WellSpan doctor helps write new safe sleep recommendations

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Dr. Michael Goodstein is on a mission to end infant sleeping deaths.

You could say the WellSpan physician is more than passionate when it comes to preventing sudden unexpected infant deaths, specifically sudden infant death syndrome, or SIDS. The Centers for Disease Control and Prevention estimates sleep-related infant deaths kill thousands each year despite recommendations that could save lives.

The neonatologist wouldn’t disagree with you.

Sudden unexpected infant death includes all sleep-related infant deaths, including accidental suffocation, unknown deaths and SIDS, which is the sudden and unexplained death of a baby under the age of one year that remains unexplained after an autopsy, an examination of the scene of death and a review of the baby’s medical history.

Sleep-related infant deaths decreased drastically in the early ’90s after the American Academy of Pediatrics and other partners launched the Safe to Sleep education campaign, recommending babies sleep on their backs instead of their stomachs. However, after a 50 percent initial decrease, the number of babies dying from sleep-related deaths in the past decade has remained steady — around 3,500 a year — and the rates of accidental suffocation and strangulation in bed have increased 30 percent from 2000 to 2010.

“It’s a national tragedy, and we don’t talk about it,” Goodstein said. “That’s a really bad thing, because with education we could fix this.”

Recently, the WellSpan York Hospital doctor helped author new AAP recommendations. Babies must still be on their backs, but to decrease the risk of SIDS it also recommends breastfeeding, routine immunizations, using a pacifier and avoiding exposure to smoke, alcohol and illicit drugs.

“If mothers didn’t smoke when they were pregnant, a third of SIDS cases would disappear,” Goodstein said.

Recommendations for a safe sleep environment include positioning babies on their backs, using a firm sleep surface, room-sharing without bed-sharing and avoiding soft bedding and overheating.

Despite the recommendations, AAP researchers earlier this year found that 10 percent to 21 percent of babies examined were placed on a nonrecommended sleep surface, 14 to 33 percent were placed in nonrecommended positions, and 87 to 93 percent had potentially hazardous items, such as loose blankets or crib bumpers, on their sleep surfaces.

“People say ‘well that looks so sad,’ but all these cute things that make cribs look beautiful are a hazard to a baby’s environment,” Goodstein said.

He said the guidelines have to be updated every few years, whether significantly changed or not. The last update was done in 2011, but new research since then includes the positive effects of skin-to-skin care for newborn infants and the effects of using bedside and in-bed sleepers, sleeping on couches or armchairs and in sitting devices.

Though the sample size is too small to compare York County deaths year to year, Goodstein said 2015 was the worst year in recent memory for SIDS deaths in York with nine deaths recorded, up from a handful in 2014.

York Hospital, he said, is working hard to decrease sleep-related deaths with a hospitalwide campaign focusing on policy, training staff and education for every family that leaves delivery.

The hospital-based safe sleep education program includes viewing the “B’more for Healthy Babies” video, reinforcement of safe sleep information from nurses and a voluntary consent form signed by parents confirming they understand the importance and the receipt of safe-sleep information. Signs and photographs throughout the hospital show babies sleeping safely, alone in their cribs without extraneous blankets, just as the guidelines recommend.

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Talking with Children about Safe Sleep

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w to Talk to Children about Infant Sleep-Related Death

  1. What is infant sleep related death?

Sometimes babies die when they are sleeping. This does not happen to all babies, but it happens to some. They may die because where they were put to sleep was not as safe as it could have been.

  1. What does a safe sleeping environment look like?

It is easy to remember what to do to keep a baby safe while sleeping. Just remember your ABCs.

A is for Alone. Babies should always sleep alone. They should never be in bed with mom and dad, brother or sister, or with the family pet.

B is for Back. Back is best. Doctors have found that babies sleep safest on their back. Remember that babies should be put to sleep on their back at nap time and bed time.

And C is for Crib. A baby should sleep only in their crib, bassinet, or portable crib at naptime and bedtime.  The baby should never be placed in mom or dad’s bed, brother or sister’s bed, on a couch, or on an arm chair. These places are not safe because they are soft. Soft places are not good for a baby when sleeping because they may cover the baby’s face and make it hard for him or her to breathe. Like soft surfaces, a baby’s crib should not have any soft items such as, pillows, blankets, bumper pads, or stuffed animals, because they could cover the baby’s face and make it hard to breathe.

  1. Why is a safe sleeping environment important?

When babies die during naptime or bedtime they are often found in places that they should not be, or they are surrounded by items that should not be there. But if you remember the ABCs of Safe Sleep, you can be sure that your baby brother or sister is sleeping safely.

  1. Feelings about Death

When someone dies, everyone is sad. After someone you love dies you may feel sad, angry, confused, or afraid. It is okay to feel these emotions. There is no wrong way to miss someone.  It is always okay to cry because you miss your family member or friend. Remember, nothing that you have said or done caused him or her to die. You can always talk to your mom, dad, or another adult about your loved one when you feel sad, angry, confused, or afraid.



Why American Infant Mortality Rates Are So High

Explaining the numbers

The first nuance is one of definition. Infant mortality is defined as the death of babies under the age of one year, but some of the differences between countries can be explained by a difference in how we count. Is a baby born weighing less than a pound and after only 21 weeks’ gestation actually “born?” In some countries, the answer is no, and those births would be counted as stillbirths. In the United States, on the other hand, despite these premature babies’ relatively low odds of survival, they would be considered born—thus counting toward the country’s infant mortality rates.

These premature births are the biggest factor in explaining the United States’ high infant mortality rate. Pre-term births can have many different maternal causes, many of which—such as high blood pressure, diabetes, Zika and other infections and age—are not entirely within an expectant mother’s control. Other factors, such as stress level, might be able to be managed, but are not entirely controllable. On the other hand, some controllable risk factors include the use of tobacco, alcohol, cocaine and other drugs. The major issue of the lack of universal access to quality prenatal care should also be considered in any discussion of preterm births and infant mortality. Also, because about 50 percent of pregnancies in the United States are unplanned, some women might not be aware they are pregnant in time to get early prenatal care, and this may be part of the reason for premature births in this country.

Across all categories, larger, heavier babies and those at later gestational ages tend to have better survival rates. “Still, at any given gestational age, American physicians are just as capable—if not more so—as other health care professionals around the world at expertly caring for premature neonates,” said Mark Sicilio, MD, an assistant professor of pediatrics at the Texas A&M College of Medicine.

Infertility treatments, which often lead to twins or triplets (who have poorer survival rates, perhaps primarily because they are likelier to be premature), have also been blamed for infant mortality numbers.

Or perhaps the blame for infant deaths lies in some sort of pollutant, virus or other toxin causing birth defects? Although these may be factors, and a major Zika outbreak causing miscarriages and microcephaly wouldn’t help the United States’ numbers, these are not currently the primary documented causes either.

The widening gap

Generally, especially compared to the worldwide statistics, American babies have good survival rates in their first few weeks of life. It is only after they reach one month of age that differences between the United States and other developed countries start to widen.

Perhaps not surprisingly, babies born to wealthier and better educated parents in the United States tended to fare about as well as infants born in European countries. On the other hand, those babies born to mothers in the United States without these advantages were more likely to die than any other group, even similarly disadvantaged populations in the other countries.

This might be due in large part to the prevalence of unintentional injuries and sudden infant death syndrome (SIDS) among American babies. Many parents are still not following sleep recommendations to prevent SIDS. More than 20 percent of babies in the United States are still not being put on their backs—the safest position—to sleep.

“It is extremely important that parents put their babies to sleep safely, on their backs in a crib with a firm mattress and no blankets, stuffed animals or pillows,” Sicilio said. “Studies have also shown an increased risk of SIDS with bed-sharing, or even allowing the infant to fall asleep on a sofa or chair with an adult. Further, allowing infants to remain asleep in car seats or strollers after arriving at their destinations is also discouraged.”

There are racial and ethnic differences in infant mortality that might help explain the differences between the United States and Europe. For example, African American and American Indian/Alaska Native babies are at higher risk of SIDS than Caucasian, Hispanic or Asian American babies. As most other developed countries have a comparatively small population with African heritage (and very few people of American Indian descent) these statistics might also help explain the numbers. Still, they probably don’t tell the whole story.

“Much research has been done on other SIDS environmental risk and protective factors,” Sicilio said. “Using a pacifier, for example, seems to decrease the risk of SIDS, perhaps because sucking on it keeps part of the brain stimulated even during sleep.”

Benefits of home nurse visits

Social programs in many European countries that provide free home visits from nurses for new parents might help increase protective factors and decrease risky ones. The nurses can give the baby a checkup, but perhaps more importantly, they can provide advice for preventing SIDS and can inspect the home for possible hazards. Although some of these home-visit programs exist in the United States, they are not nearly as widespread as they are in other countries.

“We have considerable research evidence of the beneficial effects of home nurse visits for new moms, with special emphasis on the health benefits to their children,” said Lisako McKyer, PhD, associate dean for climate and diversity and associate professor at the Texas A&M School of Public Health. “For example, research reveals that infants in homes which experienced regular visits from nurses and similar paraprofessionals had better psychological outcomes for both mother and infant, which means lower health care costs over the course of their lives.”

Part of the answer for different mortality rates may also lie in differing breast-feeding rates. Some European countries, especially those in Central Europe, have higher rates of babies being exclusively breastfed for the first six months of their lives. “As the Academy of Pediatrics says, breast is best,” Sicilio emphasizes.

Home nurse visits may be beneficial here as well, as studies have shown that they are linked to higher breastfeeding rates. Home nurse visits also seem to be very important to the most vulnerable segments of society, including teen mothers and those coping with addiction or other problems. “Visits to the vulnerable were especially valuable,” McKyer said. “They help to ameliorate the effects of other stressors on new moms and their infants and tend to result in safer home environments for children.”

These safer homes translate to less money spent on treating sick and injured infants, which is especially important considering the cost of care for the rest of the baby’s life. “We can invest a few hundred dollars on the front-end during the first year of babies’ lives to save about $1 million over the course of each of their lifetimes,” McKyer added. “Home nurse visits are also linked to reductions in emergency room visits within the first 10 days of a baby’s life from jaundice and/or dehydration, compared to infants who did not receive home nurse visits.”

Moving forward

In the end, more research is needed to determine how these and other factors really do help explain differences in infant deaths between the United States and other developed countries. For example, could the more generous parental leave policies of Europe help save infants’ lives? Research seems to indicate that maternity leave does reduce infant mortality rates, but the exact mechanism is unclear. It is possible that at least part of the reason is a disproportionally high rate of SIDS cases in child care settings.

“Parental leave policies have tremendous influence on health outcomes for both mom and baby, as well as long-term economic impact,” McKyer said. “Studies show that in countries where there is a generous parental leave policy, there are tremendous effects on morbidity and mortality rates of infants and young children. They’re considerably less likely to get sick enough to require hospitalization or to die. Again, it’s investing on the front end so that we’re not paying on the back end.” This work leads to other questions about how we might be able to bring American infant mortality rates more in line with other developed counties.

“We need to close the infant mortality gap in the United States,” Sicilio said. “I believe we are equipped to do just that.”


Original Source: http://newswise.com/articles/why-american-infant-mortality-rates-are-so-high

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Bad advice on bed-sharing

Sept. 22, 2016

To the editor
: The risks of sharing your bed with your infant are not “imaginary,” contrary to the opinion expressed by Robert LeVine and Sarah LeVine.

An adult bed poses very real risks of sudden infant death syndrome (SIDS), unintentional suffocation, strangulation or entrapment to an infant. Sleep-related infant deaths claim more babies between 1 month and 1 year of age than any other cause.

( “It’s more than OK to sleep next to your infant,” Opinion, Sept. 18)

Multiple studies bear this out. That’s why the American Academy of Pediatrics advises against bed-sharing.

The safest place for an infant to sleep is in a separate crib or bassinet with a tight-fitting sheet and nothing else, preferably in the parents’ bedroom for up to a year.

Benard Dreyer, MD, Elk Grove Village, Ill.
The writer is president of the American Academy of Pediatrics.


To the editor: The opinion piece cites the work of James McKenna, who suggests that bed-sharing is not dangerous, but even beneficial.

This goes against official recommendations of the AAP, which have been comprehensively researched, and which recommend room-sharing, but not bed-sharing.

This article gives dangerous advice, which may increase the number of babies dying of SIDS, suffocation or asphyxiation.

Thomas G. Keens, MD, Los Angeles

The writer is chair of the California SIDS Advisory Council.


To the editor: As a pediatrician and public health professional, I am deeply troubled by this opinion piece.

The AAP and the National Institutes of Health offer expert guidance that bed-sharing is in fact a significant risk factor for accidental suffocation, sudden unexpected infant death (SUID) and SIDS.

I do not think this risk is adequately reflected in the opinion.

Aside from the risk of accidental layover by the parent, bed-sharing also introduces blankets and pillows, which further increases the risk of accidental infant suffocation.

Parents need to understand that this practice is not risk free.

It is also erroneous to equate the infant sleep environment in Japan (typically a firm mat or futon bedding) with the U.S. (fluffy mattresses, pillows and blankets).

David L. Nunez, MD
Seal Beach

The writer is the Maternal Child and Adolescent Health Medical Director, Orange County


To the editor: As a board-certified forensic pathologist and medical examiner practicing in Florida, I am dismayed by the op-ed advocating bed-sharing with infants.

I have performed multiple autopsies on infants who were co-sleeping with their parents or siblings.

Many times, these infants end up face down, wedged into soft bedding or the cushions of a couch, or between the mattress and the wall, just to name a few situations.

Rollovers can also be a cause of asphyxia.

The risks are not to be underestimated.

Kelly Devers, MD, Tampa, Fla.

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Your Favorite Nursing Pillow Could Be Deadly

When you use it wrong, it puts your baby at serious risk.

Many new moms use crescent nursing pillows to help support their baby during feedings. But a coroner from Pennsylvania has take a very public stance against the popular baby registry item, claiming they may be involved in several recent infant deaths.

Three babies, all under six months of age, have been pronounced dead from similar medical causes at Penn State Hershey Medical Center since January, and Graham Hetrick was the coroner on each case, PennLive reports. After autopsies and x-rays, he attributed each of the deaths to cerebral asphyxia, or lack of oxygen to the brain.

In a recent press conference, Hetrick said that parents of all the babies had been using the same type of pillow, similar to adults’ U-shaped neck travel pillows, in their cribs or bassinets, and the children may have been napping in them. Hetrick explained that using the nursing pillows for sleeping — which is completely incorrect — and leaving babies unsupervised is very dangerous.

“It is possible for the baby to move around enough that their shoulders slip down, and the head to be pushed toward the chest,” he said, which can lead to death in minutes. “If [the pillows] are used in the sleeping area, I would caution, when they are not being observed, that this could be a potential.”

Though he can’t say 100% that the deaths resulted from the pillows (and he declined to list any specific products), Hetrick noted, “I’m not a great believer in coincidence.”

The Boppy Company, the manufacturer of the most popular line of these kinds of pillows, promotes safe sleep practices on their website — and both the products and the website have repeated warnings  to “Remove all soft bedding, toys, and pillows from your baby’s sleep area. This includes all Boppy Pillows.”

Even without conclusive evidence, Hetrick is voicing a very important reminder. Your child may look cozy in the pillow, but it is not meant for sleeping.

Link to Original Article:  http://www.goodhousekeeping.com/health/a33752/nursing-pillows-linked-to-baby-deaths/

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