/prevenção & controle , Educação em Saúde , Decúbito Dorsal , Cuidado do Lactente/normas , Mães/educaçãoRESUMO
INTRODUCTION: In developed countries, public campaigns promoting recommendations on safe infant sleep increased adherence to the supine sleeping position to more than 70% and, at the same time, reduced the incidence of sudden infant death syndrome by 53%. OBJETIVE: To determine the impact, at 60 days of life, of an educational intervention conducted in maternity centers aimed at improving adherence to the recommendations on safe infant sleep. MATERIAL AND METHODS: Intervention study with historical control conducted between February 1st and September 30th of 2014 at the Maternity Center of Hospital Meisner and Hospital Universitario Austral. The intervention was called "crib card" and consisted in training health care team members and providing families with information on safe infant sleep by means of lessons, written material and using stickers on cribs. RESULTS: Five hundred and fifty newborn infants were included. After the intervention, a 35% increase in the supine sleeping position (p < 0.0001) was observed; exclusive breastfeeding increased by 11% (p= 0.01); and co-sleeping decreased from 31% to 18% (p< 0.0005). No differences were observed in relation to bedroom sharing, living with tobacco users, or paci er use at 60 days of life. CONCLUSION: The educational intervention was useful to improve adherence to the recommendations on safe sleep at 60 days of life: using the supine position and breastfeeding improved, and the rate of co-sleeping decreased. No changes were observed in the number of household members who smoke, bedroom sharing, and pacifier use.
INTRODUCCIÓN: Las campanas públicas en países desarrollados con recomendaciones para el sueño seguro del lactante lograron aumentar la adherencia a la posición supina para dormir a más del 70% y generaron, simultáneamente, una reducción del 53% en la incidencia del síndrome de muerte súbita del lactante. OBJETIVO: Valorar el impacto a los 60 días de vida de una intervención educativa realizada en las maternidades para mejorar la adherencia a las recomendaciones sobre sueño seguro del lactante METODOLOGIA: Estudio de intervención con control histórico entre el 1/2 y el 30/9 de 2014, realizado en la Maternidad Meisner y el Hospital Universitario Austral. Dicha intervención se denominó "tarjeta cuna" y consistió en capacitar al equipo de salud y brindar información a las familias sobre sueño seguro a través de clases, adhesivos en las cunas y material escrito. RESULTADOS: Fueron incluidos 550 recién nacidos. Se observó un incremento del 35% en la posición supina al dormir tras la intervención (p < 0,0001); la lactancia materna exclusiva se incrementó un 11% (p = 0,01); se redujo el colecho de un 31% a un 18% (p < 0,0005). No se encontraron diferencias en la cohabitación, entre convivientes fumadores ni en la utilización del chupete a los 60 días. CONCLUSIÓN: La intervención educativa resultó útil para mejorar la adherencia a las recomendaciones sobre sueño seguro a los 60 días de vida: se evidenció una mejora en la posición supina, la lactancia materna y la reducción del colecho. No existieron cambios en la proporción de convivientes fumadores, la cohabitación y el uso del chupete.
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Educação em Saúde , Cuidado do Lactente/normas , Mães/educação , Sono , Decúbito Dorsal , Feminino , Humanos , Recém-Nascido , Masculino , Morte Súbita do Lactente/prevenção & controleRESUMO
The ventilatory response of infants of mothers who smoke and misuse substances and controls to carbon dioxide was assessed at 6-12 weeks and the perinatal period. Infants of mothers who smoke and misuse substances had a dampened response at the peak age of sudden infant death syndrome, greater than in the perinatal period.
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Dióxido de Carbono/fisiologia , Comportamento Materno , Complicações na Gravidez , Efeitos Tardios da Exposição Pré-Natal/etiologia , Respiração , Fumar , Transtornos Relacionados ao Uso de Substâncias , Feminino , Seguimentos , Humanos , Hipercapnia/fisiopatologia , Lactente , Recém-Nascido , Masculino , Gravidez , Testes de Função Respiratória , Fatores de Risco , Morte Súbita do Lactente/etiologia , Poluição por Fumaça de Tabaco/efeitos adversosRESUMO
OBJECTIVE: To investigate practices, knowledge, attitudes, and beliefs regarding infant sleep among adolescent mothers, a demographic at high risk for sudden unexpected infant death, and to identify novel public health interventions targeting the particular reasons of this population. STUDY DESIGN: Seven targeted focus groups including 43 adolescent mothers were conducted at high school daycare centers throughout Colorado. Focus groups were recorded, transcribed, validated, and then analyzed in NVivo 10. Validation included coding consistency statistics and expert review. RESULTS: Most mothers knew many of the American Academy of Pediatrics recommendations for infant sleep. However, almost all teens reported bedsharing regularly and used loose blankets or soft bedding despite being informed of risks. Reasons for nonadherence to recommendations included beliefs that babies are safest and sleep more/better in bed with them, that bedsharing is a bonding opportunity, and that bedsharing is easier than using a separate sleep space. The most common justifications for blankets were infant comfort and concern that babies were cold. Participants' decision making was often influenced by their own mothers, with whom they often resided. Participants felt that their instincts trumped professional advice, even when in direct contradiction to safe sleep recommendations. CONCLUSIONS: Among focus group participants, adherence with safe sleep practices was poor despite awareness of the American Academy of Pediatrics recommendations. Many mothers expressed beliefs and instincts that infants were safe in various unsafe sleep environments. Future study should investigate the efficacy of alternative educational strategies, including education of grandmothers, who have significant influence over adolescent mothers.
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Roupas de Cama, Mesa e Banho , Conhecimentos, Atitudes e Prática em Saúde , Idade Materna , Sono , Morte Súbita do Lactente/prevenção & controle , Adolescente , Feminino , Grupos Focais , Humanos , Equipamentos para Lactente , Recém-Nascido , Pesquisa Qualitativa , Fatores de RiscoRESUMO
OBJECTIVE: To describe and compare sudden unexpected infant death (SUID) investigations among states participating in the SUID Case Registry from 2010 through 2012. STUDY DESIGN: We analyzed observational data from 770 SUID cases identified and entered into the National Child Death Review Case Reporting System. We examined data on autopsy and death scene investigation (DSI) components, including key information about the infant sleep environment. We calculated the percentage of components that were complete, incomplete, and missing/unknown. RESULTS: Most cases (98%) had a DSI. The DSI components most frequently reported as done were the narrative description of the circumstances (90%; range, 85%-99%), and witness interviews (88%, range, 85%-98%). Critical information about 10 infant sleep environment components was available for 85% of cases for all states combined. All 770 cases had an autopsy performed. The autopsy components most frequently reported as done were histology, microbiology, and other pathology (98%; range, 94%-100%) and toxicology (97%; range, 94%-100%). CONCLUSIONS: This study serves as a baseline to understand the scope of infant death investigations in selected states. Standardized and comprehensive DSI and autopsy practices across jurisdictions and states may increase knowledge about SUID etiology and also lead to an improved understanding of the cause-specific SUID risk and protective factors. Additionally, these results demonstrate practices in the field showing what is feasible in these select states. We encourage pediatricians, forensic pathologists, and other medicolegal experts to use these findings to inform system changes and improvements in DSI and autopsy practices and SUID prevention efforts.
Assuntos
Autopsia , Causas de Morte , Morte Súbita do Lactente/diagnóstico , Morte Súbita do Lactente/epidemiologia , Humanos , Lactente , Recém-Nascido , Sistema de Registros , Estudos Retrospectivos , Sono , Estados Unidos/epidemiologiaRESUMO
El síndrome de muerte súbita del lactante (SMSL) consiste en la muerte inesperada de un infante menor de un año, la cual no puede ser explicada posterior a las investigaciones del caso, tales como: la anamnesis, la escena de la muerte, y la autopsia. La relevancia de este padecimiento radica en que es un fenómeno presente a nivel mundial, y es la principal causa de muerte en lactantes de 1 a 12 meses de vida. Debido a la importancia del tema, la presente investigación pretende realizar un acercamiento bibliográfico, que aborda terminología especializada; estudios de epidemiologia a nivel mundial; diversos factores de riesgo y su prevención; además del algoritmo de manejo de SMSL basado en las guías españolas de pediatría y las guías de SMSL de Massachusetts.Cabe destacar que el diagnóstico de esta muerte es de exclusión y requiere una investigación exhaustiva para poder dilucidar sus causas. Así mismo, el SMSL ha sido asociado a diferentes factores de riesgo que pueden desencadenar este evento en niños con susceptibilidad genética o adquirida, los cuales en la mayoría de los casos pueden modificarse y prevenirse educando a los padres, y a los proveedores de la salud. Debido a que el médico general, y el pediatra son los primeros profesionales en abordar al lactante y a sus familiares, es imperativo que ambos tengan conocimiento del tema en cuestión, no solo para la prevención de estos casos, sinopara el abordaje correcto en el caso que se presente una muerte súbita infantil.
Sudden Infant Death Syndrome (SIDS) is defined as the sudden death of an infant less than 1 year of age that cannot be explained after a thorough investigation is conducted, including the review of the clinical history, the examination of the death scene, and an autopsy. This condition is relevant because is a worldwide phenomenon, and it is the leading cause of death in infants between 1 to 12 months. Due to the importance of this subject, this research tries to make a bibliographic review that includes specialized terminology, worldwide epidemiology studies, risk factors, how to prevent it; and the approach, based on the Spanish and Massachusetts guidelines.The diagnosis of SIDS is based in the exclusion of causes, and requires a thorough investigation to elucidate them. Also, SIDS has been associated with different risk factors that can trigger this event in children with genetic or acquired susceptibility, which in most cases can be modified and prevented by educating the parents and the health care providers. Because the physician and the pediatrician are the first professionals to have contact with the infant and their families, it is imperative that both have knowledge of this subject, not only for the prevention of such cases, but for the correct approach in these cases.
Assuntos
Humanos , Masculino , Feminino , Morte Súbita , LactenteRESUMO
Objetiva-se nesse artigo realizar um levantamento na literatura sobre a associação entre o uso de chupetas na prevenção de morte súbita em crianças. Foi realizada uma revisão de literatura e escolhidos 34 artigos publicados entre os anos de 1978 e 2012 em bancos de dados como PubMed e Scielo, usando os descritores: "morte súbita", "chupetas" e "SIDS". À medida que a mortalidade infantil vem sendo reduzida devido às melhorias socioeconômicas, ambientais e na assistência médica, as mortes súbitas na infância (MSI) tendem a assumir papel relativamente mais importante. Concluiu-se que, de acordo com a literatura, o uso de chupeta por lactentes vem reduzindo consideravelmente a incidência de morte súbita dos mesmos (AU)
The aim of this study was to present a literature review about the use of pacifiers use in the prevention of sudden infant death. A search was conducted in PubMed and SciELO, for studies published between 1978 and 2012 using the key words: "sudden death", "pacifiers", and "SIDS". Thirty four studies were selected. As infant mortality has been reduced due to socioeconomics and environmental improvements, as well as to better medical care, there is a tendency to dedicate greater attention to the sudden infant death syndrome (SIDS). It was concluded that according to the literature the use of pacifiers may reduce considerably the incidence of sudden death of them (AU)
Assuntos
Humanos , Recém-Nascido , Lactente , Lactente , Chupetas/estatística & dados numéricos , Sono , Morte Súbita do Lactente , Brasil , Revisão , Fatores de Risco , Comportamento de SucçãoRESUMO
Nicotine may link maternal cigarette smoking with respiratory dysfunctions in sudden infant death syndrome (SIDS). Prenatal-perinatal nicotine exposure blunts ventilatory responses to hypercapnia and reduces central respiratory chemoreception in mouse neonates at Postnatal Days 0 (P0) to P3. This suggests that raphe neurons, which are altered in SIDS and contribute to central respiratory chemoreception, may be affected by nicotine. We therefore investigated whether prenatal-perinatal nicotine exposure affects the activity, electrical properties, and chemosensitivity of raphe obscurus (ROb) neurons in mouse neonates. Osmotic minipumps, implanted subcutaneously in 5- to 7-day-pregnant CF1 mice, delivered nicotine bitartrate (60 mg kg(-1) d(-1)) or saline (control) for up to 28 days. In neonates, ventilation was recorded by head-out plethysmography, c-Fos (neuronal activity marker), or serotonin autoreceptors (5HT1AR) were immunodetected using light microscopy, and patch-clamp recordings were made from raphe neurons in brainstem slices under normocarbia and hypercarbia. Prenatal-perinatal nicotine exposure decreased the hypercarbia-induced ventilatory responses at P1-P5, reduced both the number of c-Fos-positive ROb neurons during eucapnic normoxia at P1-P3 and their hypercapnia-induced recruitment at P3, increased 5HT1AR immunolabeling of ROb neurons at P3-P5, and reduced the spontaneous firing frequency of ROb neurons at P3 without affecting their CO2 sensitivity or their passive and active electrical properties. These findings reveal that prenatal-perinatal nicotine reduces the activity of neonatal ROb neurons, likely as a consequence of increased expression of 5HT1ARs. This hypoactivity may change the functional state of the respiratory neural network leading to breathing vulnerability and chemosensory failure as seen in SIDS.
Assuntos
Nicotina/toxicidade , Efeitos Tardios da Exposição Pré-Natal/etiologia , Núcleos da Rafe/patologia , Morte Súbita do Lactente/etiologia , Animais , Animais Recém-Nascidos , Modelos Animais de Doenças , Feminino , Humanos , Lactente , Troca Materno-Fetal , Camundongos , Gravidez , Núcleos da Rafe/efeitos dos fármacos , Fumar/efeitos adversos , Morte Súbita do Lactente/patologiaRESUMO
Introduction: Recommendations for Sudden Infant Death Syndrome (SIDS) are available, although it is uncertain the degree of adherence to these measures. The aim of the study is to assess the adherence to recommendations to reduce the risk of SIDS, seeking factors associated to the noncompliance with these recommendations. Patients and Method: 468 infants were enrolled in two maternity hospitals, one public and one private. Postpartum and 4-month assessments were performed. A questionnaire was used adapting a model validated by the International Child Care Practices Study. Results: Adherence to obstetric recommendations was higher (75.4%) than to pediatric recommendations (53.3%). Regarding pediatric recommendations, a compliance decrease was detected after 4 months. Follow-ups showed decrease in breastfeeding (p < 0.001 84.9% vs 48.6%) and supine position (61.2% vs 21.2%, p < 0.001). Conclusions: The decreased adherence to recommendations for SIDS prevention was mainly observed in younger and less educated women, who were not in a relationship and living in poor housing quality and crowded environments.
Introducción: Existen recomendaciones preventivas en el Sindrome de Muerte Súbita del lactante (SMSL), aunque es incierto el grado de adherencia a dichas medidas. El objetivo del estudio fue evaluar la adherencia a las recomendaciones para disminuir el riesgo de SMSL, buscando factores asociados al no cumplimiento de dichas recomendaciones. Pacientes y Método: Se incluyeron 468 recién nacidos de dos maternidades, pública y privada. Se efectuó una evaluación posparto y a los 4 meses de la adherencia a las recomendaciones. Se utilizó un cuestionario adaptando un modelo de encuesta validado por el International Child Care Practices Study Resultados: La adherencia a las recomendaciones obstétricas fue mayor (75,4%) que a las recomendaciones pediátricas (53,3%). A su vez en las recomendaciones pediátricas se evidenció una caída del cumplimiento de las recomendaciones a los 4 meses. Al seguimiento se observó reducción de lactancia (84,9% vs 48,6%; p < 0,001) y de posición supina (61,2% vs 21,2%; p < 0,001). Conclusiones: La disminución de la adherencia a las recomendaciones para la prevención del SMSL se observó principalmente en las mujeres de menor edad y menor nivel educativo, no estar en pareja, mala calidad habitacional y presencia de numerosos convivientes.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Adulto Jovem , Aleitamento Materno/estatística & dados numéricos , Mães/estatística & dados numéricos , Cooperação do Paciente , Morte Súbita do Lactente/prevenção & controle , Fatores Etários , Seguimentos , Estudos Prospectivos , Decúbito Dorsal , Inquéritos e Questionários , Fatores de TempoRESUMO
OBJECTIVE: To examine whether infants reported for maltreatment face a heightened risk of sudden infant death syndrome (SIDS) and other leading causes of sudden unexpected infant death (SUID). STUDY DESIGN: Linked birth and infant death records for all children born in California between 1999 and 2006 were matched to administrative child protection data. Infants were prospectively followed from birth through death or 1 year of age. A report of maltreatment was modeled as a time-varying covariate; risk factors at birth were included as baseline covariates. Multivariable competing risk survival models were used to estimate the adjusted relative hazard of postneonatal SIDS and other SUID. RESULTS: A previous maltreatment report emerged as a significant predictor of SIDS and other SUID. After adjusting for baseline risk factors, the rate of SIDS was more than 3 times as great among infants reported for possible maltreatment (hazard ratio: 3.22; 95% CI: 2.66, 3.89). CONCLUSION: Infants reported to child protective services have a heightened risk of SIDS and other SUID. Targeted services and improved communication between child protective services and the pediatric health care community may enhance infant well-being and reduce risk of death.