Tag: sudden unexpected infant death

Categories : PaediatricsTags :

Why Caffeine Might Hold the Key to Preventing Sudden Infant Death Syndrome

On By ModernMedia
Photo by William Fortunato on Pexels

After decades of stalled national progress in reducing the rate of Sudden Unexpected Infant Death (SUID), a category of infant mortality that includes sudden infant death syndrome (SIDS), researchers at Rutgers Health have proposed an unexpected solution: Caffeine might protect babies by preventing dangerous drops in oxygen that may trigger deaths.

The hypothesis, published in the Journal of Perinatology, comes as the number of SUID cases has plateaued in the US at about 3500 deaths a year for 25 years or one death for every 1000 live births. Despite an initial decline in the 1990s with the introduction of widespread education campaigns promoting back to sleep and other safe infant sleep recommendations by the American Academy of Pediatrics, SIDS, even on its own, remains the leading cause of death in infants between 1 and 12 months old.

“We’ve been concerned about why the rates haven’t changed,” said Thomas Hegyi, a neonatologist at Rutgers Robert Wood Johnson Medical School who led the research. “So, we wanted to explore new ways of approaching the challenge.”

That approach led Hegyi and Ostfeld to a striking realisation: Virtually all known risk factors for SIDS and other sleep-related infant deaths, from stomach sleeping to maternal smoking to bed-sharing to preterm birth, have one thing in common. They are all associated with intermittent hypoxia, brief episodes where oxygen levels drop below 80%.

“I wondered, what can counter intermittent hypoxia?” Hegyi said. “Caffeine.”

The connection isn’t entirely theoretical. Neonatologists already use caffeine to treat apnoea in premature infants, where it works as a respiratory stimulant. The drug has an excellent safety profile in babies, with minimal side effects even at high doses.

What makes caffeine particularly intriguing as a proposed preventive measure is how differently infants process it. While adults metabolise caffeine in about four hours, the half-life in newborns can be as long as 100 hours. Caffeine remains in an infant’s system for weeks, not hours.

This unique metabolism might explain a long-standing puzzle: why SIDS peaks between two and four months of age. As infants mature, they begin metabolising caffeine more quickly. The researchers suggest caffeine consumed during pregnancy or passed through breast milk might provide early protection that wanes as metabolism speeds up.

The theory also could explain why breastfeeding appears to protect against SIDS.

“We hypothesize that the protection afforded by breast milk is, in part, due to caffeine,” wrote the researchers, noting caffeine readily passes from mothers to infants through breast milk.

Barbara Ostfeld, a professor at Rutgers Robert Wood Johnson Medical School, the programme director of the SIDS Center of New Jersey and co-author of the paper, said if the theory proves true, any efforts to give infants caffeine would complement, not replace, existing risk reduction strategies.

“The idea isn’t that caffeine will replace risk-reduction behaviours,” Ostfeld said. “A baby dying from accidental suffocation, one component of SUID, is not likely to have benefited from caffeine but would have from such safe sleep practices as the elimination of pillows and other loose bedding from the infant’s sleep environment.”

The researchers plan to test their hypothesis by comparing caffeine levels in infants who died of SIDS with those who died from other causes, such as trauma or disease.

The research represents a fundamental shift in approaching SIDS prevention. While current strategies focus on eliminating environmental risks, this would be the first potential pharmaceutical intervention.

“For over 30 years, we’ve been educating New Jersey’s parents about adopting safe infant sleep practices.  These efforts have contributed to our state rates being the second lowest in the US.  Still, for various reasons, these proven recommendations are not universally adopted,” Ostfeld said. “This new hypothesis offers a way not just to address important risk factors but potentially intervene.”

Crucially, the researchers said this is hypothesis-generating research meant to inspire further study, not a recommendation for parents to give their babies caffeine. Any intervention would require extensive testing for safety and efficacy.

Still, in a field where progress has stagnated for decades, the possibility of a new approach offers hope.

As Hegyi put it, the goal is “to stimulate new thinking about a problem that has remained unchanged for 25 years.”

Source: Rutgers University

Categories : PaediatricsTags :

More than a Quarter of New Mothers have Fallen Asleep while Breastfeeding

On By ModernMedia
Photo by Wendy Wei

More than a quarter of new mothers have fallen asleep recently while feeding their babies, putting the infants at increased risk of sudden infant death syndrome (SIDS), research published in Pediatrics reveals.

More than 80% had not intended to fall asleep, and many had chosen to feed in chairs or on sofas rather than in a bed. Unfortunately, the cushions and confines of those locations can be very unsafe for babies, raising the risk of death by 49 to 67 times.

The researchers, with UVA Health and UVA Health Children’s, are urging care providers to provide additional guidance for new parents on safe feeding practices, such as informing new moms that a hormone naturally released during breastfeeding will make them feel sleepy.

“While falling asleep while feeding young infants is not in itself too surprising, what is very alarming is that the majority of mothers did not plan to fall asleep, so the sleep space was potentially unsafe for the baby while both slept,” said researcher Fern Hauck, MD, MS, a safe-sleep expert at UVA Health and the UVA School of Medicine. “This highlights the need for parents to be educated about the potential risk of falling asleep while feeding and to plan for that possibility by making the space around the baby as safe as possible. That would include removing pillows and blankets to ensure an open airway for the baby.”

Safe infant feeding

Hauck and her collaborators, including UVA’s Ann Kellams, MD, and Rachel Moon, MD, analysed survey results collected from more than 1250 new mothers as part of the Social Media and Risk-reduction Training (SMART) study conducted at 16 US hospitals in 2015 and 2016. Most respondents completed the survey when their infant was between 2 and 3 months of age.

Among the respondents, more than 28% said they had “usually” or “sometimes” fallen asleep during feeding in the prior two weeks. Of those, a whopping 83.4% said falling asleep was unplanned.

Women who fed in bed were more likely to fall asleep (33.6%) than those who fed on a chair or couch (16.8%). The American Academy of Pediatrics (AAP) recommends mothers at risk of falling asleep while breastfeeding should do so in an adult bed rather than a chair or couch.

Many of the women who fell asleep on chairs or sofas said they chose those locations specifically to avoid falling asleep, to avoid locations (such as a bed) they had been told were unsafe or to avoid disturbing someone else. (The AAP warns moms against sharing a bed or other sleep space with an infant because of the risk the parent might accidentally roll over and smother the child, or that the child could become tangled in bedding. But the group also says that beds are safer than chairs and sofas if falling asleep while feeding is a possibility.)

“We need to meet families where they are and come up with a nighttime plan for sleeping and feeding their baby that works for them and is as safe as possible,” said Kellams, a paediatrician and breastfeeding and lactation medicine specialist at UVA Health Children’s. “Our data suggest that too many of these falling asleep incidents are not planned, so discussions about how to plan for feeding your baby when you are very tired are important.”

The researchers note that providing parents with information about safe sleep and feeding has been shown to reduce risk of unexpected death significantly. But this educational outreach needs to be expanded, they say. Care providers should acknowledge that moms face a very real risk of falling asleep while feeding, even if they are trying not to, and provide practical advice on how to reduce that risk. Further, the researchers are urging additional studies to find ways to assist parents in both safe-sleep practices and breastfeeding.

“We hope that parents of young infants will think proactively about what might happen in the middle of the night,” said Moon, a paediatrician and safe-sleep expert at UVA Health Children’s. “Feeding your baby in your bed is safer than feeding on a couch or armchair if you might fall asleep.”

Source: University of Virginia Health System

Categories : PaediatricsTags :

Study Finds Multiple Unsafe Sleep Practices in Most Sudden Infant Deaths

On By ModernMedia
Photo by William Fortunato on Pexels

There were multiple unsafe sleep practices at play in more than three-quarters of Sudden Unexpected Infant Deaths reported in 23 U.S. jurisdictions between 2011 and 2020, according to a new study published in Pediatrics. The researchers say the findings underscore the need for more comprehensive safe-sleep education for new parents, including from healthcare providers.

Of 7595 infant deaths reviewed, almost 60% of the infants were sharing a sleep surface, such as a bed, when they died.

This practice is strongly discouraged by sleep experts, who warn that a parent or other bed partner could unintentionally roll over and suffocate the baby.

Infants who died while sharing a sleep surface were typically younger (less than 3 months old), non-Hispanic Black, publicly insured, and either in the care of a parent at the time of death or being supervised by someone impaired by drugs or alcohol.

These infants were typically found in an adult bed, chair or couch instead of the crib or bassinet recommended by sleep experts.

“The large number of hazardous sleep practices for both infants who were sharing a sleep surface and sleeping alone at the time of death is alarming,” said researcher Fern Hauck, MD, MS, a safe-sleep expert at UVA Health and the University of Virginia School of Medicine.

“These are known risk factors for SUID [Sudden Unexpected Infant Death], and tells us that we need to do a better job of working with families to increase acceptance of the recommendations to create safer sleep spaces for their infants.”

Sudden Unexpected Infant Deaths

To better understand the factors contributing to SUID and improve safe-sleep messaging, Hauck and her collaborators analysed data from the federal Centers for Disease Control and Prevention’s SUID Case Registry.

The researchers obtained important insights on the prevalence of practices such as prenatal smoking, a known risk factor for SUID, and breastfeeding, which is thought to have a protective benefit.

More than 36% of mothers of infants who died had smoked while pregnant. This percentage was higher among moms who bed shared than those who didn’t, 41.4% to 30.5%. Both bed sharers and non-bed sharers had breastfed at similar rates.

The researchers note that it was rare for bedsharing to be the only risk factor present during a child’s death.

The findings highlight the need for better public education about safe-sleep practices, and for care providers to take a more active role in teaching new parents about the practices, the researchers say.

“Our findings support comprehensive safe sleep counselling for every family at every encounter beyond just asking where an infant is sleeping,” the researchers wrote

In addition to helping parents understand safe-sleep practices, care providers should take steps to ensure parents can follow those practices once they leave the hospital.

For example, some families may not have the means to purchase a crib or bassinet; a hospital might direct them to resources to help with that.

“SUID deaths in the U.S. are still higher than in most other countries, and this is unacceptable,” Hauck said.

“Clinicians and others caring for infants need to have thoughtful conversations with families at risk to understand the barriers to following safe-sleep guidelines and find ways to work together to overcome them.”

Source: University of Virginia Health System