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Death Syndrome (death + syndrome)
Kinds of Death Syndrome Selected AbstractsSUDDEN INFANT DEATH SYNDROME IN TWO INFANTS FROM FAMILIES OF LOW SOCIOECONOMIC STATUSJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 12 2005D Tey Dr No abstract is available for this article. [source] Effects of alcohol and smoking during pregnancy on infant autonomic controlDEVELOPMENTAL PSYCHOBIOLOGY, Issue 3 2009William P. Fifer Abstract Prenatal exposure to smoking and alcohol increases the risk for Sudden Infant Death Syndrome (SIDS). Physiological changes associated with these exposures are not well studied. Full-term infants were tested within the first 3 days of life. We hypothesized that maternal alcohol consumption and/or smoking during pregnancy would alter autonomic nervous system function. Newborns whose mothers smoked during pregnancy had lower beat-to-beat heart rate variability in quiet sleep. Infants whose mothers consumed alcohol had lower global heart rate variability, but only in active sleep. Unexposed infants demonstrated increases in heart rate with head-up tilt and decreases in heart rate with head-down tilt, but smoking and alcohol-exposed infants showed no significant responses. These results indicate that autonomic function is altered by prenatal exposure to alcohol and smoking. Such markers may provide early identification of infants at greatest risk for SIDS. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 234,242, 2009 [source] Infant mortality among women on a methadone program during pregnancyDRUG AND ALCOHOL REVIEW, Issue 5 2010LUCY BURNS Abstract Introduction and Aims. The rate and correlates of infant death in those born to opioid-dependent women are unclear. This study aims to determine the infant mortality rate of infants born to women on a methadone program during pregnancy and to identify any modifiable risk factors. Design and Methods. A retrospective study of live births to all women in New South Wales, Australia during the period 1995,2002. Using record linkage four groups were compared: (i) live births to women on a methadone program during pregnancy who subsequently died during infancy; (ii) live births to women not on a methadone program who subsequently died during infancy; (iii) live births to women on a methadone program during pregnancy who did not die during infancy; and (iv) live births to women not on a methadone program who did not die during infancy. Results, Discussion and Conclusion. The infant mortality rate was higher among infants whose mothers were on methadone during pregnancy (24.3 per 1000 live born infants in group 1 and 4.0 per 1000 live born infants in group 2) compared with infants of all other mothers. The single main cause of death for all infants was Sudden Infant Death Syndrome. There was a higher rate of smoking among women on methadone. The findings suggest that methadone and non-methadone infant,mother pairs have different symptom profiles, diagnostic procedures and/or different patterns of access to care.[Burns L, Conroy E, Mattick RP. Infant mortality among women on a methadone program during pregnancy. Drug Alcohol Rev 2010] [source] Fetal Heart Rate Patterns and Sudden Infant Death SyndromeJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2006Cydney A. Menihan Objective:, To determine differences in electronic fetal monitoring patterns between infants who died of sudden infant death syndrome and controls. Design:, Case-control study (N= 127). Setting:, A tertiary-level women's hospital in Providence, Rhode Island. Participants:, Infants born between 1990 and 1998 who subsequently died of sudden infant death syndrome and controls. Demographic and clinical data included medical maternal charts and fetal monitoring records. Results:, Compared with controls (n= 98), the mothers whose infants subsequently died of sudden infant death syndrome (n= 29) had lower birthweight babies (sudden infant death syndrome 2,840 vs. controls 3,385 g; p < .01), were younger (22 vs. 28 years; p < .01), were more likely to receive Medicaid health insurance (odds ratio 4.6; confidence interval 1.9-11.2), were more likely to be unmarried (odds ratio 5.2; confidence interval 2.1-12.8), had less intention to breastfeed (26% vs. 57%), and were more likely to smoke (odds ratio 4.6; confidence interval 9-11.2). Main outcome measures:, There were no statistical differences in fetal heart rate variability or sleep/wake cycles detected between groups. Conclusion:, Statistical differences were found in demographic characteristics between sudden infant death syndrome mother-infant couples and their controls. However, no differences were detected in the intrapartum electronic fetal monitoring records, specifically in variability and sleep/wake cycles. JOGNN,35, 116,122; 2006. DOI: 10.1111/J.1552-6909.2006.00013.x [source] Review of risk factors for Sudden Infant Death SyndromePAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2 2001Sullivan [source] Sudden infant death syndrome during low incidence in Sweden 1997,2005ACTA PAEDIATRICA, Issue 1 2010P Möllborg Abstract Background:, Following the change from prone to supine in preferred sleeping position, the incidence of Sudden Infant Death Syndrome (SIDS) in Sweden fell from 1.1 per 1000 live births in 1992 to 0.41 in 1995. After a further small decline, we have been experiencing a plateau at around 0.25 since 2000. Aim:, To identify the changes that have occurred in the epidemiology of SIDS since the end of the Nordic Epidemiological SIDS Study in 1995. Methods:, Data from the Medical Birth Register of Sweden, covering the years 1995,2005, were used. Sleeping position is not included in the register. Results:, The incidence of SIDS has remained low in Sweden. Independent risk factors were smoking during early pregnancy, parents not living together, low maternal age, high parity and short gestational age. The odds ratio for smoking has continued to increase and the median age of death has continued to decrease since the previous study. We found no signs of seasonality in the current material. Conclusions:, Age at death continued to decrease. The high incidence during weekends persisted. Seasonality was not significant. There was no evidence of a changing effect from risk factors in the studied period. [source] Quantitative neuropathological analysis of Sudden Infant Death SyndromeCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2002T. Ansari Abstract Detailed stereological analyses of specific regions of brains of children who had died from Sudden Infant Death Syndrome (SIDS) was undertaken to determine whether global evidence of an underlying pathology exists, contributing to an increased susceptibility to SIDS. A significant reduction in the total number of neocortical neurones and neurone volume was observed in SIDS normal birth weight (NBW) infants in comparison to controls. A significant reduction in both volume and total neurone number were also noted in the dorsal motor nucleus of the vagus in SIDS NBW group when compared with controls. Anomalies in regions of the brain involved with cardiorespiratory control (brainstem) and arousal (brainstem and neocortex) may play a crucial role in the chain of events resulting in a SIDS event. [source] Assessment of infant physiology and neuronal development using magnetic resonance imagingCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2002B. Morgan Abstract Previous work has demonstrated both that there are substantial individual differences in the rate of physiological development, and that infants with risk factors for Sudden Infant Death Syndrome (SIDS) develop more slowly, suggesting that their increased vulnerability may be due to delayed neuronal development associated with compromised development in fetal or early neonatal life. This project aims to test the hypothesis that individual differences in the rate of physiological development of infants correlate with measurable differences in the rate of brain development as assessed by magnetic resonance imaging (MRI). Sixty infants were recruited to this study in three different groups that are known to have differing rates of physiological development. MRI was performed successfully in 49 cases at 6 weeks of age without sedation. Forty-one of these cases had full follow-up (15 normal; 19 IUGR; 11 ,high risk'). Postnatal physiological development was assessed by measuring age-related deep body temperature patterns during sleep. Neuronal development was assessed by subjective analysis of MRI images and objective measurements relating to myelination using T1 and diffusion weighted (23 cases) MRI images. As expected the normal group acquired the adult temperature pattern earlier, but this was not statistically significant. All MRI scan appearances were within normal limits. Ranking cases subjectively in order of maturity revealed no significant pattern. The normal group had a significantly higher myelination score than the IUGR and ,high risk' groups (P = 0.001). This trend was also shown by the diffusion weighted myelination score but did not reach statistical significance. No significant differences were seen in both the subjective and objective MRI measurements and development of nocturnal temperature patterns. The results suggest there may be differences in neurodevelopment between the different groups at 6 weeks of age but these are not linked to late development of temperature patterns. It is therefore unlikely that this related to a global delay in maturation. [source] Epidemiological investigation of Sudden Infant Death Syndrome infants , recommendations for future studiesCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2002P. Blair Abstract In recent years the study of infant care practices within the sleeping environment has proved to be the single most important set of observations for reducing the risk of Sudden Infant Death Syndrome (SIDS). To further reduce the number of deaths and resolve the debate on safe infant care practice, a closer scrutiny of this environment is required. However, anecdotal observation from uncontrolled death-scene investigations and a reluctance to diagnose SIDS because of adverse social conditions or circumstantial evidence at the time of death is undermining future research. To investigate SIDS now means investigating the wider umbrella of all Sudden Unexpected Deaths in Infancy (SUDI) because of the potential for misdiagnosis. In trying to find out why SIDS infants die we have increasingly been forced to search for why infants survive in the first few months of life and it is this comparative component of epidemiological observation that has saved so many lives. A death-scene investigation is vital to any planned future investigation of SIDS but equally essential is a sleep-scene investigation of surviving infants to put any findings into context. SIDS infants are no longer scattered across the social strata and the cot is not the only environment in which they are found, social deprivation and use of the parental bed are now more discernable. Future studies should therefore reflect these changes with a second control group of surviving infants more closely matched to the type of environment in which SIDS infants might be found. [source] Sudden infant death syndrome (SIDS) in African Americans: polymorphisms in the gene encoding the stress peptide pituitary adenylate cyclase-activating polypeptide (PACAP)ACTA PAEDIATRICA, Issue 3 2009Kevin J Cummings Abstract Aims: Mice lacking pituitary adenylate cyclase-activating polypeptide (PACAP) are prone to sudden death in the second post-natal week, having respiratory and metabolic disturbances reminiscent of the human Sudden Infant Death Syndrome (SIDS). Here we test the hypothesis that the human PACAP gene is a site of genetic variance associated with SIDS in a cohort of 92 victims and 92 matched controls. Methods: Using polymerase chain reaction and sequencing, we examined the PACAP gene in 92 SIDS cases (46 Caucasians and 46 African Americans) and 92 race- and gender-matched controls. Results: We found no significant associations between PACAP and SIDS in Caucasians. However, in the African Americans, a non-synonymous single nucleotide polymorphism (i.e. an aspartic acid/glycine coding variant, rs2856966) within exon 2 of PACAP was significantly associated with SIDS (p = 0.004), as were haplotypes containing this polymorphism (p < 0.0001). Glycine was three times more likely at this location in the African-American SIDS victims (17 cases) than African-American controls (5 cases). Conclusion: These data are the first to suggest an association between a variant within the coding region of the PACAP gene and SIDS. Based on these findings, further investigations are warranted into the functional importance of PACAP signaling in neonatal survival and the role of PACAP-signaling abnormalities in SIDS. [source] Light is recognized best through darkness: mast cells and Sudden Infant Death SyndromeCLINICAL & EXPERIMENTAL ALLERGY, Issue 11 2001L. B. Schwartz No abstract is available for this article. [source] Abnormal heart rate response to hypercapnia in boys with an apparent life-threatening eventACTA PAEDIATRICA, Issue 12 2002A Edner Aim: To determine instantaneous cardiac variability responses to increased carbon dioxide (CO2) during quiet sleep in infants who may be at risk for the Sudden Infant Death syndrome (SIDS). Methods: The cardiac rate variability before, during and after a CO2 challenge was examined in 41 infants who had experienced an apparent life-threatening event (ALTE) and 41 gender- and age-matched control infants. Results: The ALTE infants responded to CO2 breathing with a significant increase in R-R intervals, i.e. decreases in heart rate, compared to the controls (45.1% increase in R-R intervals vs. 41.4%; p= 0.005). The differences between ALTE infants and controls depended primarily on the boys' responses. Conclusion: ALTE infants, particularly ALTE boys, have an autonomic dysfunction,lower sympathetic stimulation and/or inhibited vagal withdrawal when stressed with CO2. The outcome might provide clues to the mechanisms underlying the cardiovascular processes contributing to the terminal event in SIDS. [source] Parental reported apnoea, admissions to hospital and sudden infant death syndromeACTA PAEDIATRICA, Issue 4 2001EA Mitchell Three studies were undertaken: (i) a nation-wide case-control study for sudden infant death syndrome (SIDS), with 393 cases and 1592 controls, examined the association between parental reported apnoea and SIDS; (ii) a case-cohort study, with 84 cases of parental reported apnoea and 1502 controls, aimed to identify risk factors for apnoea; and (ii) national hospital admission data for ALTE and national SIDS mortality data were compared for the years 1986 to 1994. Parental reported apnoea was associated with a significant increased risk of SIDS [adjusted odds ratio (OR) 1.86; 95% confidence interval (CI) 1.12, 3.09]. The population attributable risk was 8%. There was a significant increased risk for parental reported apnoea in infants who did not die after adjustment for potential confounders with maternal smokers, short gestation and admission to the neonatal unit. There was no association with prone sleeping position, co-sleeping and bottle feeding. The mean annual admission rate for ALTE was 9.4/1000 live births. This did not change significantly over the study period (1986,1994). In contrast, the SIDS mortality rate decreased from over 4/ 1000 to 2.1/1000. Admission rates were higher for Maori infants and boys. Conclusion: It may be concluded that the relationship between parental reported apnoea and SIDS is tenuous. [source] Previous breastfeeding does not alter thymic size in infants dying of sudden infant death syndromeACTA PAEDIATRICA, Issue 1 2000JMD Thompson The relationship between thymic weights and previous feeding histories was examined in 294 infants of 37 wk gestation or more dying of sudden infant death syndrome (SIDS). One hundred and sixty-five infants had been breastfed exclusively, 89 had been partially breastfed and 40 had never been breastfed. We found no relationship between thymic weight and type of previous feeding. The difference between these findings in SIDS and the substantially greater thymic size previously reported in 4-mo-old breastfed living infants deserves further study. [source] What Is the mechanism of SIDS?DEVELOPMENTAL PSYCHOBIOLOGY, Issue 3 2009Clues from epidemiology Abstract The cause of sudden infant death syndrome (SIDS) is unknown. Many mechanisms have been postulated, although thermal stress, rebreathing of expired gases and infection/inflammation seem the most viable hypotheses for the causation of SIDS. Deaths from SIDS have reduced dramatically following the recommendation not to place infants to sleep prone. Epidemiological data have shown that prone sleeping position is more risky in winter, colder latitudes, higher altitudes, if the infant is unwell or has excessive bedding or clothing. This suggests prone sleeping position involves either directly or indirectly a thermal mechanism. SIDS caused by an infective/inflammatory mechanism might be associated with deaths occurring during the night. Rebreathing of expired gases, airway obstruction, long QT syndrome and other genetic conditions may explain a small number of sudden unexpected deaths in infancy. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 215,222, 2009 [source] Brainstem mechanisms underlying the sudden infant death syndrome: Evidence from human pathologic studiesDEVELOPMENTAL PSYCHOBIOLOGY, Issue 3 2009Hannah C. Kinney Abstract The brainstem hypothesis is one of the leading hypotheses concerning the sudden infant death syndrome (SIDS). It states that SIDS, or an important subset of SIDS, is due to abnormal brainstem mechanisms in the control of respiration, chemosensitivity, autonomic regulation, and/or arousal which impairs the infant's response to life-threatening, but often occurring, stressors during sleep (e.g., hypoxia, hypercarbia, asphyxia, hyperthermia) and leads to sudden death in a vulnerable developmental period. In this review, we summarize neuropathologic evidence from SIDS cases that support this hypothesis, beginning with the seminal report of subtle brainstem gliosis three decades ago. We focus upon recent neurochemical studies in our laboratory concerning the neurotransmitter serotonin (5-HT) and its key role in mediating protective responses to homeostatic stressors via medullary circuits. The possible fetal origin of brainstem defects in SIDS is reviewed, including evidence for adverse effects of prenatal exposure to maternal cigarette smoking and alcohol upon the postnatal development of human brainstem 5-HT pathways. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 223,233, 2009 [source] The sleep of co-sleeping infants when they are not co-sleeping: Evidence that co-sleeping is stressfulDEVELOPMENTAL PSYCHOBIOLOGY, Issue 1 2002Melissa Hunsley Abstract Co-sleeping proponents consider the practice to be "natural" and a potential protection against sudden infant death syndrome (SIDS); others consider the practice of an infant sleeping in the parents' bed for prolonged periods at night to place an infant at risk for harm or death. For this study, co-sleeping was investigated from a different perspective, that is, as a significant early experience to investigate as it may have implications for the infant's development. The sleep of 101 normal, full-term infants was recorded nonintrusively in the home for 24 hr periods when they were 5 weeks and 6 months old. Infants were assigned to three groups: short-term co-sleepers, long-term co-sleepers, and non-co-sleepers. Their sleep states and wakefulness were compared at the two ages and over age. At 5 weeks and 6 months, the long-term co-sleeping infants differed significantly from the non-co-sleepers on a number of measures: At 5 weeks, they showed more quiet sleep and longer bouts of quiet sleep; and at 6 months, they also showed less active sleep, fewer arousals in active sleep, and less wakefulness. Each of these differences indicates a markedly lower arousal level in the long-term co-sleeping infants. This sleep pattern has been repeatedly found to be an indicator of stress. We infer that a major source of stress for these infants is the experience of sleep disturbance documented for infants when they were co-sleeping. Based on extensive evidence for long-term effects of early stress, we conclude that co-sleeping should have significant implications for infants' neurobehavioral development. © 2002 John Wiley & Sons, Inc. Dev Psychobiol 40: 14,22, 2002 [source] Debriefing critical incidents in the paediatric emergency department: Current practice and perceived needs in Australia and New ZealandEMERGENCY MEDICINE AUSTRALASIA, Issue 6 2009Theane Theophilos Abstract Anecdotally critical incident debriefing (CID) is an important topic for staff in paediatric ED. The present study aimed to determine current baseline CID practices and perceived needs of ED staff. A questionnaire regarding CID practice was circulated to all 13 Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites in Australia and New Zealand (including all tertiary paediatric ED), and completed by 1 senior doctor and 1 senior nurse. All PREDICT sites participated (13 nurses, 13 doctors). Seventy per cent did not currently have a hospital protocol on debriefing and 90% did not have ED-specific guidelines. The most commonly debriefed topics were death of a patient, multi-trauma and sudden infant death syndrome, also ranked highest in importance for debriefing. The median reported debriefs per department were 4 per year (range 0,12), all conducted within a week of the CI with half within 24 h. ED workers most likely to be invited to the CID session were doctors, nurses and social workers (96%). Debriefing was mostly conducted internally (62%) and most likely facilitated by a doctor (81%) or nurse (54%). Debriefing addressed both clinical and emotional issues (89%) within the same session (69%). Debriefing was rated as very important, median of 8/10 by doctors and 10/10 by nurses. Almost 90% of those surveyed indicated that they would like a CID programme and guidelines for their department. Debriefing is perceived as important by senior ED clinicians, yet few ED have formalized guidelines or programmes. Best-practice guidelines should be developed. [source] Incidence and geographical distribution of sudden infant death syndrome in relation to content of nitrate in drinking water and groundwater levelsEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 12 2001M. George Background Previous studies indicate that the enteral bacterial urease is inhibited in victims of sudden infant death syndrome (SIDS). One possible inhibitor of this bacterial activity is nitrate. If ambient pollution by nitrate is involved in the etiology of SIDS only a fraction of the nitrate concentration not infrequently found in drinking water would be enough for this inhibition. Methods Occurrence of SIDS (n = 636) in Sweden during the period 1990 through 1996 were analysed regarding geographical and seasonal distribution in relation to the nitrate concentration in drinking water and changes in the groundwater level. Results Both the birth rate and the incidence of SIDS decreased during the study period. One quarter of the municipalities constituting 11% of the population had no cases, the maximum incidence being 6·5 per 1000 live births. Seasonality: The northernmost parts of the country had its highest incidence when the rest of the country had its lowest incidence, and the occurrence of individual deaths was associated with the recharge of groundwater which increases its nitrate content. The local incidence of SIDS was correlated (rs = 0·34,0·87) to maximally recorded concentrations of nitrate in drinking water. Conclusions The seasonal distribution of SIDS was widely different from the south to the north of the country and seems to be associated with differences in the groundwater level changes subsequent to precipitation, frost penetration, and melting of snow. Use of drinking water with high peak concentrations or great variations in nitrate concentration was correlated to the incidence of SIDS. [source] Increased sibling mortality in children with fetal alcohol syndromeADDICTION BIOLOGY, Issue 2 2004Larry Burd We compared the rate of all-cause mortality in siblings of children diagnosed with fetal alcohol syndrome (FAS) with the siblings of matched controls. The siblings of children with FAS had increased mortality (11.4%) compared with matched controls (2.0%), a 530% increase in mortality. The age of death in case siblings deaths occurred later (between 1 day and 7 years) compared with the controls (1 day to 4 years) [odds ratio (OR),=,2.4 (0.4,-,15.6)]. Siblings of children with FAS had increased risk of death due to infectious illness [OR,=,13.7 (1.2,-,361)] and sudden infant death syndrome compared with controls [OR,=,10.2 (1.2,-,75.1)]. A diagnosis of FAS is an important risk marker for mortality in the siblings of the proband even if they do not have FAS. Maternal alcoholism appears to be a useful risk marker for increased mortality risk in diagnosed cases and their siblings. This has important implications in the management of family members of children with FAS. [source] Cot mattresses as reservoirs of potentially harmful bacteria and the sudden infant death syndromeFEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY, Issue 1 2004Richard E. Sherburn Abstract Cot mattress materials were investigated as potential reservoirs of bacteria in relation to the sudden infant death syndrome (SIDS). The sleeping position of the infant significantly influenced bacterial population density of cot mattress polyurethane foams (p<0.0000001) and their covers (p<0.004). Staphylococcus aureus was isolated at significantly higher frequency (p<0.03) from the infant's head region of cot mattress materials. Significantly higher bacterial population densities (p<0.001) were associated with polyurethane foams from non-integral mattresses (exposed polyurethane foam), when compared to those from mattresses completely covered by polyvinyl chloride (integral type mattress). The frequency of isolation of S. aureus from polyurethane foams from non-integral mattresses was also significantly higher (p=0.03) than from foams from the integral type. The following factors were significantly associated with increased frequency of isolation of S. aureus: from the polyurethane foam, previous use of non-integral mattresses by another child (p=0.03 for all sample sites, p=0.01 for torso region); from the covers, sleeping in the prone position (p=0.003 head region, p=0.001 torso region). Prone sleeping was also significantly associated with increased bacterial population levels (p=0.01) and increased frequency of isolation of Escherichia coli (p=0.02) from the torso region of cot mattress covers. These findings could explain some recently identified risk factors for SIDS associated with type and previous use of cot mattresses. Clostridium perfringens was isolated at very low frequency and Streptococcus pyogenes was not isolated from any cot mattress materials tested. [source] Alteration in regulation of inflammatory response to influenza a virus and endotoxin in suckling rat pups: a potential relationship to sudden infant death syndromeFEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY, Issue 1 2004Jane Blood-Siegfried Abstract Data increasingly implicate a possible role of immune and inflammatory responses to infection in sudden infant death syndrome (SIDS). We have previously described a dual challenge model that results in pathology, organ damage, vascular collapse and unexplained death similar to that seen in SIDS. In this study, we examined changes in inflammatory cytokine mRNA in the lung and liver and regulation of pathways associated with nitric oxide production. Our data suggest that priming of the immune system by mild viral infection disturbs normal inflammatory response to endotoxin. This results in an increased nitric oxide synthase production, most likely the cause of liver pathology and clotting abnormalities. [source] Association between pacifier use and breast-feeding, sudden infant death syndrome, infection and dental malocclusionINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 6 2005Ann Callaghan RN RM BNurs(Hons) Executive summary Objective, To critically review all literature related to pacifier use for full-term healthy infants and young children. The specific review questions addressed are: What is the evidence of adverse and/or positive outcomes of pacifier use in infancy and childhood in relation to each of the following subtopics: ,breast-feeding; ,sudden infant death syndrome; ,infection; ,dental malocclusion. Inclusion criteria, Specific criteria were used to determine which studies would be included in the review: (i) the types of participants; (ii) the types of research design; and (iii) the types of outcome measures. To be included a study has to meet all criteria. Types of participants,The participants included in the review were healthy term infants and healthy children up to the age of 16 years. Studies that focused on preterm infants, and infants and young children with serious illness or congenital malformations were excluded. However, some total population studies did include these children. Types of research design, It became evident early in the review process that very few randomised controlled trials had been conducted. A decision was made to include observational epidemiological designs, specifically prospective cohort studies and, in the case of sudden infant death syndrome research, case,control studies. Purely descriptive and cross-sectional studies were excluded, as were qualitative studies and all other forms of evidence. A number of criteria have been proposed to establish causation in the scientific and medical literature. These key criteria were applied in the review process and are described as follows: (i) consistency and unbiasedness of findings; (ii) strength of association; (iii) temporal sequence; (iv) dose,response relationship; (v) specificity; (vi) coherence with biological background and previous knowledge; (vii) biological plausibility; and (viii) experimental evidence. Studies that did not meet the requirement of appropriate temporal sequencing of events and studies that did not present an estimate of the strength of association were not included in the final review. Types of outcome measures,Our specific interest was pacifier use related to: ,breast-feeding; ,sudden infant death syndrome; ,infection; ,dental malocclusion. Studies that examined pacifier use related to procedural pain relief were excluded. Studies that examined the relationship between pacifier use and gastro-oesophageal reflux were also excluded as this information has been recently presented as a systematic review. Search strategy, The review comprised published and unpublished research literature. The search was restricted to reports published in English, Spanish and German. The time period covered research published from January 1960 to October 2003. A protocol developed by New Zealand Health Technology Assessment was used to guide the search process. The search comprised bibliographic databases, citation searching, other evidence-based and guidelines sites, government documents, books and reports, professional websites, national associations, hand search, contacting national/international experts and general internet searching. Assessment of quality, All studies identified during the database search were assessed for relevance to the review based on the information provided in the title, abstract and descriptor/MeSH terms, and a full report was retrieved for all studies that met the inclusion criteria. Studies identified from reference list searches were assessed for relevance based on the study title. Keywords included: dummy, dummies, pacifier(s), soother(s), comforter(s), non-nutritive sucking, infant, child, infant care. Initially, studies were reviewed for inclusion by pairs of principal investigators. Authorship of articles was not concealed from the reviewers. Next, the methodological quality of included articles was assessed independently by groups of three or more principal investigators and clinicians using a checklist. All 20 studies that were accepted met minimum set criteria, but few passed without some methodological concern. Data extraction, To meet the requirements of the Joanna Briggs Institute, reasons for acceptance and non-acceptance at each phase were clearly documented. An assessment protocol and report form was developed for each of the three phases of review. The first form was created to record investigators' evaluations of studies included in the initial review. Those studies that failed to meet strict inclusion criteria were excluded at this point. A second form was designed to facilitate an in-depth critique of epidemiological study methodology. The checklist was pilot tested and adjustments were made before reviewers were trained in its use. When reviewers could not agree on an assessment, it was passed to additional reviewers and discussed until a consensus was reached. At this stage, studies other than cohort, case,control and randomised controlled trials were excluded. Issues of clarification were also addressed at this point. The final phase was that of integration. This phase, undertaken by the principal investigators, was assisted by the production of data extraction tables. Through a process of trial and error, a framework was formulated that adequately summarised the key elements of the studies. This information was tabulated under the following headings: authors/setting, design, exposure/outcome, confounders controlled, analysis and main findings. Results, With regard to the breast-feeding outcome, 10 studies met the inclusion criteria, comprising two randomised controlled trials and eight cohort studies. The research was conducted between 1995 and 2003 in a wide variety of settings involving research participants from diverse socioeconomic and cultural backgrounds. Information regarding exposure and outcome status, and potential confounding factors was obtained from: antenatal and postnatal records; interviews before discharge from obstetric/midwifery care; post-discharge interviews; and post-discharge postal and telephone surveys. Both the level of contact and the frequency of contact with the informant, the child's mother, differed widely. Pacifier use was defined and measured inconsistently, possibly because few studies were initiated expressly to investigate its relationship with breast-feeding. Completeness of follow-up was addressed, but missing data were not uniformly identified and explained. When comparisons were made between participants and non-participants there was some evidence of differential loss and a bias towards families in higher socioeconomic groups. Multivariate analysis was undertaken in the majority of studies, with some including a large number of sociodemographic, obstetric and infant covariates and others including just maternal age and education. As might be expected given the inconsistency of definition and measurement, the relationship between pacifier use and breast-feeding was expressed in many different ways and a meta-analysis was not appropriate. In summary, only one study did not report a negative association between pacifier use and breast-feeding duration or exclusivity. Results indicate an increase in risk for a reduced overall duration of breast-feeding from 20% to almost threefold. The data suggest that very infrequent use may not have any overall negative impact on breast-feeding outcomes. Six sudden infant death syndrome case,control studies met the criteria for inclusion. The research was conducted with information gathered between 1984 and 1999 in Norway, UK, New Zealand, the Netherlands and USA. Exposure information was obtained from a variety of sources including: hospital and antenatal records, death scene investigation, and interview and questionnaire. Information for cases was sought within 2 days after death, within 2,4 weeks after death and in one study between 3 and 11 years after death. Information for controls was sought from as early as 4 days of a nominated sudden infant death syndrome case, to between 1 and 7 weeks from the case date, and again in one study some 3,11 years later. In the majority of the studies case ascertainment was determined by post-mortem. Pacifier use was again defined and measured somewhat inconsistently. All studies controlled for confounding factors by matching and/or using multivariate analysis. Generally, antenatal and postnatal factors, as well as infant care practices, and maternal, family and socioeconomic issues were considered. All five studies reporting multivariate results found significantly fewer sudden infant death syndrome cases used a pacifier compared with controls. That is, pacifier use was associated with a reduced incidence of sudden infant death syndrome. These results indicate that the risk of sudden infant death syndrome for infants who did not use a pacifier in the last or reference sleep was at least twice, and possibly five times, that of infants who did use a pacifier. Three studies reported a moderately sized positive association between pacifier use and a variety of infections. Conversely, one study found no positive association between pacifier use at 15 months of age and a range of infections experienced between the ages of 6 and 18 months. Given the limited number of studies available and the variability of results, no meaningful conclusions could be drawn. Five cohort studies and one case,control study focused on the relationship between pacifier use and dental malocclusion. Not one of these studies reported a measure of association, such as an estimate of relative risk. It was therefore not possible to include these studies in the final review. Implications for practice, It is intended that this review be used as the basis of a ,best practice guideline', to make health professionals aware of the research evidence concerning these health and developmental consequences of pacifier use, because parents need clear information on which they can base child care decisions. With regard to the association between pacifier use and infection and dental malocclusion it was found that, due to the paucity of epidemiological studies, no meaningful conclusion can be drawn. There is clearly a need for more epidemiological research with regard to these two outcomes. The evidence for a relationship between pacifier use and sudden infant death syndrome is consistent, while the exact mechanism of the effect is not well understood. As to breast-feeding, research evidence shows that pacifier use in infancy is associated with a shorter duration and non-exclusivity. It is plausible that pacifier use causes babies to breast-feed less, but a causal relationship has not been irrefutably proven. Because breast-feeding confers an important advantage on all children and the incidence of sudden infant death syndrome is very low, it is recommended that health professionals generally advise parents against pacifier use, while taking into account individual circumstances. [source] Microvolt T Wave Alternans Inducibility in Normal Newborn Puppies: Effects of DevelopmentJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2002Ph.D., SALIM F. IDRISS M.D. T Wave Alternans in Normal Newborn Puppies.Introduction: The cause of sudden infant death syndrome is unknown, but increased cardiac vulnerability due to repolarization instability may be a contributing factor. The QT interval normally is long at birth and increases further during the first few postnatal months. Although excessive QT intervals indicate increased cardiac vulnerability in the long QT syndrome, the impact of less pronounced QT prolongation during this developmental period is unclear. In adults and older children, the ease of inducing microvolt-level T wave alternans (TWA) is used as a measure of repolarization instability and arrhythmia vulnerability. The aim of this study was to determine if TWA is inducible in normal newborn puppies. Methods and Results: Atrial pacing was performed in 15 anesthetized beagle puppies 7 to 35 days old. The pacing drive cycle length was systematically decreased in 20-msec steps from baseline until AV conduction blocked. Pacing was performed for 8 minutes at each cycle length. Three-lead ECGs were recorded continuously during the last 5 minutes of pacing at each cycle length. The recordings were analyzed off-line for the presence of microvolt-level TWA using a sensitive spectral analysis technique. Microvolt-level TWA was present in all puppies. TWA was not present at baseline but developed and increased in amplitude as heart rate increased. The threshold heart rate for TWA did not correlate with age. However, due to age-dependent changes in baseline heart rate, the 7- to 14-day-old animals needed a 50% to 78% increase in heart rate to reach threshold heart rate, whereas the oldest animals needed only a 5% to 25% increase. Conclusion: These data suggest that developmentally dependent dynamic repolarization instability exists in puppies as manifest by the inducibility of TWA. [source] Fetal Heart Rate Patterns and Sudden Infant Death SyndromeJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2006Cydney A. Menihan Objective:, To determine differences in electronic fetal monitoring patterns between infants who died of sudden infant death syndrome and controls. Design:, Case-control study (N= 127). Setting:, A tertiary-level women's hospital in Providence, Rhode Island. Participants:, Infants born between 1990 and 1998 who subsequently died of sudden infant death syndrome and controls. Demographic and clinical data included medical maternal charts and fetal monitoring records. Results:, Compared with controls (n= 98), the mothers whose infants subsequently died of sudden infant death syndrome (n= 29) had lower birthweight babies (sudden infant death syndrome 2,840 vs. controls 3,385 g; p < .01), were younger (22 vs. 28 years; p < .01), were more likely to receive Medicaid health insurance (odds ratio 4.6; confidence interval 1.9-11.2), were more likely to be unmarried (odds ratio 5.2; confidence interval 2.1-12.8), had less intention to breastfeed (26% vs. 57%), and were more likely to smoke (odds ratio 4.6; confidence interval 9-11.2). Main outcome measures:, There were no statistical differences in fetal heart rate variability or sleep/wake cycles detected between groups. Conclusion:, Statistical differences were found in demographic characteristics between sudden infant death syndrome mother-infant couples and their controls. However, no differences were detected in the intrapartum electronic fetal monitoring records, specifically in variability and sleep/wake cycles. JOGNN,35, 116,122; 2006. DOI: 10.1111/J.1552-6909.2006.00013.x [source] Smoking Cessation Counseling for Pregnant Women Who Smoke: Scientific Basis for Practice for AWHONN's SUCCESS ProjectJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2004FAAN, Susan A. Albrecht PhD Objectives: To review the literature addressing smoking cessation in pregnant women. To develop the project protocol for the Association of Women's Health, Obstetric and Neonatal Nurse's (AWHONN) 6th research-based practice project titled "Setting Universal Cessation Counseling, Education and Screening Standards (SUCCESS): Nursing Care of Pregnant Women Who Smoke." To evaluate the potential of systematic integration of this protocol in primary care settings in which women seek care at the preconception, pregnant, or postpartum stages. Literature Sources: Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included low-birth-weight infants and effects of prenatal smoking on the infant and the effects of preconception and prenatal smoking cessation intervention on premature labor and birth weight. Literature Selection: Comprehensive articles, reports, and guidelines relevant to key concepts and published after 1964 with an emphasis on new findings from 1996 through 2002. Ninety-eight citations were identified as useful to this review. Literature Synthesis: Tobacco use among pregnant women and children's exposure to tobacco use (secondhand smoke) are associated with pregnancy complications such as placental dysfunction (including previa or abruption), preterm labor, premature rupture of membranes, spontaneous abortions, and decreased birth weight and infant stature. Neonates and children who are exposed to secondhand smoke are at increased risk for developing otitis media, asthma, other respiratory disorders later in childhood; dying from sudden infant death syndrome; and learning disorders. The "5 A's" intervention and use of descriptive statements for smoking status assessment were synthesized into the SUCCESS project protocol for AWHONN's 6th research-based practice project. Conclusions: The literature review generated evidence that brief, office-based assessment, client-specific tobacco counseling, skill development, and support programs serve as an effective practice guideline for clinicians. Implementation and evaluation of the guideline is under way at a total of 13 sites in the United States and Canada. [source] Socio-cultural perceptions of sudden infant death syndrome among migrant Indian mothersJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 11 2009Henna Aslam Aim: To explore socio-cultural influences on migrant mother decisions and beliefs regarding co-sleeping as a risk factor for sudden infant death syndrome (SIDS). Methods: Semi-structured interviews with five Indian-born women in a socio-economically disadvantaged suburb in the south-west of Sydney were conducted between September and December 2007. Transcripts were analysed using principles of discourse analysis. Results: Discourse analysis revealed that SIDS-related decisions and beliefs about co-sleeping as a risk factor for SIDS are constructed amid competing discourses of motherhood and child health. Mothers are either actively or unconsciously deciding how they negotiate or resist dominant Western discourses of motherhood and child health to make ,the best' health-related decisions for their children. Participants resisted acknowledging child sleep practices recommended by health practitioners, particularly recommendations to put to sleep the baby in its own cot. This resistance was expressed by constructing messages as ,inapplicable' and ,inappropriate'. Co-sleeping was constructed as a highly valued practice for its physical and social benefits to the child, mother and family by facilitating child security, breastfeeding, bonding and family connectedness. Conclusion: This study illustrates how decisions and behaviour are shaped by socio-cultural influences embedded in discourses and context. It also shows that in-depth investigation through a social constructivist lens is particularly useful for investigating influences on knowledge acquisition, interpretation and implementation among migrant groups. A greater appreciation of the social meanings and ideologies attached to behaviours can help to ensure that the correct messages reach the correct populations, and that child health outcomes can be achieved and maintained both for overseas and Australian-born populations. [source] Infant care practices associated with sudden infant death syndrome: Findings from the Pacific Islands Families studyJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5 2007Philip J Schluter Aim: To report infant care practice prevalence for known modifiable sudden infant death syndrome (SIDS) risk factors among a generally disadvantaged yet low-SIDS rate population of mothers with Pacific infants. Methods: The Pacific Islands Families study follows a cohort of Pacific infants born at a large tertiary hospital in South Auckland, between 15 March and 17 December 2000. Maternal self-report of infant care practices was undertaken at interview 6 weeks post-partum. Results: Overall, 1376 mothers self-reported upon their care practices for infants with median age of 7 weeks. Current maternal smoking was reported by 29%. Of infants: 50% were fully breastfed; 1% were placed prone to sleep; 50% usually bed-shared with their mother and 12% usually bed-shared with a mother who smoked; and 94% usually and 1% occasionally slept in the same room as their mother. Except for room sharing (P = 0.09), there were significant differences in these practices between the three major Pacific Island ethnic subgroups (all P < 0.001). Conclusion: Adoption of bed-sharing and room-sharing practices appears to be saving Pacific infants' lives, even though the New Zealand Cot Death Association has discouraged bed-sharing and not actively promoted room sharing. Mothers need to receive adequate information antenatally about the risks and benefits of room-sharing, bed-sharing and safe-sleeping practices and environments should they decide or have no option but to bed-share. [source] Interpretation of recent sudden infant death syndrome rates in Western AustraliaJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 12 2005CJ Freemantle Abstract:, The diagnosis of sudden infant death syndrome (SIDS) has undergone several changes in definition since first being recognised as a cause of death. Linked total population data from Western Australia enable investigations to determine changes in classifications of mortality for the infants of Aboriginal and non-Aboriginal mothers (Aboriginal and Torres Strait Islander people are referred to throughout this report as ,Aboriginal'). Data for recent years show a shift away from a classification of ,SIDS' towards a classification of ,unascertainable', particularly for Aboriginal infants. This has implications for the accurate translation of data into policy and practice. [source] Research and sudden infant death syndrome: Definitions, diagnostic difficulties and discrepanciesJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 8 2004RW Byard Abstract: The diagnosis of causes of sudden infant death is an often complex and difficult process. Variable standards of autopsy practice and the use of different definitions for entities such as sudden infant death syndrome (SIDS) have also contributed to confusion and discrepancies. For example, the term SIDS has been used when the requirements of standard definitions have not been fulfilled. In an attempt to correct this situation recent initiatives have been undertaken to stratify cases of unexpected infant death and to institute protocols that provide frameworks for investigations. However, if research is to be meaningful, researchers must be scrupulous in assessing how extensively cases have been investigated and how closely cases fit with internationally recognized definitions and standards. Unless this approach is adopted, evaluation of research findings in SIDS will be difficult and the literature will continue to be beset by contradictions and unsubstantiated conclusions. [source] | |||||||||||||||||||||||||||||||