MEDIA ADVISORY
April 26th, 2001

Breastfeeding and Avoiding Smoke Exposure Reduce SIDS Risks; Report from the CDC Epidemic Intelligence Service 50th Anniversary Conference April 2001
John Painter with the Louisiana Office of Public Health presented a report on "SIDS in the Back to Sleep Era" at the Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service 50th Anniversary Conference in Atlanta this week. Provided below is a summary of his presentation.
The unmatched case control study was conducted using three different data sources from 1997 and 1998:

The cases were ascertained from the Louisiana Child Death Review Panel, which includes all deaths under 1 year of age that were classified as SIDS based on autopsy and medical history. The controls were obtained from the Louisiana Pregnancy Risk Assessment Monitoring System (PRAMS), which routinely surveys a sample of mothers between 2 to 6 months after delivery. Both cases and controls were linked with their birth certificate record.
The study involved the records of 117 SIDS cases and 3,119 controls. There are approximately 70 SIDS deaths in Louisiana each year. SIDS among blacks accounted for two-thirds of the cases and occurred at nearly 3 times the rate of whites.

The purpose of the study was to determine if the current SIDS cases could be due to a lack of adherence to "back to sleep," or if other factors have now taken over as the most important risk factors for SIDS. After controlling for demographic factors, the preventable factors with the highest odds ratio were postnatal maternal smoking and not being breastfed. The incidence of stomach sleeping was similar for cases and controls and was therefore not found to be statistically significant in this study. Unfortunately, in using these data sources they were not able to control for two potentially important factors, the effect of co-sleeping or of sleeping on soft bedding, because this data wasn't collected.

While SIDS rates have been reduced by nearly 50% since the beginning of the Back to Sleep campaign, SIDS is still a significant cause of death. In Louisiana, thirty-one percent of post-neonatal infant mortality is due to SIDS. Although we are encouraged by the success of the campaign to date, the declines in SIDS rates appear to be leveling off recently and other risk
factors may need to be addressed. We know that increasing adherence to back to sleep will not alone eliminate all SIDS cases. The study concluded that additional babies may be saved by altering other preventable risk factors for SIDS - encouraging breastfeeding and eliminating second-hand smoke exposure after birth.

JUST THE FACTS..................... SIDS
Taken from the AAP Website

Since 1992, the American Academy of Pediatrics has recommended that infants be placed to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS).

There is concern that the annual SIDS rate, which has decreased by more than 40 percent since the Back to Sleep recommendation in 1992, appears to be leveling off. To counter this, we believe the Back to Sleep campaign should continue and be expanded to emphasize-among other things-safe sleeping conditions.

Infants who are used to sleeping on their backs are at particularly high risk for SIDS when they are subsequently placed to sleep on their stomachs.

SIDS is still responsible for more infant deaths in the United States than any other cause of death during infancy. The condition is rare during the first month of life, peaks between 2 and 4 months old, and then declines.

Black infants have a SIDS rate over two times the national average and they are twice as likely to be placed on their stomachs as white infants. Also, although many parents may know about the recommendation, many child caregivers, such as child care center workers, do not.

Some people fear a baby may aspirate when she sleeps on her back. There's been no increase in aspiration or complaints of vomiting with the dramatic rise of placing a baby to sleep on his back. Aspiration is a very rare cause of infant death.

Infants should not be put to sleep on waterbeds, sofas, soft mattresses, or other soft surfaces and soft materials or objects such as pillows, quilts, comforters, or sheepskins, should not be placed under an infant.

Soft materials such as pillows or stuffed toys can obstruct infants' airways, even if they are lying on their backs, and should be kept out of an infant's bed.

A certain amount of "tummy time" is recommended while infants are awake for developmental reasons and to avoid flat spots on their head. Flat spots also can be avoided by placing the baby in different directions in the crib-but still on his back.

Devices designed to maintain sleep position or to reduce the risk of rebreathing are not recommended since none of these have been sufficiently tested for their safety or effectiveness.

There are no new data indicating the value of home monitors.







If you are interested in further information on any of these subjects please contact me, I will do all I can to answer your questions or concerns.

MEDIA ADVISORY
May 2nd, 2001

CHIME Study Findings
Provided below is summary of the latest published findings of the Collaborative Home Infant Monitoring Evaluation (CHIME) Study. The article, entitled "Cardiorespiratory Events Recorded on Home Monitors: Comparison of Healthy Infants with Those at Increased Risk for SIDS" has been published in The Journal of the American Medical Associations (JAMA 285:2199-2207).
Home infant monitors have been marketed in the US for several years without any formal scientific assessment of their effectiveness in helping detect potentially fatal cardiorespiratory events in infants. The Collaborative Home Infant Monitoring Evaluation Study, conducted over a four-year period was designed to determine whether infants for whom monitoring was recommended were in fact at increased risk of extreme cardiorespiratory events such as bradycardia (slowed heart rate) and apnea (periodic cessation of breathing). The study authors examined 29,000 monitoring days on four categories of infants: (1) healthy term infants, (2) infants who had experienced a prior Apparent Life Threatening Event (ALTE), (3) siblings of SIDS victims, and (4) preterm infants (<34 weeks' gestation).

Key findings from the study include:

There was no higher risk of conditional and extreme events for infants with prior ALTEs or siblings of SIDS victims.
Preterm infants had an increased risk, but this risk fell outside the age range most common to SIDS incidence.
Most apnea events were signified by 3 obstructed breaths, which most home monitors would generally fail to detect.

The authors conclude that extreme cardiorespiratory events are common only to preterm infants, but their timing precludes them from consideration as precursors to SIDS. There is no evidence of a cause and effect relationship between such events and SIDS.

In recent years, parents have increasingly used special home monitors to detect heartbeat and breathing problems of babies thought to be at increased risk of sudden infant death syndrome, based on the theory that breathing and heart-rate lapses immediately precede SIDS. While the study was not designed to determine how useful home monitors are in preventing SIDS, "the physiological basis for such practice is more in doubt than ever," Dr. Alan Jobe of Children's Hospital Medical Center in Cincinnati wrote in an accompanying editorial.


The findings of this study lend further evidence to support the position that there may be little medical reason to prescribe home monitors for subsequent siblings of SIDS victims. While this data is critical in further unraveling the mystery of SIDS, it will no doubt cause anxiety among SIDS parents who are considering a pregnancy following the death of their baby. It may be important to note the following:

Monitoring of subsequent siblings should be a personal decision made between parents and their physician/pediatrician;
While monitoring a subsequent sibling may not prevent SIDS, it may provide the piece of mind that many parents need to cope with the emotional stress of having another baby;
For all babies, continued emphasis should be placed on the importance of strict adherence to the recommendation to place infants on their backs for sleep and all other risk reduction recommendations as the best protection against SIDS.