New SIDS Research

It is sudden, without warning and deadly. Sudden Infant Death Syndrome (SIDS) claims the lives of approximately 100 children in North Carolina every year. It is the leading cause of death among infants one month to one year old. While we know the risk of SIDS can be reduced, there is much about it that remains a mystery, but new research offers some promising clues into the cause of SIDS.

In an article published in the February 3, 2010 issue of the Journal of the American Medical Association (JAMA), Harvard researchers report that babies who die of SIDS may have low levels of serotonin, a brain chemical involved in regulating breathing and other vital functions. According to the study, tissue samples from infants who died of SIDS showed a serotonin level in the brain that was 26 percent lower than those infants who died of other causes. They also had lower levels of an enzyme involved in synthesizing serotonin. The researchers say this discovery brings them a step closer to understanding why babies who appear to be perfectly healthy might die suddenly, and that it could eventually lead to the development of a screening test to identify at-risk infants.

Risks

Most deaths due to SIDS occur between two and four months of age, and increase during cold weather months. We also know African-American infants are twice as likely and Native Americans three times more likely to die of SIDS than Caucasian infants. Many researchers believe there is no single risk factor likely to cause a SIDS death; rather there are several combined risk factors. In fact, it is thought that SIDS results from a simultaneous occurrence of an underlying vulnerability, a critical developmental period and an environmental stressor. This is called the “Triple Risk Model”.

The JAMA study found that 95% of SIDS cases had one or more risk factors and 88% had two or more. Ninety-three percent has at least one extrinsic (environmental) factor—49% stomach sleeping, 14% side sleeping, 37% face down, 20% bed sharing and 44% had a trivial illness prior to death.

While this new study is promising in suggesting a possible biological cause of SIDS, it does not alter the need to remain vigilant in educating new parents and caregivers about the importance of safe sleep positioning. The American Academy of Pediatrics recommends back sleeping as the only acceptable sleep position for babies under one year of age. Putting babies to sleep on their stomach increases the risk for SIDS. Some researchers believe it puts pressure on a child’s jaw and narrows the airway which hampers breathing. Another theory suggests that a face down position increases an infant’s risk of “rebreathing” his or her own exhaled air, particularly if the baby is sleeping on a soft mattress or with excessive bedding, stuffed toys, or a pillow near their face. This could cause carbon dioxide to accumulate depriving the baby of oxygen.

Reducing the Risk

In addition to placing infants on their backs to sleep there are several other simple steps parents and caregivers can take to help reduce the risk of SIDS:

• Put babies on a firm mattress to sleep, never on a pillow, waterbed, couch or other soft surface. Cribs are safest.
• Keep toys and fluffy blankets out of the crib while baby sleeps.
• Keep babies from overheating by layering their clothes and not overdressing them. Some research suggests that babies who get too warm could go into a deeper sleep, making it more difficult to awaken.
• Make sure the rooms where babies sleep stay in a safe temperature range of 68 to 75 degrees Fahrenheit.
• Keep tobacco smoke away from babies.
• Breastfeed if possible.

North Carolina's Safe Sleep Initiative

For fifteen years, the North Carolina Healthy Start Foundation has lead the way in educating parents about infant safe sleep positioning resulting in a reduction of SIDS rates in our state. Although SIDS rates in North Carolina have decreased significantly over the past 10 years, they continue to exceed the national average and progress seems to have leveled off. As part of its infant safe sleep initiative the Foundation has a variety of outreach and training programs:

• Infant Safe Sleep Public Education Campaign : Since 1994 this multimedia, bilingual campaign (initially known as the North Carolina Back to Sleep Campaign) has informed families, childcare providers, health and social service providers and policymakers about SIDS and ways to reduce its risk. It also addresses ways to prevent accidental infant suffocation and asphyxiation.
• HOPES (Hospital Outreach and Partnerships for Education About Infant Safe Sleep): Funded since 2007 by the CJ Foundation for SIDS, this initiative aims to increase the number of hospitals that develop and institutionalize evidence-based safe sleep practices and policies in newborn nurseries and neonatal intensive care units. Since 2007, nearly 600 healthcare professionals have been trained as part of HOPES. Educational materials and onesies with a safe sleep message have been distributed to all babies born in participating hospitals during October, SIDS Awareness month. More than 10000 new parents have received the information since 2007.
• BESST (Baby’s Easy Safe Sleep Training and Toolkit): This on-going community-based training and education initiative was originally developed in 2005 with one-time funding from Blue Cross and Blue Shield Foundation of North Carolina. The two-hour training addresses everything from proper sleep positioning to what to look for in a safe crib and the link between secondhand smoke and SIDS. In an effort to broaden the reach of the safe sleep initiative, attendees receive all the training materials so they can share the information in their respective local communities. In 2009, more than 200 health and human services professionals and community leaders received training to reduce the risk of SIDS.
• ITS-SIDS: This "train-the-trainer" partnership between the North Carolina Healthy Start Foundation and the North Carolina Division of Child Development (DCD), from July 2002 to June 2006, continues to reduce SIDS (previously the primary cause of infant deaths in N.C.’s childcare settings). ITS-SIDS trained childcare providers to develop and implement safe sleep policies and procedures and provided parent education materials. This project has since been institutionalized within DCD.

North Carolina Healthy Start Foundation

The North Carolina Healthy Start Foundation was established in 1990 with a five year, $5 million pledge from Glaxo, Inc. for the purpose of providing leadership in the state's effort to reduce North Carolina's unacceptably high infant mortality rate. Since its inception, the Foundation has grown into a nationally recognized, private, nonprofit organization dedicated to reducing infant death and illness and to improving the health of women and young children in North Carolina. As the Foundation celebrates its 20th anniversary we pledge to continue to work tirelessly to improve the health of our state’s citizens.

Web site link: http://www.nchealthystart.org/public/sids/index.htm