{"id":137,"date":"2018-11-04T13:49:58","date_gmt":"2018-11-04T21:49:58","guid":{"rendered":"http:\/\/www.han.co\/blog\/?p=137"},"modified":"2018-11-05T23:38:55","modified_gmt":"2018-11-06T07:38:55","slug":"a-brief-summary-of-sids-research","status":"publish","type":"post","link":"http:\/\/www.han.co\/blog\/?p=137","title":{"rendered":"A brief summary of SIDS research"},"content":{"rendered":"<p>I&#8217;ve recently read all of the recent guidelines and studies on SIDS and spoken to several NICU doctors and nurses. Below is a summary of everything useful that I learned. Please also see the reference links for the original source material.<\/p>\n<h4><strong>Actionable Takeaways<\/strong><\/h4>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Follow AAP 2016 SIDS recommendation \/ NIH \u00e2\u20ac\u0153Safe to Sleep\u00e2\u20ac\u009d Campaign (see below material). [1,2,4,5]<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">No hat on baby while sleeping [2, NICU RN during discharge course]<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Consider providing a pacifier before sleeping. Even if use of pacifier is short, there seems to be some evidence to show that it helps reduce the risk of SIDS. They are OK with leaving pacifier in the sleep area, but I think it\u00e2\u20ac\u2122s probably better to remove it after it falls out of the baby\u00e2\u20ac\u2122s mouth. [2]<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Don\u00e2\u20ac\u2122t leave babies sleeping in non-CPSC approved sleep surfaces. In particular, do not leave your baby in a car seat, stroller, swing, infant carrier, or sling. Move them to an approved sleeping surface. [4]<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Maybe consider increasing room ventilation by leaving a window open or using a fan (though the evidence supporting room ventilation as a means to reduce SIDS risk is weak enough that the AAP does not actually include it in their recommendations) [2].<\/span>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Including use of bedroom heating during last sleep [12]<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Using a fan [13]<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Well-ventilated room [14]<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Recommendation from NICU doctors on intervention if witnessing an episode of sleep apnea, baby not breathing, or other Apparent Life Threatening Event (ALTE is something that is frightening to observer usually involving apnea, color change, marked limpness, choking, etc):<\/span>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">NICU RN: Give her some time to self recover, like 10 seconds. Then start stimulating her (rubbing her back, changing her position). If she was feeding take away from breast or bottle and change position. Do not shake baby in attempt to awake. <\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><b><span style=\"font-weight: 400;\">NICU Doctor: Same advice as above. On when to start CPR: if skin color changes, or if unresponsive after stimulation. Always start with breaths first, quite often that is enough. <\/span><\/b><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h4><strong>Knowledge Takeaways<\/strong><\/h4>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">\u00e2\u20ac\u0153Sleep apnea\u00e2\u20ac\u009d, where the baby stops breathing while sleeping is common, and the babies that experienced it during studies, did not die from it. In the CHIME study, a longitudinal study conducted in early 2000s involving 1,000+ babies and home monitoring devices, they found 41% of all infants experienced at least one sleep apnea event where the infant stops breathing for at least 20 seconds or a heart rate of &lt;80 bpm for more than 5 seconds (for infants &lt;44 weeks) <\/span><a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/193798\"><span style=\"font-weight: 400;\">[9]<\/span><\/a><span style=\"font-weight: 400;\">. 10% of all infants had \u00e2\u20ac\u0153extreme events\u00e2\u20ac\u009d with breathing that stopped for at least 30 seconds.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">There has not been any evidence that \u00e2\u20ac\u0153sleep apnea\u00e2\u20ac\u009d and ALTE (Apparent Life Threatening Events) are precursors to SIDS. <\/span><a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/193798\"><span style=\"font-weight: 400;\">[9]<\/span><\/a>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">\u00e2\u20ac\u0153Premature babies are more likely to experience sleep apnea. Highest rates of extreme events were observed among infants who were 43 or less weeks.\u00e2\u20ac\u009d<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">\u00e2\u20ac\u0153Peak incidence of SIDS generally occurs at older mean Postconceptional ages (PCA) of 44.2, 46.8, and 52.7 weeks for infants born at 24 to 28, 29 to 32, and 37 weeks, respectively. These differences in timing suggest that extreme events are not likely to be immediate precursors to SIDS, although it does not eliminate the possibility that they are markers of vulnerability. and die of SIDS.\u00e2\u20ac\u009d<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">There is no solid evidence that SIDS is genetic [2].<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">There is no evidence that the use of home monitoring will SIDS.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">My thoughts:<\/span>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">SIDS is a collection of different causes of death, often times these deaths are completely unexplained. SIDS risk factors are very similar to suffocation. So all the recommendations that Moon, et al provides \u00e2\u20ac\u0153were developed to reduce the risk of SIDS and sleep related suffocation, asphyxia, and entrapment among infants\u00e2\u20ac\u009d.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">There\u00e2\u20ac\u2122s an unsettling amount that is unknown about SIDS:<\/span>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">It might be issues with the brain stem and autonomous functions that regulate breathing or heart rate.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">It might be, and often is, related to suffocation where loose clothing, loose bedding, rebreathing, and other factors may lead to death.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">It might be related to overheating and over-bundling. Some experts hypothesize that it stems from some event or development prior to birth (e.g. women who smoke or drink while pregnant have babies with higher Odds Ratios [OR] for SIDS).<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">It sometimes is environmental (sleeping in same room as parents reduces [OR], exposure to smoke).<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">In some studies, incidents of SIDS was initially misdiagnosed, and it ended up being infanticide or other not actual SIDS causes.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Because the causes are varied, there needs to be better segmentation by actual underlying cause, to understand and prevent SIDS. Because it occurs relatively infrequently (91 deaths out of 100,000 births or approximately 0.1%), and because SIDS is often unexplained, it is difficult to segment and analyze the constituent causes. Thus, the SIDS recommendations are generally around preventing suffocation, which has undoubtedly been a leading cause.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">It\u00e2\u20ac\u2122s unsettling to know how little is known, and even more unsettling to know that premature babies are at higher risk of SIDS. [15]<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3><span style=\"font-weight: 400;\">References<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">What I found most helpful in reviewing the literature was going through the references in the AAP 2016 technical report [2].<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\"><a href=\"http:\/\/pediatrics.aappublications.org\/content\/pediatrics\/early\/2016\/10\/20\/peds.2016-2938.full.pdf\"><span style=\"font-weight: 400;\">AAP 2016 SIDS recommendations<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\"><a href=\"http:\/\/pediatrics.aappublications.org\/content\/pediatrics\/138\/5\/e20162940.full.pdf\">AAP 2016 Evidence base for the above recommendations<\/a> (actual facts and research to support recommendations)\u00c2\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">[old] AAP 2011 SIDS recommendations: <\/span><a href=\"https:\/\/timedotcom.files.wordpress.com\/2014\/11\/e1341.full.pdf\"><span style=\"font-weight: 400;\">https:\/\/timedotcom.files.wordpress.com\/2014\/11\/e1341.full.pdf<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Article by Rachel Moon (author of above): <\/span><a href=\"https:\/\/www.healthychildren.org\/English\/ages-stages\/baby\/sleep\/Pages\/A-Parents-Guide-to-Safe-Sleep.aspx\"><span style=\"font-weight: 400;\">https:\/\/www.healthychildren.org\/English\/ages-stages\/baby\/sleep\/Pages\/A-Parents-Guide-to-Safe-Sleep.aspx<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\"><a href=\"https:\/\/www.nichd.nih.gov\/sites\/default\/files\/publications\/pubs\/documents\/safe_sleep_environment_rev.pdf\">NIH Safe to Sleep two sheeter<\/a> (their \u00c2\u00a0&#8220;Safe to Sleep&#8221; campaign is based on American \u00c2\u00a0Academy of Pediatric&#8217;s Taskforce on SIDS. Rachel Y. Moon, MD heads the task force<\/span><\/li>\n<li><a href=\"https:\/\/www.nichd.nih.gov\/sites\/default\/files\/publications\/pubs\/Documents\/NICHD_Safe_to_Sleep_brochure.pdf\"><span style=\"font-weight: 400;\">20 page version of above two pager:<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.nichd.nih.gov\/sites\/default\/files\/publications\/pubs\/Documents\/NICHD_Safe_to_Sleep_brochure.pdf\"><span style=\"font-weight: 400;\">for parents<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.nichd.nih.gov\/sites\/default\/files\/publications\/pubs\/Documents\/STS_brochure_Grandparents_ed.pdf\"><span style=\"font-weight: 400;\">20 page version of above two pager, for grandparents<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/193798\"><span style=\"font-weight: 400;\">Cardiorespiratory Events Recorded on Home Monitors: Comparison of Healthy Infants With Those at Increased Risk for SIDS<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Apnea, Sudden Infant Death Syndrome, and Home Monitoring (AAP Policy Statement) <\/span><a href=\"http:\/\/pediatrics.aappublications.org\/content\/111\/4\/914\"><span style=\"font-weight: 400;\">http:\/\/pediatrics.aappublications.org\/content\/111\/4\/914<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.cdc.gov\/sids\/data.htm\"><span style=\"font-weight: 400;\">https:\/\/www.cdc.gov\/sids\/data.htm<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7479275\"><span style=\"font-weight: 400;\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7479275<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18838649\"><span style=\"font-weight: 400;\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18838649<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/0277953689900592\"><span style=\"font-weight: 400;\">https:\/\/www.sciencedirect.com\/science\/article\/pii\/0277953689900592<\/span><\/a><span style=\"font-weight: 400;\"> (this paper is very old)<\/span><\/li>\n<li><a href=\"http:\/\/pediatrics.aappublications.org\/content\/early\/2017\/06\/01\/peds.2016-3334\">http:\/\/pediatrics.aappublications.org\/content\/early\/2017\/06\/01\/peds.2016-3334<\/a> ; <a href=\"https:\/\/news.rutgers.edu\/news\/premature-infants-greater-risk-sids\/20170625#.W6GTT5NKjOQ\">https:\/\/news.rutgers.edu\/news\/premature-infants-greater-risk-sids\/20170625<\/a>; <a href=\"https:\/\/www.webmd.com\/parenting\/baby\/news\/20060207\/longer-sids-risk-premature-babies#1\">https:\/\/www.webmd.com\/parenting\/baby\/news\/20060207\/longer-sids-risk-premature-babies#1<\/a><\/li>\n<li style=\"font-weight: 400;\"><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>I&#8217;ve recently read all of the recent guidelines and studies on SIDS and spoken to several NICU doctors and nurses. Below is a summary of everything useful that I learned. Please also see the reference links for the original source material. Actionable Takeaways Follow AAP 2016 SIDS recommendation \/ NIH \u00e2\u20ac\u0153Safe to Sleep\u00e2\u20ac\u009d Campaign (see [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-137","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"http:\/\/www.han.co\/blog\/index.php?rest_route=\/wp\/v2\/posts\/137","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/www.han.co\/blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.han.co\/blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.han.co\/blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.han.co\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=137"}],"version-history":[{"count":0,"href":"http:\/\/www.han.co\/blog\/index.php?rest_route=\/wp\/v2\/posts\/137\/revisions"}],"wp:attachment":[{"href":"http:\/\/www.han.co\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=137"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.han.co\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=137"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.han.co\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=137"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}