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More Sleep-Caused Infant Deaths Preventable

Arizona team says to look beyond SIDS to sleeping position and environment

SATURDAY, May 14, 2005 (HealthDay News) -- Putting your baby to sleep on its back -- a proven strategy to reduce the risk of sudden infant death syndrome (SIDS) -- isn't always enough to reduce the risk of infant death.

That's what an Arizona team of researchers reported Saturday at the Pediatric Academic Societies' annual meeting in Washington, D.C.

Paying attention to the sleeping environment is also crucial, said study co-author Dr. Justin Sales, a pediatric resident at Maricopa Medical Center and Children's Hospital, in Phoenix.

"A lot of parents think, 'If my baby is asleep on his back, we don't have to worry about SIDS,'" Sales said. "What we are showing is there are other sleep-associated risk factors, such as inappropriate bedding or sleep surfaces, that play a role."

While those factors have been known and publicized, Sales said they need to be re-emphasized in the current campaign to reduce SIDS risk, called the Back to Sleep campaign, promoted by the U.S. National Institute of Child Health and Human Development (NICHD).

Sales, along with lead author Dr. Anu Partap and their colleagues, made those conclusions after they reviewed all sleep-associated deaths of infants in Arizona between 1999 and 2001. They used data from the Arizona Department of Health Service's Child Fatality Review Program.

SIDS is the second-leading cause of infant death in the state, they said. But deaths caused by bedding, sleep surface and bed-sharing are reported separately, which may result in an underestimation of the current risk of unsafe sleep practices. If SIDS cases are combined with the other incidents the researchers studied, sleep-associated deaths become the leading cause of infant death in the state, they found.

SIDS is defined as the sudden and unexplained death of a child under the age of 1. It is the leading cause of death for infants between 1 month and 12 months of age, according to the NICHD.

The researchers found that 134 infants died from SIDS or sleep hazards resulting in suffocation or asphyxiation in the period between 1999 to 2001. Of the total deaths, 104 were attributed to SIDS and 30 were caused by sleep environment, such as sleep surface, bedding or bed sharing.

The investigators determined that 72 percent of the cases had "reducible risk" factors -- that is, they theoretically could have been prevented if parents followed all precautions.

When they broke down the information by ethnic groups, they found that black infants had a five times higher rate of dying from a sleep-associated cause of death, and infants under Medicaid coverage had a 1.5 times higher rate.

The team concludes that Arizona needs to consider developing a broader safe sleep campaign, one that especially reaches out to the black and Medicaid populations.

However, the Back to Sleep campaign has been effective, the researchers found. SIDS has declined by 50 percent, Sales said, since the national campaign was launched more than a decade ago. Paying attention to proper sleeping surfaces and environment could reduce it more, he added.

Earlier this month, other researchers puzzled over statistics showing the incidence of SIDS is going down while the overall unexpected infant death rate remains mostly unchanged in the United States. Reporting in the journal Pediatrics, they said the paradox may be the result of some SIDS deaths being reclassified into different categories, such as suffocation, and the Arizona research seems to add credibility to the supposition.

Improper bedding for babies includes bumper pads and pillows as well as large comforters, experts say. Improper surfaces include adult beds and couches, Sales noted.

Another expert agreed with Sales' points. "To me, the message they are giving is there are many preventable deaths in Arizona," said Dr. Debra Weese-Mayer, professor of pediatrics and director of pediatric respiratory medicine at Rush University Medical Center in Chicago.

"His paper is very good because it's a wake-up call again," Weese-Mayer said.

The information about ethnic and economic disparities is also interesting, she said. But she had a caveat, cautioning that a death from SIDS might not have been avoided even if the comforters or other improper bedding wasn't there. "They're making an assumption that if the stuff is in the bed, it is a preventable death [if it had not been put in there]. We don't know that."

SIDS has a genetic component, she noted, that is not yet fully understood. While the death rate from SIDS has declined, Weese-Mayer said, "we still have a big problem. We should not be complacent about SIDS."

Parents "should follow all the recommendations," she said. Those include placing healthy babies on their back. (Some medical conditions might require a baby to sleep on the stomach, caution experts; parents should check with their child's doctor.)

The baby's feet should be facing the foot of the bed, Weese-Mayer said, and a light sheet should be used to cover him.

The temperature in the baby's room should be comfortably warm but not excessively; no smoking should be allowed, as exposure to smoke has been shown to increase the risk of SIDS.

More information

To learn more about reducing SIDS risk, visit the American Academy of Pediatrics.

SOURCES: Justin Sales, M.D., M.P.H., pediatric resident, Maricopa Medical Center and Children's Hospital, Phoenix, Ariz.; Debra Weese-Mayer, M.D., professor of pediatrics and director of pediatric respiratory medicine, Rush University Medical Center, Chicago, Ill.; Pediatric Academic Societies meeting, May 14, 2005, Washington, D.C.
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