Please find below a reference list of recently published, peer-reviewed papers relating to SIDS or SUDI. The references have kindly been supplied by members of ISPID and may include papers in press. Any publication will be listed here for no longer than 2 years.
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SIDS, prone sleep position and infection: An overlooked epidemiological link in current SIDS research? Key evidence for the "Infection Hypothesis". Goldwater PN. Med Hypotheses 2020; 144: 110114. doi:10.1016/j.mehy.2020.110114
"Mainstream SIDS researchers appear to have overlooked the key relationship between prone sleep position and infection. This omission has major implications for current and future SIDS research."
Recurrent sudden unexpected death in infancy: a case series of sibling deaths. Garstang JJ, Campbell MJ, Cohen MC, Coombs RC, Daman Willems C, McKenzie A, Moore A, Waite A. Arch Dis Child 2020:archdischild-2019-318379. doi:10.1136/archdischild-2019-318379
"Objectives: To determine the rate of sudden unexpected death in infancy (SUDI) for infants born after a previous SUDI in the same family, and to establish the causes of death and the frequency of child protection concerns in families with recurrent SUDI. Conclusions: The SUDI rate for siblings is 10 times higher than the current UK SUDI rate. Homicide presenting as recurrent SUDI is very rare. Many parents continued to smoke and exposed infants to hazardous co-sleeping situations, with these directly leading to or contributing to the death of six siblings. SUDI parents need support to improve parenting skills and reduce risk to subsequent infants."
Sudden Infant Death Syndrome. Letter. Keten A, Okdemir E. Am J Forensic Med Pathol 2020; 41 (2): 141. doi:10.1097/PAF.0000000000000551
Letter to the editor highlighting research into organ weight as of possible interest in the pathology of SIDS.
How might non nutritional sucking protect from sudden infant death syndrome. Zavala Abed B, Oneto S, Abreu AR, Chediak AD. Med Hypotheses 2020; 143: 109868. doi:10.1016/j.mehy.2020.109868
Review proposing a mechanism to explain how pacifiers might help prevent SIDS.
Blood and urine biomarkers associated with long-term respiratory dysfunction following neonatal hyperoxia exposure: implications for prematurity and risk of SIDS. Collada A, Mayer CA, MacFarlane PM. Respir Physiol Neurobiol 2020: 103465. doi:10.1016/j.resp.2020.103465
"In the present study, we identified serotonin (5-HT), dopamine (DA) and hyaluronan (HA) as three potential biomarkers that may be increased by neonatal hyperoxia and tested whether they would be associated with an impaired HVR in a rat model of supplemental O2 exposure."
Cerebellar heterotopia of infancy in sudden infant death syndrome: an observational neuropathological study of four cases. Matschke J, Sperhake JP, Wilke N, Püschel K, Glatzel M. Int J Legal Med 2020. doi:10.1007/s00414-020-02316-x
"We report four cases of SIDS in which neuropathological investigation revealed cerebellar heterotopia of infancy, a distinct malformation of the cerebellum, and discuss the potential impact of this condition on the aetiology and pathogenesis of SIDS."
Maternal intentions towards infant sleeping practices in Ireland. O'Brien N, McGarvey C, Hamilton K, Hayes B. Acta Paediatr 2020. doi:10.1111/apa.15352
"A cross-sectional survey of post-partum mothers was performed in the Rotunda Hospital over four months. Educational campaigns on safe sleep for infants in Ireland need to address modifiable SIDS risks factors, focusing on younger, non-Irish mothers, with lower educational attainment."
Maternal bereavement the year before or during pregnancy and total and cause-specific infant mortality: a cohort study from Denmark and Sweden. László KD, Johansson S, Miao M, Li J, Olsen J, Yuan W, Cnattingius S. Psychosom Med 2020. doi:10.1097/PSY.0000000000000822
Cohort study investigating associations between maternal bereavement the year before or during pregnancy and total and cause-specific infant mortality.
Pacifiers: a cause for confusion. Wild BM, Kornfeld B. Pediatr Ann 2020; 49 (5): e204-e206. doi:10.3928/19382359-20200419-01
"Pacifier avoidance is recommended in the newborn nursery to optimize exclusive breast-feeding rates according to the Baby-Friendly Hospital Initiative. There are many reasons why parents may choose to provide a pacifier to their infant, particularly due to the association between pacifier use with sleep and risk reduction for sudden infant death syndrome. Early use of a pacifier does not likely cause direct harm to infants or lead to difficulty breast-feeding. Pediatricians should partner with families to share a clear message in support of establishing exclusive breast-feeding, ideally before introduction of a pacifier."
Mother-infant co-sleeping and maternally reported infant breathing distress in the UK Millennium Cohort. Waynforth D. Int J Environ Res Public Health 2020; 17 (9): 2985. doi:10.3390/ijerph17092985
"The hypothesis that mother-infant co-sleeping will be associated with a lower probability of infant breathing distress is tested in the UK Millennium Cohort Study (n = 18,552 infants). Maternal, infant, family, and socio-economic covariates were included in logistic regression analysis, and in a machine learning algorithm (Random Forest) to make full use of the number of variables available in the birth cohort study data. Results from logistic regression analysis showed that co-sleeping was associated with a reduced risk of breathing difficulties (OR = 0.69, p = 0.027)."
Obstetricians' and gynecologists' communication practices around smoking cessation in pregnancy, secondhand smoke and sudden infant death syndrome (SIDS): a survey. Sontag JM, Singh B, Ostfeld BM, Hegyi T, Steinberg MB, Delnevo CD. Int J Environ Res Public Health 2020; 17 (8): 2908. doi:10.3390/ijerph17082908
USA: "An increased awareness of statewide cessation resources by ob/gyns is needed to assist patients with cessation. The development of standardized risk messaging may reduce the variation in communication practices among ob/gyns."
Pathology of unexpected sudden cardiac death: obstructive sleep apnea is part of the challenge. Ottaviani G, Buja LM. Cardiovasc Pathol 2020: 107221. doi:10.1016/j.carpath.2020.107221
Editorial reviewing "the pathology of SCD, including sudden infant death syndrome (SIDS) and sudden intrauterine unexplained death (SIUD); OSA with its cardiovascular consequences; the possible link between SCD and OSA, discussing the potential mechanisms underlying these two frequent, but yet overlooked pathologies."
Factors associated with age of death in sudden unexpected infant death. Allen K, Anderson TM, Chajewska U, Ramirez JM, Mitchell EA. Acta Paediatr 2020. doi:10.1111/apa.15308
"Factors that varied with age of death are well-documented risk factors for SUID. The majority of these risk factors were associated with younger age at death after allowing for gestational age at birth."
Infant mortality related to NO2 and PM exposure: systematic review and meta-analysis. Kihal-Talantikite W, Marchetta GP, Deguen S. Int J Environ Res Public Health 2020; 17 (8): 2623. doi:10.3390/ijerph17082623
"In spite of a few number of epidemiological studies selected in the present literature review, our finding is in favor of a significant increase of infant death with the increase of air pollution exposure during either the pregnancy period or the first year of a newborn's life. Our findings have to be interpreted with caution due to weaknesses that could affect the strength of the associations and then the formulation of accurate conclusions. Future studies are called to overcome these limitations; in particular, (i) the definition of infant adverse outcome, (ii) exposure assessment, and (iii) critical windows of exposure, which could affect the strength of association."
Baby-box schemes in England: parent and practitioner experiences, and recommendations. Ball HL, Taylor CE. BMC Pediatr 2020; 20 (1): 154. doi:10.1186/s12887-020-02064-2
"Many assumptions exist about the origins and purpose of baby-boxes; this misinformation needs correcting, especially as it relates to infant death reduction and safe infant sleep. Baby-box schemes take multiple forms from those motivated by social welfare to those motivated by commercial profit. The English experience of partnership schemes between healthcare facilities and commercial box-providers reveals some success stories, along with multiple points of ambiguity, unanticipated difficulty, and concerns for infant safety."
No association to sudden infant death syndrome detected by targeted amplicon sequencing of 24 genes. Ferrante L, Opdal SH, Nygaard V. Acta Paediatr 2020. doi:10.1111/apa.15295
"There was no association between rare variants in the included genes and SIDS."
Death-scene investigations contribute to legal protection in unexpected child deaths in Norway. Bøylestad L, Stray-Pedersen A, Vege Å, Osberg S, Rognum T. Acta Paediatr 2020. doi:10.1111/apa.15284
"Death-scene investigations illuminate uncertainty about the cause of death, especially in grey-area cases where accidental suffocation, neglect or abuse is suspected. Knowledge about the course of events and the cause of death enhances both the child's and the caregiver's legal protection. Death-scene investigations should therefore be mandatory."
Multidisciplinary study of sudden unexpected infant death in Liguria (Italy): an nine-year report. Ventura F, Barranco R, Smith A, Ceccherini I, Bandettini R, Coviello D, Morando A, Nozza P, Buffelli F, Fulcheri E, Palmieri A. Minerva Pediatr 2020. doi:10.23736/S0026-4946.20.05599-1
"We conducted a retrospective analysis of cases of SUID referred to the SIDS-ALTE Center of the Liguria Region (Italy) from 2010 to 2018."
Prevalence of risk factors for sudden infant death among Indigenous and non-Indigenous people in Australia. Shipstone RA, Young J, Kearney L, Thompson JMD. Acta Paediatr 2020. doi:10.1111/apa.15274
"Aim: To examine differences in the prevalence of risk factors for sudden unexpected death in infancy (SUDI) between Aboriginal and Torres Strait Islander and non-Indigenous infants."
Risk and protective factors for sudden infant death syndrome. Oliveira AMF, Andrade PR, Pinheiro EM, Avelar AFM, Costa P, Belela-Anacleto ASC. Rev Bras Enferm 2020; 73 (2) : e20190458. doi:10.1590/0034-7167-2019-0458
Brazil: "Objectives: To verify the occurrence of the risk and protective factors for sudden infant death syndrome during nursing consultation. Methods: Retrospective cohort study conducted based on medical records from a primary care unit in the municipality of São Paulo."
SIDS associated RYR2 p.Arg2267His variant may lack pathogenicity. Kohli U, Nayak HM. J Electrocardiol 2020; 60: 23-26. doi:10.1016/j.jelectrocard.2020.03.007
"We report a family with 5 members (mother and 4 children) who are carriers of a rare RYR2 variant (c.6800G > A, p.Arg2267His [Exon: 45], heterozygous) which has previously been identified in a SIDS victim and shown to confer a gain-of-function CPVT phenotype in vitro. All of these 5 family members including the mother (age range 7 to 41 years) have had negative exercise stress tests, echocardiograms and Holter monitors. These findings suggest that caution should be exercised in inferring pathogenicity of rare RYR2 variants based on in vitro functional data which does not always translate to human phenotype."
Triadin knockout syndrome is absent in a multi-center molecular autopsy cohort of sudden infant death syndrome and sudden unexplained death in the young and is extremely rare in the general population. Clemens DJ, Gray B, Bagnall RD, Tester DJ, Dotzler SM, Giudicessi JR, Matthews E, Semsarian C, Behr ER, Ackerman MJ. Circ Genom Precis Med 2020; 13 (2): e002731. doi:10.1161/CIRCGEN.119.002731
"Triadin knockout syndrome (TKOS) is a potentially lethal arrhythmia disorder caused by recessively inherited null variants in TRDN-encoded cardiac triadin. TKOS is an exceedingly rare clinical entity that does not contribute meaningfully to either sudden infant death syndrome or sudden unexplained death in the young. However, despite its rarity and absence in large sudden death cohorts, TKOS remains a malignant and potentially lethal disorder which requires further research to better care for these patients."
A review of long QT syndrome: everything a hospitalist should know. Sharma N, Cortez D, Disori K, Imundo JR, Beck M. Hosp Pediatr 2020; 10 (4): 369-375. doi:10.1542/hpeds.2019-0139
"In this article, we will review various aspects of long QT syndrome (LQTS) necessary for hospitalists who care for children, adolescents, and young adults who have known LQTS and also review presenting features that should make one consider LQTS as a cause of hospitalization."
Back to the breast: a historical overview of the perceived connections between sudden infant death syndrome and breastfeeding. Cowgill B. J Hum Lact 2020; 36 (2): 310-317. doi:10.1177/0890334420906837
Historical review article.
Explaining sudden infant death with cardiac arrhythmias: complete exon sequencing of nine cardiac arrhythmia genes in Dutch SIDS cases highlights new and known DNA variants. Liebrechts-Akkerman G, Liu F, van Marion R, Dinjens WNM, Kayser M. Forensic Sci Int Genet 2020; 46: 102266. doi:10.1016/j.fsigen.2020.102266
"By using targeted massively parallel sequencing (MPS) in 142 Dutch SIDS cases, we performed a complete exon screening of all 173 exons from 9 cardiac arrhythmias genes SCN5A, KCNQ1, KCNH2, KCNE1, KCNE2, CACNA1C, CAV3, ANK2 and KCNJ2 (∼34,000 base pairs), that were selected to harbour previously established SIDS-associated DNA variants."
Geographic variation in sudden unexpected infant death in the United States. Mitchell EA, Yan X, Ren SY, Anderson TM, Ramirez JM, Lavista Ferres JM, Johnston R. J Pediatr 2020; 220: 49-55. doi:10.1016/j.jpeds.2020.01.006
"Objectives: To assess the geographic variation of sudden unexpected infant death (SUID) and test if variation in geographic factors, such as state, latitude, and longitude, play a role in SUID risk across the US."
Central serotonin and autoresuscitation capability in mammalian neonates. Erickson JT. Exp Neurol 2020; 326: 113162. doi:10.1016/j.expneurol.2019.113162
"The purpose of this review is to discuss some of the methodological considerations associated with 5-HT-deficient animal models, to summarize major findings arising from their use, and to highlight several key issues related to 5-HT involvement in gasping and the autoresuscitation response."
Sudden infant death syndrome: do the parents follow the recommendations? [Spanish]. Ruiz Botia I, Cassanello Peñarroya P, Díez Izquierdo A, Martínez Sánchez JM, Balaguer Santamaria A. An Pediatr (Barc) 2020; 92 (4): 222-228. doi:10.1016/j.anpedi.2019.06.011
"The objective of this study is to describe the prevalence of prone position during sleep as well as other risk factors associated with SIDS in a sample of Spanish babies and infants. There is a high prevalence of modifiable risk factors for SIDS among the studied population. Personalized education should be promoted, along with other campaigns to raise awareness and prevent SIDS."
Parental knowledge of safe infant sleep and sudden infant death syndrome is inadequate in Croatia. Barbir I, Ball H, Zakarija-Grković I. Acta Paediatr 2020. doi:10.1111/apa.15207
"Sudden infant death syndrome (SIDS) is the leading category of death for post-neonatal babies in wealthy countries and rates range from 0.06 to 0.9/1000 liveborn infants (1). Most research into infant sleep safety and SIDS is conducted in large countries and published in English; smaller nations may not have the resources to conduct SIDS case-control studies, nor the population size to make them viable. Consequently, in some countries SIDS risk-reduction guidance can be patchy, and parental safe sleep knowledge may be ad-hoc and based on guidance issued in other countries."
Back to sleep: teaching adults to arrange safe infant sleep environments. Carrow JN, Vladescu JC, Reeve SA, Kisamore AN. J Appl Behav Anal 2020. doi:10.1002/jaba.681
"Behavioral skills training (BST) is an evidence-based teaching strategy shown to successfully teach various safety skills to children and adults. The current study evaluated the effectiveness of behavioral skills training to teach safe infant sleep practices to typically developing adults."
T-wave alternans in nonpathological preterm infants. Marcantoni I, Sbrollini A, Agostinelli G, Surace FC, Colaneri M, Morettini M, Pozzi M, Burattini L. Ann Noninvasive Electrocardiol 2020: e12745. doi:10.1111/anec.12745
"Our preliminary retrospective study suggests that nonpathological PTI show TWA of few tens of µV, the interpretation of which is still an open issue but could indicate a condition of cardiac risk possibly related to the low development status of the infant. Further investigations are needed to solve this issue."
Transitional objects of grief. Goldstein RD, Petty CR, Morris SE, Human M, Odendaal H, Elliott AJ, Tobacco D, Angal J, Brink L, Prigerson HG. Compr Psychiatry 2020; 98: 152161. doi:10.1016/j.comppsych.2020.152161
"Bereaved parents often keep, cherish and visit saved objects of their deceased child. This research examined the hypothesis that these objects behave as transitional objects of grief in bereaved mothers during three years following their infants' deaths from Sudden Infant Death Syndrome."
A standardized postmortem protocol to assess the real burden of sudden infant death syndrome. Rizzo S, De Gaspari M, Carturan E, Paradiso B, Favretto D, Thiene G, Basso C. Virchows Arch 2020. doi:10.1007/s00428-020-02747-2
"In conclusion, since the application of a standardized protocol of post-mortem investigation, inflammatory, mostly infective, cardio-pulmonary diseases have been identified as the most common cause of SUID, with SIDS falling from 94 to 42% of SUID. Efforts must be made to implement a uniform autopsy protocol to provide reliable epidemiological data on SIDS."
Infant care practices and parent uptake of safe sleep messages: a cross-sectional survey in Queensland, Australia. Cole R, Young J, Kearney L, Thompson JMD. BMC Pediatr 2020; 20 (1): 27. doi:10.1186/s12887-020-1917-5
"This study aims to describe contemporary infant care practices employed by families related to the current public health SUDI prevention program."
The SIDS summit. Hageman JR. Pediatr Ann 2020; 49 (1): e1-e2. doi:10.3928/19382359-20191211-02
"Report on the 3rd Annual SIDS Summit organized by Dr. Jan-Marino (Nino) Ramirez, the Director of the Center for Integrative Brain Research at Seattle Children's Hospital, and John Kahan, the Chief Data Analytics Officer at Microsoft and the president of Aaron Matthew SIDS Research Guild of Seattle Children's Hospital."
Estimating the burden of prematurity on infant mortality: a comparison of death certificates and child fatality review in Ohio, 2009-2013. Montgomery M, Conrey E, Okoroh E, Kroelinger C. Matern Child Health J 2020; 24 (2): 135-143. doi:10.1007/s10995-019-02851-z
"Among 456 deaths categorized as sudden infant death syndrome on death certificates, approximately 50% (230) were categorized as missing, unknown, or undetermined by Child Fatality Reviews."
U-shaped pillows and sleep-related infant deaths, United States, 2004-2015. Cottengim C, Parks SE, Erck Lambert AB, Dykstra HK, Shaw E, Johnston E, Olson CK, Shapiro-Mendoza CK. Matern Child Health J 2020; 24 (2): 222-228. doi:10.1007/s10995-019-02847-9
"An examination of the demographics and circumstances of 141 infant deaths during 2004-2015 in the US National Fatality Review Case Reporting System with u-shaped pillows in the sleep environment."
Jean W Keeling. Khong TY, Malcomson R. Pediatr Dev Pathol 2020; 23 (1): 4-7. doi:10.1177/1093526619892715
This is a short appreciation of Jean W Keeling as a pediatric pathologist.
Distinct populations of sudden unexpected infant death based on age. Lavista Ferres JM, Anderson TM, Johnston R, Ramirez JM, Mitchell EA. Pediatrics 2020; 145 (1). pii:e20191637. doi:10.1542/peds.2019-1637
"The aim of this study is to determine if there are statistically different subcategories of SUID that are based on the age of death of an infant. Proposes sudden unexpected early neonatal deaths (SUENDs; days 0-6) and postperinatal SUIDs (days 7-364) as separate categories for research."
Knowledge assessment of sudden infant death syndrome risk factors in expectant mothers: A prospective monocentric descriptive study. Gemble A, Hubert C, Borsa-Dorion A, Dessaint C, Albuisson E, Hascoet JM. Arch Pediatr 2020; 27 (1): 33-38. doi:10.1016/j.arcped.2019.10.012
France: "In this prospective, descriptive monocentric study, we aimed to evaluate the level of expectant women's knowledge about SIDS."
Considerations in Safe to Sleep® messaging: Learning from African-American mothers. Stiffler D, Matemachani SM, Crane L. J Spec Pediatr Nurs 2020; 25 (1): e12277. doi:10.1111/jspn.12277
"The purpose of this study was to identify why African-American mothers do not tend to follow the Safe to Sleep® recommendations and to begin to identify a way to frame the Safe to Sleep® message so that African-American mothers might be more likely to follow these recommendations."
Premature birth, homeostatic plasticity and respiratory consequences of inflammation. Gauda EB, McLemore GL. Respir Physiol Neurobiol 2020; 274:103337. doi:10.1016/j.resp.2019.103337
"We propose in this review that simply being born early in the last trimester can trigger homeostatic plasticity within the respiratory network tipping the balance toward inhibition that persists in infancy. We discuss the intersection of premature birth, homeostatic plasticity and biological mechanisms leading to respiratory depression during inflammation in former premature infants."
Risk of adverse birth outcomes after maternal varenicline use: A population-based observational study in Denmark and Sweden. Pedersen L, Petronis KR, Nørgaard M, Mo J, Frøslev T, Stephansson O, Granath F, Kieler H, Sørensen HT. Pharmacoepidemiol Drug Saf 2020; 29 (1): 94-102. doi:10.1002/pds.4894
"Use of varenicline during pregnancy does not appear to increase the risk of major congenital malformations or other adverse birth outcomes."
Modeling safe infant sleep in the hospital. Frey E, Hamp N, Orlov N. J Pediatr Nurs 2020; 50: 20-24. doi:10.1016/j.pedn.2019.10.002
"Quality improvement project to improve safe sleep practice (SSP) adherence by healthcare providers working with infants admitted to an inpatient pediatric unit in an urban academic center specifically increasing compliance on five core SSP (supine, alone in the crib, no objects in crib, appropriate bundling, and flat crib)."
Investigation of Sudden Infant Death Syndrome (Book)
Cohen MC, Scheimberg IB, Beckwith JB, Fern R. Hauck FR (eds). Cambridge University Press, 2019.
This book is a compassionate, scientifically rigorous, multidisciplinary approach to the causes of sudden infant death syndrome (SIDS), detailing the current standards of investigation. It includes tables, diagrams and illustrations to guide the reader through essential steps in successfully diagnosing SIDS for practitioners and all involved. Several of the editors and contributors to the book are ISPID members. The editors have decided to donate their royalties from the book to the Aaron Matthew SIDS Research Guild and the American SIDS Institute. The book can be purchased here. Members of ISPID will receive a 20% discount, details are available in the Members Only section "New Papers".
A possible cause of Sudden Infant Death Syndrome. Blix AS. Med Hypotheses 2019; 136: 109520. doi:10.1016/j.mehy.2019.109520
"It is suggested that an orienting response to loud sound causes apnea, which, in already asphyxic infants, triggers a maximal secondary chemoreceptor response, with massive vagal stimulation of the heart, which causes heart arrest."
Outpatient- or community-based interventions to prevent SIDS and sleep-related deaths. Pretorius K, Rew L. J Spec Pediatr Nurs 2019: e12279. doi:10.1111/jspn.12279
"To determine the state of science of outpatient- or community-based interventions for sudden infant death syndrome prevention in the United States, an integrative review was completed and studies identified through the application of inclusion and exclusion criteria."
Personalising safe sleep messaging for infant caregivers in the United States. Vilvens HL, Vaughn LM, Southworth H, Denny SA, Gittelman MA. Health Soc Care Community 2019. doi:10.1111/hsc.12920
"The purpose of our study was to better understand why parents/caregivers might not practice safe sleep behaviours. In autumn 2016, we conducted 'pulse' interviews with 124 parents/caregivers of children under the age of one year at a variety of local community events, festivals and meetings in cities with high infant mortality rates around the Midwestern US state of Ohio."
Sudden unexpected infant death: review and analysis of adherence to recommendations. Konstat-Korzenny E, Cohen-Welch A, Fonseca-Portilla R, Morgenstern-Kaplan D. Cureus 2019; 11 (11): e6076. doi:10.7759/cureus.6076
"A cross-sectional study to analyze the sleeping environments in infants that attended both the inpatient and outpatient services at a public pediatric hospital in Mexico City."
A retrospective study of death scene investigation practices for sudden unexpected death of infants (SUDI) in Cape Town, South Africa. Bennett T, Martin LJ, Heathfield LJ. Forensic Sci Med Pathol 2019. doi:10.1007/s12024-019-00206-2
"This study assessed DSI practices at one of the largest mortuaries in Cape Town (Salt River Mortuary) to assess the scope of these practices within a resource-constrained context."
Protocols, practices, and needs for investigating sudden unexpected infant deaths. Cottengim C, Parks S, Rhoda D, Andrew T, Nolte KB, Fudenberg J, Sens MA, Brustrom J, Payn B, Shapiro-Mendoza CK. Forensic Sci Med Pathol 2019. doi:10.1007/s12024-019-00196-1
"Understanding case identification practices, protocols, and training needs of medical examiners and coroners (MEC) may inform efforts to improve cause-of-death certification. We surveyed a U.S.-representative sample of MECs and described investigation practices and protocols used in certifying sudden unexpected infant deaths (SUID). We also identified MEC training and resource needs."
The real divide: the use of algorithm-derived Indigenous status to measure disparities in sudden unexpected deaths in infancy in Queensland. Shipstone RA, Young J, Thompson JMD. Aust N Z J Public Health 2019; 43 (6): 570-576. doi:10.1111/1753-6405.12951
"This study investigated the under-identification of Indigenous infants in death records and examines the impact of a multi-stage algorithm on disparities in sudden unexpected deaths in infancy (SUDI)."
Can we still do something and what? - for a seemingly missing syndrome?: "Yes we can". Piumelli R, Arzilli C, Nassi N, Peruzzi M, Ernst CM, Salvatori C. Ital J Pediatr 2019; 45 (1): 132. doi:10.1186/s13052-019-0735-6
"In this letter, the authors compare the incidence of SUDI and SIDS in the Tuscany Region to the incidence reported by Campi and Bonati in their paper "Can we still do something-and what?- for a seemingly missing syndrome?" that was recently published in this journal. The Tuscany data are directly gathered from the autopsies while the others from the death certificates that are often not reliable, thus causing an underestimation of the phenomenon. The real picture of the extent of SIDS is crucial to evaluate the effectiveness of back to sleep campaigns."
Sudden infant death as the most severe phenotype caused by genetic modulation in a family with atrial fibrillation. Santori M, Gil R, Blanco-Verea A, Riuró H, Díaz-Castro Ó, López-Abel B, Brugada R, Carracedo Á, Pérez GJ, Scornik FS, Brion M. Forensic Sci Int Genet 2019; 43: 102159. doi:10.1016/j.fsigen.2019.102159
"Assesses the functional impact of two combined KCNH2 variants involved in atrial fibrillation, syncope and sudden infant death syndrome."
How reliable is parental/carer assessment of infant health status? Byard RW, Shipstone R, Thompson JMD, Young J. Forensic Sci Med Pathol 2019; 15 (4): 629-630. doi:10.1007/s12024-019-00157-8
"The evaluation of parent/carer statements must be tempered by the knowledge that their opinions may not always (for completely understandable reasons) be reliable, and should not be uncritically accepted as a basis for deciding the time course for a lethal process."
Take a deep breath and wake up: The protean role of serotonin preventing sudden death in infancy. Cummings KJ, Leiter JC. Exp Neurol 2019; 326: 113165. doi:10.1016/j.expneurol.2019.113165
"The purpose of this review is to synthesize what is known about adaptive responses of the infant to severely hypoxic conditions, which unleash a flood of neuromodulators that inhibit cardiorespiratory function, thermogenesis, and arousal and the emerging role of serotonin, which combats this cardiorespiratory inhibition to foster autoresuscitation, eupnea, and arousal to ensure survival following an hypoxic episode."
First genome sequence of Cellulomonas hominis isolated from cerebrospinal fluid in the context of sudden infant death syndrome. Sardi S, Garcia P, Zandotti C, Chanteloup A, Baptiste E, La Scola B, Andreani J. New Microbes New Infect 2019; 33: 100623. doi:10.1016/j.nmni.2019.100623
Quality of investigations into unexpected deaths of infants and young children in England after implementation of national child death review procedures in 2008: a retrospective assessment. Fleming P, Pease A, Ingram J, Sidebotham P, Cohen MC, Coombs RC, Ewer AK, Ward Platt M, Fox J, Marshall D, Lewis A, Evason-Coombe C, Blair P. Arch Dis Child 2019; pii: archdischild-2019-317420. doi:10.1136/archdischild-2019-317420
"In 2008, new statutory national procedures for responding to unexpected child deaths were introduced throughout England. There has, to date, been no national audit of these procedures. Data were obtained from 91 bereaved families. Documentation of multiagency assessments was poorly recorded. Most (88%) families received a home visit from the police, but few (37%) received joint visits by police and healthcare professionals. Postmortem examinations closely followed national guidance; 94% involved paediatric pathologists; 61% of families had a final meeting with a paediatrician to explain the investigation outcome. There was no improvement in frequency of home visits by health professionals or final meetings with paediatricians between 2008-2013 and 2014-2017 and no improvement in parental satisfaction with the process. Statutory procedures need to be followed more closely. The implementation of a national child mortality database from 2019 will allow continuing audit of the quality of investigations after unexpected child deaths. An important area amenable to improvement is increased involvement by paediatricians."
Innovation to prevent sudden infant death: the wahakura as an Indigenous vision for a safe sleep environment. Tipene-Leach D, Abel S. Aust J Prim Health 2019. doi:10.1071/PY19033
"The bassinet-like wahakura is an Indigenous initiative for the prevention of Sudden Unexpected Death in Infancy (SUDI). It was developed by New Zealand Māori in 2005 when Māori were rejecting the 'stop bedsharing' SUDI prevention message and the SUDI disparity between Māori and non-Māori had become entrenched. Made of native flax, the wahakura was promoted as a culturally resonant, in-bed safe sleep device that would disrupt the SUDI risk associated with 'bedsharing where there was smoking in pregnancy' without relying on smoking cessation. A significant movement of weavers and health professionals grew around the wahakura program. A body of research, including infant care surveys, retrospective case review, qualitative enquiry and a randomised controlled trial comparing wahakura and bassinet safety demonstrated the device's public health plausibility, acceptability to Māori women and its essential safety. This facilitated the distribution, by District Health Boards, of safe sleep devices, including a related device called the Pēpi-Pod, and safe sleep education to high-risk, mainly Māori, mothers. Infant mortality in New Zealand fell by 29%, primarily among Māori infants, over the period 2009-15, suggesting that Māori cultural concepts, traditional activities and community engagement can have a significant effect on ethnic inequities in infant mortality."
Pre-loss personal factors and prolonged grief disorder in bereaved mothers. Goldstein RD, Petty CR, Morris SE, Human M, Odendaal H, Elliott A, Tobacco D, Angal J, Brink L, Kinney HC, Prigerson HG; PASS Network. Psychol Med 2019; 49 (14): 2370-2378. doi:10.1017/S0033291718003264
"Identifying characteristics of individuals at greatest risk for prolonged grief disorder (PGD) can improve its detection and elucidate the etiology of the disorder. The Safe Passage Study, a study of women at high risk for sudden infant death syndrome (SIDS), prospectively examined the psychosocial functioning of women while monitoring their healthy pregnancies. Mothers whose infants died of SIDS were followed in bereavement. Six personal factors (anxiety, depression, alcohol use, previous loss, living child in the home, and maternal age) predicted PGD in 2 years of bereavement. There is a convergence of risk groups to high rates at 2–3 years, marked by increased PGD rates in mothers at low risk. The risk factors showed different effects on PGD."
Prolongation of bronchopulmonary C-fiber-mediated apnea by prenatal nicotinic exposure in rat pups: role of 5-HT3 receptors. Zhao L, Gao X, Zhuang J, Wallen M, Leng S, Xu F. FASEB J 2019; 33 (10): 10731-10741. doi:10.1096/fj.201900279RR
"Prenatal nicotinic exposure (PNE) reportedly sensitizes bronchopulmonary C-fibers (PCFs) and prolongs PCF-mediated apnea in rat pups, contributing to the pathogenesis of sudden infant death syndrome. Our results showed that PNE up-regulated the pulmonary 5-HT concentration and strengthened the PCF 5-HT3R-mediated apnea. PNE significantly facilitated neural excitability by shortening the decay time of 5-HT3R currents, lowering the stimulus threshold, and increasing 5-HT3B IR. In summary, PNE prolongs the apnea mediated by 5-HT3Rs in PCFs, likely by increasing 5-HT3B subunits to enhance the excitability of 5-HT3 channels."
Promoting smoke-free homes through biomarker feedback documenting child exposure to tobacco toxins: protocol for a randomized clinical trial. Thomas JL, Schreier M, Luo X, Lowry S, Hennrikus D, An L, Wetter DW, Ahluwalia JS. JMIR Res Protoc 2019; 8 (10): e12654. doi:10.2196/12654
This study aims to test a novel approach to motivate the adoption of home smoking restrictions and to eliminate child SHS exposure by providing parents with objective data documenting home SHS exposure and "biomarker feedback" of child ingestion of tobacco toxins, that is, objective, laboratory-based results of assays performed on child urine, documenting levels of nicotine; cotinine; and NNAL (4-[methylnitrosamino]-1-[3-pyridyl]-1-butanol), which is a metabolite of the known tobacco carcinogen NNK (4-[methylnitro-samino]-1-[3-pyridyl]-1-butanone).
Inconsistent classification of unexplained sudden deaths in infants and children hinders surveillance, prevention and research: recommendations from The 3rd International Congress on Sudden Infant and Child Death. Commentary. Goldstein RD, Blair PS, Sens MA, Shapiro-Mendoza CK, Krous HF, Rognum TO, Moon RY. Forensic Sci Med Pathol 2019. doi:10.1007/s12024-019-00156-9
This report details the proceedings conclusions from the 3rd International Congress on Unexplained Deaths in Infants and Children, held November 26-27, 2018 at the Radcliffe Institute at Harvard University. The Congress was motivated by the increasing rejection of the diagnosis Sudden Infant Death Syndrome (SIDS) in the medical examiner community, leading to falsely depressed reported SIDS rates and undermining the validity and reliability of the diagnosis, which remains a leading cause of infant and child mortality. We describe the diagnostic shift away from SIDS and the practical issues contributing to it. The Congress was attended by major figures and opinion leaders in this area from countries significantly engaged in this problem. Four categories (International Classification of Diseases (ICD)-11 categories of MH11, MH12, MH14, PB00-PB0Z) were recommended for classification, and explicit definitions and guidance were provided for death certifiers. SIDS was reframed as unexplained sudden death in infancy or SIDS/MH11 to emphasize that either term signifies the lack of explanation following a rigorous investigation. A distinct category for children over the age of 1 was recommended (MH12). Definitions and exclusions were provided for the alternative categories of accidental asphyxia and undetermined. As recommended, unexplained sudden death in infancy or SIDS on a death certificate will code a unique, trackable entity, accurately reflecting the inability to determine a definitive explanation, while satisfying surveillance needs and reliable identification for research efforts. The conclusions will be submitted to the World Health Organization for inclusion in the upcoming ICD-11.
Polymorphisms in the myeloid differentiation primary response 88 pathway do not explain low expression levels in sudden infant death syndrome. Bjørnvall CD, Opdal SH, Rognum TO, Ferrante L. Acta Paediatr 2019; 108 (7): 1262-1266. doi:10.1111/apa.14696
The results showed that none of the genetic variants selected from the MyD88 pathway were associated with neither SIDS nor infectious death. Most of the rare genetic variants were homozygote for the common allele in all groups, while the rest revealed allelic variation.
Global trends in the extent of death scene investigation performed for sudden and unexpected death of infant (SUDI) cases: A systematic review. Bennett T, Martin LJ, Heathfield LJ. Forensic Sci Int 2019; 301: 435-444. doi:10.1016/j.forsciint.2019.06.013
A systematic review was conducted to review the scope of death scene investigation of SUDI cases worldwide. Overall, where a standardised death scene investigation was performed, it added value to the post-mortem investigation; as such, death scene investigation should be encouraged in SUDI investigation. To this end, protocols should be established nationally, and contain core analyses, which could be expanded depending on the needs and resources of the country.
Breastfeeding duration and infant sleep location in a cohort of volunteer breastfeeding counselors. Bailey C, Tawia S, McGuire E. J Hum Lact 2019: 890334419851801. doi:10.1177/0890334419851801
Breastfeeding targets have been difficult to achieve globally, and innovative ideas are required to improve breastfeeding outcomes through public health messaging. There was a strong association in the current study between breastfeeding outcomes and degree of closeness of the infant to the mother at night. This finding should be brought into the discourse on breastfeeding and infant sleep arrangements, accompanied by evidence-based advice about safe sleeping and the promotion of breastfeeding.
USA's experience with sudden unexpected infant death and sudden death in the young case registries. Shapiro-Mendoza CK, Cottengim C. Arch Dis Child 2019; pii: archdischild-2019-317205. doi:10.1136/archdischild-2019-317205
The extent to which laws and mandates that facilitate investigations and autopsies in England and how often they are practised and enforced will be important for the English registry to examine. The US CDC and NIH look forward to partnering with and learning from data captured in England’s and other national sudden death registries.
Origins of disparities in preventable child mortality in England and Sweden: a birth cohort study. Zylbersztejn A, Gilbert R, Hjern A, Hardelid P. Arch Dis Child 2019; pii: archdischild-2018-316693. doi:10.1136/archdischild-2018-316693
Birth cohort study using linked administrative health databases from England and Sweden. Interventions that improve maternal health before and during pregnancy to reduce the prevalence of adverse birth characteristics and address poverty could reduce child mortality due to RTIs and SUDIs in England.
Content of infant safe sleep counseling and maternal reported practices in an urban clinic. Burrell TD, McDonald EM, Mahoney P, Musci RJ, Shields W, Gielen A, Solomon BS. Acad Pediatr 2019; 19 (7): 801-807. doi:10.1016/j.acap.2019.06.014
We described the content of safe sleep counseling by pediatric providers and examined pediatric provider and caregiver factors that may be related to the delivery of safe sleep counseling. Pediatric provider counseling on safe sleep is inconsistent across AAP recommendations demonstrating a need for enhanced provider education and a more standardized approach to assess infant sleep practices.
Evaluation of the presence and distribution of leptomeningeal inflammation in SIDS/SUDI cases and comparison with a hospital-based cohort. Jack E, Haas E, Haddix TL. Childs Nerv Syst 2019. doi:10.1007/s00381-019-04268-z
This study further elucidates the relevance of the presence of inflammatory cells and iron in the leptomeninges. Whether in a hospital-based or more forensically relevant population, the presence of inflammatory cells in the leptomeninges (even in great abundance) is common.
Obstructive sleep apnea and sleep position: does it matter for infants with a cleft palate? Greenlee CJ, Scholes MA, Gao D, Friedman NR. Cleft Palate Craniofac J 2019; 56 (7): 890-895. doi:10.1177/1055665618817664
There were no significant improvements in OSA metrics during nonsupine sleep in infants with CP ± L. Prior to recommending nonsupine positioning which increases infant's exposure to sudden infant death syndrome risk, we advocate obtaining a PSG to verify an objective improvement in OSA.
Observed compliance with safe sleeping guidelines in licensed childcare services. Staton S, Pattinson C, Smith S, Pease A, Blair P, Young J, Irvine S, Thorpe K. Arch Dis Child 2019; pii: archdischild-2019-317000. doi:10.1136/archdischild-2019-317000
Despite 25 years of public health messaging, non-compliance with safe sleeping guidelines was observed to be high in (Australian) childcare services. Understanding of the reasons underlying non-compliance, particularly in contexts were legislative mandate and access to information regarding safe sleeping is high, is critical to informing ongoing public health messaging and should be the focus of future studies.
An evaluation of pathologists' application of the diagnostic criteria from the San Diego definition of SIDS and unclassified sudden infant death. Shipstone RA, Young J, Thompson JMD, Byard RW. Int J Legal Med 2019. doi:10.1007/s00414-019-02126-w
This study demonstrates that with clear guidelines for interpretation, the San Diego definition can be applied reliably, with discrepancies resolved through a process of peer review.
Sudden infant death syndrome (SIDS) and the routine otoacoustic emission infant hearing screening test: an epidemiological retrospective case-control study. Blair PS, Rubens D, Pease A, Mellers D, Ingram J, Ewer AK, Cohen MC, Sidebotham P, Ward Platt M, Coombs R, Davis A, Hall A, Fleming P. BMJ Open 2019; 9 (7): e030026. doi:10.1136/bmjopen-2019-030026
Retrospective case-control study, UK. Otoacoustic emission (OAE) signal recordings were not associated with an increased risk of SIDS. The strongest predictors of SIDS were bed-sharing in hazardous (infant sleeping next to a carer who smoked, drank alcohol or slept on a sofa) circumstances (35% vs 3% controls, p<0.0001), infants found prone (33% vs 3% controls, p<0.0001) and infants whose health in the final week was 'not good' (53% vs 9% controls, p<0.0001).
Sudden infant death syndrome: Do parents follow the recommendations? [Spanish] Ruiz Botia I, Cassanello Peñarroya P, Díez Izquierdo A, Martínez Sánchez JM, Balaguer Santamaria A. An Pediatr (Barc) 2019; pii: S1695-4033(19)30251-6. doi:10.1016/j.anpedi.2019.06.011
The objective of this study is to describe the prevalence of prone position during sleep as well as other risk factors associated with SIDS in a sample of Spanish babies and infants. There is a high prevalence of modifiable risk factors for SIDS among the studied population. Personalized education should be promoted, along with other campaigns to raise awareness and prevent SIDS.
Monitoring of chemical risk factors for sudden infant death syndrome (SIDS) by hydroxyapatite-graphene-MWCNT composite-based sensors. Sudhan N, Lavanya N, Leonardi SG, Neri G, Sekar C. Sensors (Basel) 2019; 19 (15). pii: E3437. doi:10.3390/s19153437
The high performances of the developed sensors make them suitable for monitoring unhealthy actions (e. g. smoking, drinking coffee) in breastfeeding women and environmental factors (bad air quality), which are associated with an enhanced risk for SIDS.
The serotonin brainstem hypothesis for the sudden infant death syndrome. Kinney HC, Haynes RL. J Neuropathol Exp Neurol 2019; 78 (9): 765-779. doi:10.1093/jnen/nlz062
The serotonin brainstem hypothesis has been a leading hypothesis for SIDS over the last 2 decades. Our laboratory has studied this hypothesis over time with a variety of tissue techniques, including tissue receptor autoradiography, high performance liquid chromatography, Western blot analysis, immunocytochemistry, and proteomics. The purpose of this article is to review the progress in our laboratory toward supporting this hypothesis. We conclude that an important subset of SIDS infants has serotonergic abnormalities resulting from a "core lesion" in the medullary reticular formation comprised of nuclei that contain serotonin neurons. This lesion could lead to a failure of protective brainstem responses to homeostatic challenges during sleep in a critical developmental period which cause sleep-related sudden death.
Physicians' knowledge and practice of safe sleep recommendations for infants in South Dakota. Angal J, Gogoi M, Zenel J, Elliott AJ. S D Med 2019; 72 (8): 349-353.
Despite the knowledge of SIDS risk factors, gaps were seen in dissemination of information regarding all risk factors to parents. While sleep position, postnatal exposures and breast feeding were more likely to be addressed, other elements of a safe sleep environment such as bedding surface, bed sharing, pacifier use and room ventilation were less likely to be covered. These findings indicate the need for improved health care provider education/communication in South Dakota.
SIDS, BRUE, and safe sleep guidelines. Behnam-Terneus M, Clemente M. Pediatr Rev 2019; 40 (9): 443-455. doi:10.1542/pir.2017-0259
In 2016, the American Academy of Pediatrics (AAP) published a clinical practice guideline in which they recommended redefining apparent life-threatening event with the more specific term brief resolved unexplained event (BRUE). The purpose of this review is to detail how to apply the BRUE classification guidelines in practice. The recently updated AAP guidelines for sudden infant death syndrome prevention and safe infant sleeping environment are also discussed.
Sleep-related risk and worrying behaviours: a retrospective review of a tertiary centre's experience. Vigo A, Noce S, Costagliola G, Bruni O. Eur J Pediatr 2019. doi:10.1007/s00431-019-03460-2
This retrospective study aims at helping physicians select babies considered at risk for fatal events during sleep. It does so by describing the clinical features and outcome of worrying infants' behaviour during sleep, with the activation of an emergency medical service and/or emergency department, subsequently referred to the Centre for Paediatric Sleep Medicine and sudden infant death syndrome, Regina Margherita Children's Hospital, Turin, Italy.
Ambient air pollution and sudden infant death syndrome in Korea: a time-stratified case-crossover study. Hwang MJ, Cheong HK, Kim JH. Int J Environ Res Public Health 2019; 16 (18). pii: E3273. doi:10.3390/ijerph16183273
In this study, we aimed to estimate the risk of SIDS in relation to exposure to air pollution and the effects of its modifying factors. A mortality dataset with supplementary infant mortality survey data from Statistics Korea was used and combined the concentration of ambient air pollution data from AirKorea based on the date of death and residential addresses of the SIDS cases. In females, an increase in NO2 and CO levels was associated with a higher risk of SIDS in low-birthweight and preterm infants. The OR per 15.7 ppb increment in NO2 was highest among preterm infants, with a value of 5.12 (95% CI: 1.27-20.63), and low-birthweight individuals, with a value of 4.11 (95% CI: 1.74-9.72), at a moving average of 0 to 3 days. In males, however, no significant association was found. In the present study, exposure to air pollution was associated with an increased risk of SIDS. This association was more evident in susceptible infants with a low-birthweight or in cases of preterm birth.
Carbon dioxide rebreathing induced by crib bumpers and mesh liners using an infant manikin. Maltese MR, Leshner M. BMJ Paediatr Open 2019; 3 (1): e000374. doi:10.1136/bmjpo-2018-000374
This study characterises CO2 rebreathing in crib bumpers, mesh liners and other products used to mitigate the crib-to-baby interaction. Product permeability, which has been proposed as a regulatory metric, is not an adequate predictor of CO2 rebreathing. The seal and penetration force are important factors as found in mattresses and other bedding materials by previous authors.
Implications of mothers' social networks for risky infant sleep practices. Moon RY, Carlin RF, Cornwell B, Mathews A, Oden RP, Cheng YI, Fu LY, Wang J. J Pediatr 2019: S0022-3476(19)30593-1. doi:10.1016/j.jpeds.2019.05.027
A prospective cohort of mothers with infants <6 months of age were recruited from January 2015 to December 2016. Mothers completed a survey about their personal social networks and infant care practices. Both the type of networks mothers have, and the norms regarding infant sleep practices that circulate within these networks differed by race. Network norms were strongly associated with infant sleep practices and may partially explain the racial disparity therein.
An integrated analysis of maternal-infant sleep, breastfeeding, and Sudden Infant Death Syndrome research supporting a balanced discourse. Marinelli KA, Ball HL, McKenna JJ, Blair PS. J Hum Lact 2019: 890334419851797. doi:10.1177/0890334419851797
The aims of this integrated analysis were to (a) review breastfeeding and maternal and infant sleep research literature via historical, epidemiological, anthropological, and methodological lenses; (b) use this information to determine where we are currently in safeguarding both infant lives and breastfeeding; and (c) postulate the direction that research might take from this point forward to improve our knowledge and inform our policy and practice.
Prevalence and associated factors of supine sleep position in 3-month-old infants: findings from the 2015 Pelotas (Brazil) birth cohort. da Silva BGC, da Silveira MF, de Oliveira PD, Domingues MR, Neumann NA, Barros FC, Bertoldi AD. BMC Pediatr 2019; 19 (1): 165. doi:10.1186/s12887-019-1534-3
The aim of this study was to assess the prevalence of supine sleep position and associated factors among 3-month-old infants from a birth cohort in the city of Pelotas, southern Brazil. Among the 4108 infants assessed in this study, 2274 (55.4%) slept in supine position at 3 months and only 66 (1.6%) in prone position. Maternal white skin color, higher family income and maternal schooling, advanced maternal age, maternal cohabiting with a partner, receiving counseling from health care professionals and non-bed-sharing were associated with higher prevalence of infants sleeping in supine position at 3 months.
Ethnic and socioeconomic variation in cause-specific preterm infant mortality by gestational age at birth: national cohort study. Kroll ME, Kurinczuk JJ, Hollowell J, Macfarlane A, Li Y, Quigley MA. Arch Dis Child Fetal Neonatal Ed 2019: fetalneonatal-2018-316463. doi:10.1136/archdischild-2018-316463
Ethnic and socioeconomic variation in cause-specific infant mortality of preterm babies by gestational age at birth, in England and Wales 2006-2012. Risks of death from congenital anomalies and combined rarer causes (infection, intrapartum conditions, SIDS and unclassified) increased with deprivation, the rate ratios comparing the most with the least deprived quintile being, respectively, 1.54 (1.22 to 1.93) and 2.05 (1.55 to 2.72). Gestation-specific preterm infant mortality shows contrasting ethnic patterns of death from immaturity-related conditions in extremely-preterm babies, and congenital anomalies in moderate/late-preterm babies. Socioeconomic variation derives from congenital anomalies and rarer causes in moderate/late-preterm babies. Future research should examine biological origins of extremely preterm birth.
The EASE project revisited: improving safe sleep practices in Ohio birthing and children's hospitals. Macklin JR, Gittelman MA, Denny SA, Southworth H, Arnold MW. Clin Pediatr (Phila) 2019: 9922819850461. doi:10.1177/0009922819850461
USA: The objective was to implement a quality improvement program to improve compliance with appropriate safe sleep practices in both children's and birthing hospitals. Each site implemented 3 PDSA (Plan-Do-Study-Act) cycles to improve safe sleep behaviors. A total of 37.0% of infants in children's hospitals were observed to follow the current American Academy of Pediatrics recommendations at baseline; compliance improved to 59.6% at the project's end ( P < .01). Compliance at birthing centers was 59.3% and increased to 72.5% ( P < .01) at the collaborative's conclusion.
Baby box distributions: public health benefit or concern? Middlemiss W, Brownstein NC, Leddy M, Nelson S, Manchiraju S, Grzywacz JG. Public Health Rep. 2019: 33354919847731. doi:10.1177/0033354919847731
Reducing the high number of sleep-related infant deaths in the United States (3700 deaths in 2015, or approximately 90 deaths per 100 000 live births) is the primary motivation for distributing baby boxes. However, empirical evidence documenting the effectiveness of a cardboard baby box either as a safe sleep space or a means of decreasing sleep-related infant deaths is absent from the literature. This absence of scientific evidence of the safety and effectiveness of the baby box for reducing sleep-related infant deaths raises 2 questions: "What is driving distribution?" and "What are the potential concerns?"
Epidemiology of sudden unexpected death in infancy in Argentina: secular trend and spatial variation. Chapur VF, Alfaro EL, Bronberg R, Dipierri JE. Arch Argent Pediatr 2019; 117 (3): 164-170. doi:10.5546/aap.2019.eng.164
Describes the spatial and temporal variation of SUDI in Argentina between 1991 and 2014. The proportion of SUDI and its causes show inter-regional heterogeneity; codes related to inaccurate diagnoses predominated in more unfavorable regions, while sudden infant death syndrome was prevalent in the more developed regions.
The use of post-mortem lividity to determine sleep position in sudden unexpected deaths in infancy. Shipstone R, Thompson JMD, Young J, Byard RW. Acta Paediatr 2019. doi:10.1111/apa.14834
Compares parental reports of position found in sudden unexpected deaths in infancy (SUDI) to autopsy reports of lividity and to more accurately classify infant sleep position. There was a discordance between the position an infant was reported to have been found and the position of lividity at autopsy in 22/228 SUDI (9.6%). All infants had anterior lividity despite 13 reportedly found supine, three on their side and six in an unknown position. Using anterior lividity at autopsy to change the position found increased the proportion of prone infants from 37.7% to 47.4%. Previously published odds ratios may have underestimated the risk of sudden infant death associated with prone sleep position. SUDI death scene investigation protocols should require photographic documentation of lividity prior to transporting an infant.
Reappraisal of variants previously linked with Sudden Infant Death Syndrome: results from three population-based cohorts. Paludan-Müller C, Ghouse J, Vad OB, Herfelt CB, Lundegaard P, Ahlberg G, Schmitt N, Svendsen JH, Haunsø S, Bundgaard H, Hansen T, Kanters JK, Olesen MS. Eur J Hum Genet 2019. doi:10.1038/s41431-019-0416-3
"The study aimed to investigate the pathogenicity of cardiac ion channel variants previously associated with SIDS. Of the 92 SIDS-associated variants, 59 (64%) were present in ExAC, 18 (20%) in Inter99, and 24 (26%) in UKBB. Using the Inter99 cohort, we found no difference in J-point amplitude and QTc-interval between carriers and non-carriers for 14/18 variants. There was no difference in the risk of syncope (P = 0.32), malignant ventricular arrhythmia (P = 0.96), and all-cause mortality (P = 0.59) between carriers and non-carriers. The ACMG guidelines reclassified 75% of all variants as variant-of-uncertain significance, likely benign, and benign. We identified ~2/3 of variants previously associated with SIDS and found no significant associations with electrocardiographic traits, syncope, malignant ventricular arrhythmia, or all-cause mortality. These data indicate that many of these variants are not highly penetrant, monogenic causes of SIDS and underline the importance of frequent reappraisal of genetic variants to avoid future misdiagnosis."
Is prone sleeping dangerous for neonates? Polysomnographic characteristics and NDN gene analysis. Wong SB, Zhao LL, Chuang SH, Tsai WH, Yu CH, Tsai LP. Ci Ji Yi Xue Za Zhi 2019; 31 (2): 113-117. doi:10.4103/tcmj.tcmj_29_18
In this study, daytime polysomnography (PSG) data from 17 neonates aged 2-3 days during supine and prone sleep were reported and the NDN gene, an important gene for neonatal respiratory control, was sequenced for correlation with neonatal respiratory parameters. Heart rate (HR), oxygen saturation, carbon dioxide concentration, sleep stages, central apnea index (CAI), obstructive apnea/hypopnea index (OAHI), and oxygen nadir were compared between supine and prone sleep and between participants with different single-nucleotide polymorphisms (SNPs) in the NDN gene. Tachycardia and respiratory instability were recorded in neonates during prone sleep, suggesting that neonates are vulnerable to cardiopulmonary events during prone sleep. Therefore, young neonates should be kept in the supine sleep position unless there are contraindications.
National registry for sudden unexpected deaths of infants and children in England: why do we need one and do families want one? Review. Matthews E, Blair P, Sisodiya S, Jones S, Sebire N, Behr E, Fleming P. Arch Dis Child 2019: archdischild-2018-316542. doi:10.1136/archdischild-2018-316542
Detailed controlled observational studies of infant deaths identifying risk factors and providing evidence-based advice for parents has seen a dramatic reduction in incidence over the last 30 years by almost 80% but greater knowledge is needed if future deaths of infants and older children are to be prevented and families optimally supported. We propose that a national registry of sudden unexpected deaths in infancy and childhood would accurately determine incidence, identify unknown risk factors and highlight good care practices, ensuring these can be standardised nationally. For such a project to be successful, however, parents must be at the heart of it. We held a consultation day between families, professionals and supporting charities (The Lullaby Trust, Child Bereavement UK, SUDC UK and CRY) to seek opinion on the desire for a registry and how best to ensure families are engaged. Here, we summarise our rationale for a registry and the feedback we received from attendees regarding their views of the proposal and the practical aspects of administering it.
Mechanisms underlying a critical period of respiratory development in the rat. Review. Wong-Riley MTT, Liu Q, Gao X. Respir Physiol Neurobiol 2019; 264: 40-50. doi:10.1016/j.resp.2019.04.006
Against several expected trends of development, abrupt neurochemical, metabolic, ventilatory, and electrophysiological changes occur in the respiratory system at P12-13. This results in a transient synaptic imbalance with suppressed excitation and enhanced inhibition, and the response to acute hypoxia is the weakest at this time, both at the cellular and system's levels. The basis for the synaptic imbalance is likely to be contributed by a reduced expression of brain-derived neurotrophic factor (BDNF) and its TrkB receptors in multiple brain stem respiratory-related nuclei during the critical period. Exogenous BDNF or a TrkB agonist partially reverses the synaptic imbalance, whereas a TrkB antagonist accentuates the imbalance. A transient down-regulation of pituitary adenylate cyclase-activating polypeptide (PACAP) at P12 in respiratory-related nuclei also contributes to the vulnerability of this period. Carotid body denervation during this time or perinatal hyperoxia merely delays and sometimes prolongs, but not eliminate the critical period. The rationale for the necessity of the critical period in postnatal development is discussed.
Nurses leading safe infant sleep initiatives in the hospital setting. Hitchcock SC, Ruhl C. Nurs Womens Health 2019; 23 (2): 148-162. doi:10.1016/j.nwh.2019.02.003
"In birthing hospitals, many parents report being given incorrect and sometimes no information about infant sleep safety, which creates immediate and long-term safety concerns. In this article, we provide an overview of sudden unexpected infant death, including sudden unexpected postnatal collapse, and the latest safe sleep recommendations from the American Academy of Pediatrics. We also offer practical guidelines for nurses-those working at the bedside and those in leadership positions-who may be seeking to improve the quality of infant sleep practices in their organizations."
Sudden Infant Death Syndrome: current perspectives. Horne RSC. Intern Med J 2019; 49 (4): 433-438. doi:10.1111/imj.14248
This review outlines the evidence behind current SIDS risk reduction recommendations.
In utero exposure to nicotine abolishes the postnatal response of the cardiac sodium current to isoproterenol in newborn rabbit atrium. Biet M, Ton AT, Delabre JF, Morin N, Dumaine R. Heart Rhythm 2019; 16 (4): 494-501. doi:10.1016/j.hrthm.2019.02.013
"We provide the first evidence linking fetal exposure to nicotine to long-term alterations of INa response to isoproterenol. These changes may impair INa adaptation to sympathetic tone and prevent awakening from sleep apnea, thus leading to arrhythmias that could potentially be involved in SIDS. Our data also raise concerns about the use of nicotine replacement therapies for pregnant women."
Impaired CO2-Induced Arousal in SIDS and SUDEP. Review. Buchanan GF. Trends Neurosci 2019; 42 (4): 242-250. doi:10.1016/j.tins.2019.02.002
Circumstances surrounding SIDS and SUDEP deaths often facilitate CO2 elevation, and faulty CO2 arousal mechanisms could, at least in part, contribute to death.
Continuing major inconsistencies in the classification of unexpected infant deaths. Byard RW, Shipstone RA, Young J. J Forensic Leg Med 2019; 64: 20-22. doi:10.1016/j.jflm.2019.03.007
The classification of the cause of unexpected infant deaths by both pathologists and researchers may be quite inconsistent. For example, if an infant is found lying face down on soft bedding the death may still be certified as 'sudden infant death syndrome (SIDS)', 'accidental suffocation', 'undetermined', 'unclassified sudden infant death (USID)', or 'sudden unexpected death in infancy (SUDI)'. As the San Diego definition of SIDS does not appear to be rigorously or consistently applied, clarifying 'mechanical asphyxia not determined with certainty' may help to more clearly separate SIDS from USID. Including a classification algorithm with the definition may also help to better define unsafe sleep factors and suffocation. This commentary reviews the current situation with regard to classifying these deaths and concludes that the absence of diagnostic pathological markers with conflicting classification systems has led to idiosyncratic certification practices.
In vitro analyses of suspected arrhythmogenic thin filament variants as a cause of sudden cardiac death in infants. Shafaattalab S, Li AY, Lin E, Stevens CM, Dewar LJ, Lynn FC, Sanatani S, Laksman Z, Morin RD, van Petegem F, Hove-Madsen L, Tieleman DP, Davis JP, Tibbits GF. Proc Natl Acad Sci U S A. 2019; 116 (14): 6969-6974. doi:10.1073/pnas.1819023116
To investigate the genetic pathogenesis of SUDI, we sequenced >70 genes from 191 autopsy-negative SUDI victims. The approach used in this study provides critical physiological and mechanistic bases to investigate sarcomeric mutations in the pathogenesis of SUDI.
Increased central cholinergic drive contributes to the apneas of serotonin-deficient rat pups during active sleep. Davis MR, Magnusson JL, Cummings KJ. J Appl Physiol (1985) 2019; 126 (5): 1175-1183. doi:10.1152/japplphysiol.00909.2018
Serotonin in the central nervous system (CNS) is necessary for maintaining the stability of breathing in the early postnatal period, particularly during active sleep. Here we show that the administration of atropine to the CNS selectively stabilizes the respiratory pattern of tryptophan hydroxylase 2-deficient rat pups and reduces their apneas. This suggests that CNS serotonin stabilizes breathing at least in part by reducing central cholinergic drive.
Impaired neonatal cardiorespiratory responses to hypoxia in mice lacking PAC1 or VPAC2 receptors. Barrett KT, Hasan SU, Scantlebury MH, Wilson RJA. Am J Physiol Regul Integr Comp Physiol 2019; 316 (5): R594-R606. doi:10.1152/ajpregu.00250.2018
The stress peptide pituitary adenylate cyclase activating polypeptide (PACAP) and its specific receptor PACAP type 1 receptor (PAC1) have been implicated in sudden infant death syndrome (SIDS). PACAP is also critical to the neonatal cardiorespiratory response to homeostatic stressors identified in SIDS, including hypoxia. However, which of PACAP's three receptors, PAC1, vasoactive intestinal peptide receptor type 1 (VPAC1), and/or vasoactive intestinal peptide receptor type 2 (VPAC2), are involved is unknown. These findings suggest that PAC1 plays the principal role in mediating the cardiorespiratory effects of PACAP in response to hypoxic stress during neonatal development and that defective PACAP signaling via PAC1 may contribute to the pathogenesis of SIDS.
The α3 and α4 nicotinic acetylcholine receptor (nAChR) subunits in the brainstem medulla of sudden infant death syndrome (SIDS). Aishah A, Hinton T, Waters KA, Machaalani R. Neurobiol Dis 2019; 125: 23-30. doi:10.1016/j.nbd.2019.01.010
Abnormalities in nicotine receptor binding and in the expression of the nicotinic acetylcholine receptor (nAChR) subunits α7 and β2 have been reported in the brainstem of SIDS infants. This study focuses on the α3 and α4 nAChR subunits as α3 is important for early postnatal survival while α4 is crucial for nicotine-elicited antinociception and sleep-wake cycle regulation. These findings suggest that abnormalities in endogenous acetylcholine synthesis and regulation may underlie the altered α3 and α4 nAChR subunit expressions in the SIDS brainstem medulla since the changes were not related to cigarette smoke exposure.
Evidence for an association of interferon gene variants with Sudden Infant Death Syndrome. Hafke A, Schürmann P, Rothämel T, Dörk T, Klintschar M. Int J Legal Med 2019; 133 (3): 863-869. doi:10.1007/s00414-018-1974-6
This large study of 251 SIDS cases for common variants in 13 candidate genes governing the immune system has provided first evidence for a role of IFNG in the etiology of SIDS and should stimulate further research into the clinicopathological relevance of immunomodulatory genes for this fatal syndrome.
Aerodynamic factors affecting rebreathing in infants. Itzhak N, Greenblatt D. J Appl Physiol (1985) 2019; 126 (4): 952-964. doi:10.1152/japplphysiol.00784.2018
A fundamentally new aerodynamics-based approach to the study of rebreathing of expired air in infants is presented. Rebreathing is implicated in unexplained Sudden Infant Death Syndrome (SIDS) when infants sleep in a prone position. This is the first time that aerodynamic parameters are systematically varied and their effects on rebreathing quantified. The study provides us with a deeper understanding of the effects of breathing frequency, tidal volume (birthweight) and environmental conditions.
Infants who die in shared sleeping situations differ from those who die while sleeping alone. Review. Collins-Praino LE, Byard RW. Acta Paediatr 2019; 108 (4): 611-614. doi:10.1111/apa.14692
Literature review investigating differences between infants who are sharing a sleeping surface with others, compared to those who die alone. The results demonstrate differences between infants who are sharing a sleeping surface with others, compared to those who die alone. It is likely, therefore, that lethal mechanisms for some shared sleepers are not the same as for SIDS infants sleeping alone, and may involve suffocation.
Sudden unexpected infant death characteristics in the French region of West Provence-Alpes-Côte d'Azur. Tuchtan L, Delteil C, Levrat F, Bacquet J, Garcia P, Fayol L, Gorincour G, Zandotti C, Girard N, Drancourt M, Léonetti G, Piercecchi Marti MD, Bartoli C. Paediatr Int Child Health 2019; 39 (2): 104-110. doi:10.1080/20469047.2018.1533734
Asymptomatic infectious conditions were associated with a high proportion of SUID cases. Non-supine sleep positions were still practised. There is a need to increase SUID prevention campaigns.
Neuropathology of early Sudden Infant Death Syndrome - hypoplasia of the pontine kolliker-fuse nucleus: a possible marker of unexpected collapse during skin-to-skin care. Lavezzi AM, Ferrero S, Paradiso B, Chamitava L, Piscioli F, Pusiol T. Am J Perinatol 2019; 36 (5): 460-471. doi:10.1055/s-0038-1669398
The delayed development of the KFN could represent a specific finding of eSIDS occurring during SSC. Therefore, it is necessary to point out that the SSC represents a further risk factor that must be added to others already known for sudden infant death syndrome. Then this practice needs appropriate monitoring strategies of the infant's conditions.
Sudden Infant Death Syndrome: a global public health issue and nursing's response. Pretorius K, Rew L. Compr Child Adolesc Nurs 2019; 42 (2): 151-160. doi:10.1080/24694193.2018.1451569
"In this article, we review SIDS, describe nursing's unique professional position in addressing this problem, and explore how the principles of social justice can inform nursing's response. Motivated by nursing's ethical and moral obligations, the profession is called to take an active role in educating others regarding this phenomenon, to participate in research, and to develop or advocate for policy that aims to reduce the incidence of SIDS on an international scale."
Sudden Infant Death Syndrome: the role of multidisciplinary teams. Experience of the SIDS-ALTE center of Liguria region. Review. Palmieri A, Fulcheri E, Nozza P, Ceriolo P, Aiello C, Ferrando A, Costabel S, Morasso S, Caglieris S, Ventura F. Minerva Pediatr 2019; 71 (2): 196-200. doi:10.23736/S0026-4946.18.04971-X
Italy: "The aim of this paper was to highlight the importance of a multidisciplinary and multiprofessional management of SIDS for a complete approach to this tragic event. Both biomedical and psychosocial aspects are evaluated, focusing on the impact of SIDS diagnosis on the family. The paper describes the organization of our team, composed of a network of specialists involved in both prevention and management of SIDS. A protocol is proposed to improve SIDS diagnosis and management. In our team, the clinical pediatrician is the coordinator of specialists and the mediator between the family and the other specialists, thanks to his direct relationship with parents."
Conversations with families about reducing the risk of sudden infant death syndrome. Review. Pease A, Blair P, Ingram J, Fleming P. J of Health Vis 2019; 7 (5): 226-231. doi:10.12968/johv.2019.7.5.226
Inequalities in the burden of sudden and unexpected deaths in infancy make targeted action by health professionals a viable option for intervention. Most of the deaths that now occur have at least one known modifiable risk factor present, so the potential impact of supporting families with implementing safer sleep strategies is great and may bring about a further reduction in infant deaths. This article describes the latest evidence for action on three of the major risk factors for SIDS: sleeping position; smoking; and co-sleeping. It goes on to discuss how to translate this evidence into effective communication strategies for families, including giving information about why or how the messages increase safety for sleeping babies.
The Sudden Infant Death Syndrome mechanism of death may be a non-septic hyper-dynamic shock. Gabbay U, Carmi D, Birk E, Dagan D, Shatz A, Kidron D. Med Hypotheses 2019; 122: 35-40. doi:10.1016/j.mehy.2018.10.018
A hypothesis for increased CO in conjunction with stressors which may provide a mechanism for death.
The influence of bed-sharing on infant physiology, breastfeeding and behaviour: a systematic review. Baddock SA, Purnell MT, Blair PS, Pease AS, Elder DE, Galland BC. Sleep Med Rev 2019; 43: 106-117. doi:10.1016/j.smrv.2018.10.007
"Objective risk arises if the infant is unable to mount an appropriate physiological or behavioural response to their micro-environment. More studies in the bed-sharing setting are needed to identify infant risk, the potential benefits of a safer environment, and how bed-sharing interacts with infant care practices other than sleep."
Qualitative analysis of serious case reviews into unexpected infant deaths. Garstang JJ, Sidebotham P. Arch Dis Child 2019; 104 (1): 30-36. doi:10.1136/archdischild-2018-315156
"Most SUDI cases occurred in hazardous sleep environments and are potentially preventable. They occurred in families well known to services with concerns about neglect, substance misuse and poor engagement. More consideration is needed on how best to support such vulnerable families."
Neonatal circumcision and prematurity are associated with sudden infant death syndrome (SIDS). Elhaik E. J Clin Transl Res 2019; 4 (2): 136-151. doi:10.18053/jctres.04.201802.005
Sudden infant death syndrome (SIDS) is the most common cause of postneonatal unexplained infant death. The allostatic load hypothesis posits that SIDS is the result of cumulative perinatal painful, stressful, or traumatic exposures that tax neonatal regulatory systems. We collated latitudinal data from 15 countries and 40 US states sampled during 2009 and 2013. We used linear regression analyses and likelihood ratio tests to calculate the association between SIDS and the phenotypes. Epidemiological analyses are useful to generate hypotheses but cannot provide strong evidence of causality. Biological plausibility is provided by a growing body of experimental and clinical evidence linking aversive preterm and early-life SIDS events. Together with historical and anthropological evidence, our findings emphasize the necessity of cohort studies that consider these phenotypes with the aim of improving the identification of at-risk infants and reducing infant mortality.
Maternal smoking before and during pregnancy and the risk of sudden unexpected infant death. Anderson TM, Lavista Ferres JM, Ren SY, Moon RY, Goldstein RD, Ramirez JM, Mitchell EA. Pediatrics 2019: e20183325. doi:10.1542/peds.2018-3325
SUID risk more than doubled (adjusted odds ratio [aOR] = 2.44; 95% confidence interval [CI] 2.31-2.57) with any maternal smoking during pregnancy and increased twofold between no smoking and smoking 1 cigarette daily throughout pregnancy. These data support the need for smoking cessation before pregnancy. If no women smoked in pregnancy, SUID rates in the United States could be reduced substantially.
The association between preterm labour, perinatal mortality and infant death (during the first year) in Bishop Lavis, Cape Town, South Africa. Brink LT, Gebhardt GS, Mason D, Groenewald CA, Odendaal HJ. S Afr Med J. 2019; 109 (2): 102-106. doi:10.7196/SAMJ.2019.v109i2.13438
As part of the Safe Passage Study of the PASS Network in Cape Town, South Africa, the outcomes of 6 866 singleton pregnancies were prospectively followed from recruitment in early pregnancy until the infant was 12 months old to assess pregnancy outcome. Preterm birth and fetal growth restriction play significant roles in fetal, neonatal and infant losses.
Effect of education and cardboard bassinet distribution on newborn bed-sharing. Heere M, Moughan B, Alfonsi J, Rodriguez J, Aronoff S. Glob Pediatr Health 2019; 6: 2333794X19829173. doi:10.1177/2333794X19829173
This study sought to determine if infant sleep education plus a cardboard bassinet reduced bed-sharing, a risk factor for sudden infant death syndrome (SIDS) and sleep-related deaths (SRD), in the first week of life. Bed-sharing rates: Control: 6.3% (5.2,7.4); Intervention: 4.7% (3.5,5.9). Rate ratio (Control/Intervention) was 1.36 (0.95,1.83) and the Bayesian probability that the rate ratio >1 was .96 and .97 by calculation and simulation, respectively. Bed-sharing rates for exclusively breastfed infants: Control: 11% (7.4, 14.6); Intervention: 5.9% (2.7, 9.2); Rate ratio was 2.00 (1.01, 3.15) and the Bayesian probability that the rate ratio >1 was .993. Infant sleep education plus a cardboard bassinet reduced the rate of bed-sharing in the first week of life, particularly among exclusively breastfeeding dyads.
Can we still do something - and what? - for a seemingly missing syndrome? Campi R, Bonati M. Ital J Pediatr 2019; 45 (1): 28. doi:10.1186/s13052-019-0621-2
Italian infant mortality rates were analysed between 1996 and 2015. Interventions that support safe sleep must be maintained, but research is still needed since although these dramatic deaths have been reduced their causes remain unknown. The challenge is now to shift their trend which has been constant for too long.
Impact of a baby-friendly-aligned pacifier policy on pacifier use at 1 month of age. Ekambaram M, Irigoyen MM, Paoletti A, Siddiqui I. Acad Pediatr 2019: S1876-2859(19)30041-5. doi:10.1016/j.acap.2019.02.002
Pacifier use decreases the risk of sudden infant death syndrome, but its impact on breastfeeding remains controversial. A Baby-Friendly-aligned pacifier policy delayed pacifier adoption but did not impact overall pacifier use or breastfeeding rates at 1 month of age. The finding of lower pacifier use rates among female infants post-intervention requires verification in other populations before evaluating public heath relevance.
Can infant sleeping bags be recommended by medical professionals as protection against sudden infant death syndrome? Glover Williams A, Finlay F. Arch Dis Child 2019; 104 (3): 305-307. doi:10.1136/archdischild-2018-316093
Literature review. Sleeping bags are used in 48-95% of infants in the UK and advocated for by the Lullaby Trust for their safety in the prevention of SIDS. The case control studies included found that sleeping bags are as safe, if not safer than other bedding when examining SIDS as an outcome. For sleeping bags to be safe they must be well made and appropriately used, which includes the correct size, Tog, clothing and other bedding for bedroom temperature.
Implementation of a statewide program to promote safe sleep, breastfeeding and tobacco cessation to high risk pregnant women. Ahlers-Schmidt CR, Schunn C, Engel M, Dowling J, Neufeld K, Kuhlmann S. J Community Health 2019; 44 (1): 185-191. doi:10.1007/s10900-018-0571-4
The purpose of this project was to evaluate outcomes of Safe Sleep Instructor-led community baby showers, which included safe sleep promotion, breastfeeding promotion and tobacco cessation education. Certified Safe Sleep Instructors (n = 35) were trained on how to plan and host a Community Baby Shower to provide education to pregnant women of low socioeconomic status or with high risk of infant mortality. Based on the result of the pre- and post-event surveys, certified Safe Sleep Instructors were able to plan and host successful events to increase knowledge and confidence related to risk reduction strategies to reduce sleep-related infant deaths.
Noncardiac genetic predisposition in Sudden Infant Death Syndrome. Gray B, Tester DJ, Wong LC, Chanana P, Jaye A, Evans JM, Baruteau AE, Evans M, Fleming P, Jeffrey I, Cohen M, Tfelt-Hansen J, Simpson MA, Ackerman MJ, Behr ER. Genet Med 2019; 21 (3): 641-649. doi:10.1038/s41436-018-0131-4
We aimed to identify noncardiac genes underpinning SIDS and determine their prevalence compared with ethnically matched controls. A monogenic basis for SIDS amongst the previously implicated noncardiac genes and their encoded biological pathways is negligible.
A comparison of infant sleep safety guidelines in nine industrialized countries. Doering JJ, Salm Ward TC, Strook S, Campbell JK. J Community Health 2019; 44 (1): 81-87. doi:10.1007/s10900-018-0556-3
All guidelines recommended the supine sleep position and avoidance of smoke exposure. While most guidelines addressed the remaining 11 categories, specific recommendations varied among guidelines. These findings can inform the broad context of SIDS reduction work, offer opportunities for collaboration among countries, and promote multi-country and global conversations about how research evidence is translated into recommendations for practice.
Qualitative analysis of serious case reviews into unexpected infant deaths. Garstang JJ, Sidebotham P. Arch Dis Child 2019; 104 (1): 30-36. doi:10.1136/archdischild-2018-315156
Most SUDI cases occurred in hazardous sleep environments and are potentially preventable. They occurred in families well known to services with concerns about neglect, substance misuse and poor engagement. More consideration is needed on how best to support such vulnerable families.
Tricuspid valve hemangioma associated with hypoplastic left heart syndrome presenting as Sudden Infant Death Syndrome. Gupta B, Ghosh S, Kujur M, Khetan K, Kumar T. Turk Patoloji Derg 2019; 35 (1): 55-57. doi:10.5146/tjpath.2015.01362
Primary cardiac tumors are rare in children with a low incidence varying from 0.0017 to 0.28% in autopsy studies. Approximately 90% of the reported primary cardiac tumors in the pediatric population are benign and the most common subtype is rhabdomyomas accounting for approximately 60%, while hemangiomas are rare primary tumors with a 5% incidence. Hypoplastic left heart syndrome is abnormal development of the left-sided cardiac structures, leading to obstruction of blood flow from the left ventricle out-flow tract. Here we report a case of tricuspid hemangioma in association with hypoplastic left heart syndrome, a rare association not previously reported in the literature.
Brief Resolved Unexplained Event (BRUE). Kondamudi NP, Virji M. StatPearls. Treasure Island (FL, USA): StatPearls Publishing; 2019 Jan - 2018 Oct 27.
The American Academy of Pediatrics published a clinical practice guideline in 2016 recommending replacing the term apparent life-threatening event (ALTE) with a new term named brief resolved unexplained event (BRUE).The diagnosis of brief resolved unexplained event can only be made when there is no explanation for a qualifying event after an appropriate history and physical examination. Review of previous apparent life-threatening event literature reveals that a small subset of infants with a diagnosis compatible with a brief resolved unexplained event may have a serious underlying disease or are prone to recurrent episodes. High-risk infants are those younger than two months of age, those with a history of prematurity (higher in less than 32 weeks gestation), and those with more than one event.