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How can we reduce the risk of cot death?

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NCT's Big Weekend 2010
How can we reduce the risk of cot death?
Presented by Joyce Epstein, Director, FSID

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How can we reduce the risk of cot death?

  1. 1. How can we reduce the risk of cot death?
  2. 2. <ul><li>Registered charity since 1971 </li></ul><ul><li>Fund research </li></ul><ul><li>Support families </li></ul><ul><li>Improve investigations </li></ul><ul><li>Disseminate information </li></ul>
  3. 3. Definition of Cot Death <ul><li>Cot death is the sudden and unexpected death of a baby for no obvious reasons. The post-mortem examination may explain some deaths. </li></ul><ul><li>Those that remain unexplained after post-mortem examination may be registered as sudden infant death syndrome (SIDS), sudden infant death, sudden unexpected death in infancy, unascertained or cot death. </li></ul>
  4. 4. Rate of Sudden Infant Deaths per 1,000 live births:1989-2007 England & Wales, birth to 12 months
  5. 5. Childhood mortality in 2007 The majority of deaths are in infancy Source: Office of National Statistics. Figures are provisional .
  6. 6. Incidence of SIDS by age at death
  7. 7. Rate by age of mother, 2007 (source ONS)
  8. 8. Research <ul><li>FSID has funded around £10m of research since 1971 </li></ul><ul><li>Pathology, infection, respiration, infant care, genetics, temperature control, immunology, allergy, maternal depression, epidemiology… </li></ul><ul><li>Neurology (US) </li></ul>
  9. 9. Some current FSID research <ul><li>To consider theory that anaphylactic shock (allergy) explains some cases of SIDS, Dr A Walls, Southampton </li></ul><ul><li>Why do Asian families have fewer cot deaths, Dr E Moya, Bradford </li></ul><ul><li>Does exposure to air pollution increase the risk, Professor J Jaakkola, Birmingham </li></ul><ul><li>Looking at genetic variants in SIDS babies to see if Long QT Syndrome is involved, Dr R Coombs, Sheffield </li></ul><ul><li>Study of bedsharing, room sharing and separate sleeping, Prof P Fleming, Bristol </li></ul>
  10. 10. More current FSID research <ul><li>Role of infection in SIDS (staph aureus), Dr C Blackwell, Australia </li></ul><ul><li>Role of infection in SIDS (e coli) Dr P Goldwater, Australia </li></ul><ul><li>Whole genome association study in SIDS and control babies, Dr T Bajanowski, Germany </li></ul><ul><li>Is MRI an alternative to autopsy, Dr S Thayyil, Institute of Child Health </li></ul><ul><li>Effect on heart and breathing of babies sitting in a car seat, Dr R Arya, Swindon </li></ul>
  11. 11. Newest FSID funded project <ul><li>Are babies born to women who suffer high levels of stress in pregnancy more vulnerable to cot death? </li></ul><ul><li>Theory: this would be because the baby’s own stress levels would be affected </li></ul><ul><li>Sue Conroy, Institute of Psychiatry, London </li></ul><ul><li>Pilot </li></ul>
  12. 12. Epidemiological research <ul><li>Has yielded valuable information on reducing the risk of cot death </li></ul><ul><li>Looks at 100s of babies who have lived and who have died, carefully matched, and examines what factors - especially aspects of infant care - differ between the two groups </li></ul><ul><li>Forms the basis of FSID’s evidence-based advice on safe infant care </li></ul>
  13. 14. <ul><li>Place your baby on the back to sleep in a cot in a room with you </li></ul><ul><li>Do not smoke in pregnancy or let anyone smoke in the same room as your baby </li></ul><ul><li>Do not share a bed with your baby if you have been drinking alcohol, if you take drugs or if you are a smoker </li></ul><ul><li>Never sleep with your baby on a sofa or armchair </li></ul><ul><li>Do not let your baby get too hot – keep your baby’s head uncovered – place you baby in the “feet to foot” position </li></ul>
  14. 15. Back to Sleep and Feet to Foot
  15. 16. Further information inside the leaflet <ul><li>Do not share a bed with your baby if the baby was premature or was of low birth weight or if you feel very tired </li></ul><ul><li>“ The safest place for your baby to sleep is in a cot in a room with you for the first six months” </li></ul><ul><li>More detail on how to avoid overheating the baby, eg use blankets not duvet, keep cot away from heaters, out of direct sunlight </li></ul><ul><li>Breastfeed your baby </li></ul><ul><li>“ It is possible that using a dummy at the start of any sleep period reduces the risk of cot death” </li></ul>
  16. 17. The safest place for your baby to sleep is in a cot in a room with you <ul><li>It is widely accepted that sleeping with a baby in the parental bed is dangerous if either parent is a smoker. </li></ul><ul><li>But at least 6 research studies have found a small but statistically significant increase in risk even if the parents are non-smokers </li></ul><ul><li>No study has found that sleeping in the same bed with your baby reduces the risk </li></ul>
  17. 18. SIDS and bed sharing with non-smokers Mitchell EA et al (1992) J Paediatr Child Health 28 (Suppl 1): S3-S8; RuysJH et al (2007) Acta Paediatr 10:1339-403; Vennemann M et al (2009) Pediatrics 123:1162-70; Tappin D et al (2005) J Pediatr 147 : 32-37; McGarvey C et al (2006) Arch Dis Child 91 : 318-323; Carpenter RG et al (2004) Lancet 363 : 185-191 New Zealand Nether lands Germ’y Scotl’d Ireland Europe Cases 393 138 333 146 276 745 Controls 1,592 1628 998 276 831 2,411 OR 2.4 (sig) 9.1 at 4 weeks (sig) 19.86 <13 weeks (sig) 8.0 <11 weeks (sig) 8.0 <11 weeks (sig) 2.1 at 4 weeks (sig)
  18. 19. It’s lovely to take your baby to bed for a cuddle or feed, but it’s safest to put her back in the cot before you go to sleep
  19. 20. <ul><li>A recent BMJ paper (Blair et al 2009) warned parents not to “demonise” the bed, but still stated again that the safest place for a baby to sleep is in a cot in a room with the parents </li></ul><ul><li>That advice is also issued by Unicef Baby Friendly Initiative, RCPCH, the departments of health in England, Wales, Northern Ireland and Scotland; and similar by health departments world-wide (US, Canada, Australia, New Zealand, Germany, France…) </li></ul>
  20. 21. <ul><li>52% of cot deaths could be prevented if the baby slept in the parents’ room but not in their bed </li></ul><ul><li>Carpenter R et al (2004) Lancet 363:185-91 </li></ul>
  21. 22. Does bedsharing promote breastfeeding? <ul><li>Remarkably difficult to prove </li></ul><ul><li>Certainly an association </li></ul><ul><li>But it is at least as possible, and maybe more likely, that any causative link is in the opposite direction </li></ul><ul><li>Research is on-going on this subject </li></ul>
  22. 23. Survival analysis of the combined effect of feeding method and bed sharing on SIDS mortality Carpenter R G (2006) Paediatr Child Health 11 (Suppl A) : 24A-28A
  23. 24. Dummies <ul><li>“ It is possible that using a dummy at the start of any sleep period reduces the risk of cot death” </li></ul><ul><li>do not begin to use a dummy until breastfeeding is established </li></ul><ul><li>stop at 6-12 months </li></ul>
  24. 25. Meta analysis of ‘last sleep’ dummy use and SIDS Hauck FR et al (2005) Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis Pediatrics 116 : e716-e723
  25. 26. What if a baby accustomed to a dummy fails to be given a dummy on one occasion? <ul><li>There is a claim that this may lead to an increased risk </li></ul><ul><li>Based on two studies: one had other inconsistencies in its results, thus introducing a confounder; the other did not clearly show the risk of omitting a dummy is greater than if a dummy had never been used, the baby may merely revert to the baseline risk of not using a dummy </li></ul>
  26. 27. Do dummies interfere with breastfeeding? <ul><li>5 RCTs have been published </li></ul><ul><li>4 showed no adverse effect </li></ul><ul><li>The fifth showed a small effect on exclusive breast feeding but not overall breast feeding, of early dummy introduction (2-5 days) but no effect at all of late dummy introduction (>4 weeks) </li></ul><ul><li>1Kramer MS et al (2001) JAMA 286 : 322-326 </li></ul><ul><li>2Schubiger G et al (1997) Eur J Pediatr 156 : 874-877 </li></ul><ul><li>3Collins C T et al (2004) BMJ 329 : 193-198 </li></ul><ul><li>Jenik AG et al (2009) J Pediatr </li></ul><ul><li>5Howard C R et al (2003) Pediatrics 111 : 511-518 </li></ul>
  27. 28. How can we reduce the risk of cot death? <ul><li>Sleep the baby on its back </li></ul><ul><li>Do not smoke in pregnancy or let anyone smoke near the baby after birth </li></ul><ul><li>Do not let the baby get too hot </li></ul><ul><li>The safest place for a baby to sleep is in a cot in a room with the parent </li></ul><ul><li>It is especially risky to sleep in a bed with your baby if you have been drinking, taking drugs, are a smoker, or the baby was LBW or prem </li></ul><ul><li>Never sleep with a baby on a sofa </li></ul><ul><li>Breastfeed </li></ul><ul><li>It is possible that dummies reduce the risk; wait until breastfeeding is established; take away the dummy 6-12 months of age </li></ul>
  28. 29. Thank you

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