Littlest Infants Still Slumber Unsafely

Their mothers aren't putting them on their backs to sleep

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HealthDay Reporter

MONDAY, March 3, 2003 (HealthDayNews) -- More and more American babies are benefiting from the nation's "Back to Sleep" campaign, designed to combat Sudden Infant Death Syndrome.

But not, it seems, those who need it most.

A new study finds the mothers of the smallest babies -- those weighing less than 3.3 pounds at birth -- are getting mixed messages from their doctors and other health professionals about the best sleeping position for their infants.

The National Institutes of Health study of 907 mothers of low birth-weight babies revealed that one-third of the moms of the smallest babies who reported placing their 1-month-old infants on their stomachs did so on their doctors' recommendations.

This is troubling news, the study authors say, because these very low birth-weight babies are at four times the risk for Sudden Infant Death Syndrome (SIDS), compared to normal weight babies. And prone sleeping raises the risk of SIDS.

"Parents and health-care providers are not applying the 'Back to Sleep' intervention recommendations to very low birth-weight babies compared to larger pre-term infants or full-term infants. This data should help neonatologists to address sleep position in pre-term infants before they are discharged from the neonatal ICU," says Dr. Carl E. Hunt, one of the study authors and director of the National Center on Sleep Disorders Research.

The study, which appears in the March issue of Pediatrics, was funded by the National Institute of Child Health and Human Development.

Since 1992, the American Academy of Pediatrics has recommended that babies be put to sleep on their backs, rather than their stomachs, to cut their risk of SIDS. The result of the "Back to Sleep" campaign: SIDS deaths have dropped from 5,000 to less than 3,000 annually, the academy reports.

This decrease was reflected in the new Pediatrics study. The percentage of mothers of babies weighing less than six-and-a-half pounds at birth -- considered a low birth weight -- who put their infants to sleep on their stomach at age one month dropped from 20 percent to 11 percent from 1995 to 1998.

"This is the good news from the study," says Dr. Louis Vernacchio, the study's lead author. "However, the very low birth-weight infants (those weighing less than 3.3 pounds at birth) were substantially more likely to be put to sleep on their bellies, and that is concerning, given their very high risk of SIDS."

One possible reason for this, a neonatal doctor speculates, is that premature babies often have lung problems. And because some studies have shown those babies breathe better when on their stomachs, health-care workers sometimes place them on their stomach in the hospital. New mothers, seeing this, might assume they should do the same at home.

"The mothers of prone sleepers did report that physicians were a major influence on their decision," says Dr. John Kattwinkel, professor of pediatrics at the University of Virginia. "But that doesn't say that the physician actually instructed the mother to place the baby prone."

"It may well be that the mothers observed their babies being managed prone in the hospital and therefore assumed that was the physician's recommendation. Mothers do follow what they observe as well as what they are told," he says.

Adds Hunt: Parents should also know that babies are better off sleeping on their backs than their sides.

"In the smallest babies, the decline in prone sleeping was replaced almost entirely by side sleeping, while in the larger pre-terms it was replaced largely by supine sleeping. Overall, the risk of SIDS when sleeping side is twice that of infants sleeping supine," he says.

More information

The American Academy of Pediatrics has tips on precautions you can take at home to reduce the risk of Sudden Infant Death Syndrome (SIDS). And the Journal of the American Medical Association has a fact sheet on SIDS.

SOURCES: Carl E. Hunt, M.D., director, National Center on Sleep Disorders Research, National Institutes of Health, Bethesda, Md.; John Kattwinkel, M.D., professor, pediatrics, University of Virginia, Charlottesville; Louis Vernacchio, M.D., M.Sc., Boston University; March 2003 Pediatrics

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