SIDS state conference 1998

Connecticut Nursing News, Jun-Aug 1998 by Wyzatecki, Deborah A

Incidence of SIDS in 1960 was 9,000 and in 1996 2,906, 3 years after Back to Sleep Program started.

The second Connecticut SIDS Conference was held April 2, 1998 at the Hartford Medical Society and sponsored by the SIDS Center. Guest speaker was Dr. Marie Valdes-Dapena, who presented an update on SIDS research. The atmosphere was an informal one; presentation was an overall view of SIDS research past and present that compared what we know for fact and what is still being researched. The second half of the presentation was to be on the grief process and the importance of first responders to the families touched by SIDS. The group present was mostly Home Care Nurses so the group decided to dispense with the set topics and use the time for discussion of our specific knowledge needs and share our techniques for dealing with families. Representation by the March of Dimes, SIDS Center and Home Care-proprietary, VNAs and OB hospital staff nurses brought out many questions and extremely helpful discussion on working with families touched by SIDS. The more we spoke the more we realized our strengths come from sharing with each other.

Having done work with the SIDS Network, I was very interested in the research presented. Here is an overview of the facts presented by Dr. ValdesDapena.

SIDS is the leading cause of death in infants one month to one year. This is still true, even though the statistics have declined since the start of the BACK TO SLEEP program that was started in 1992. #2 is congenital anomalies, #3 is infection, #4 is injuries, #5 is homicide. These statistics bear out statewide and nationally.

The diagnosis of SIDS includes: 1) a thorough infant autopsy; 2) a thorough investigation of the scene of the event; 3) a thorough health history; 4) no discernible cause of death and lack of pathology.

Cases that mimic SIDS are asphyxiation, occult trauma, sepsis, myocarditis, congenital heart defects, hyperthermia, seizure disorders and botulism (found in Southern California).

The incidences of SIDS in the 1960's was 8-9,000 per year. In 1993, the first year after the BACK TO SLEEP program started, rates declined to 4,930; in 1994-4,073; in 1995-3,397; in 1996-2,906. This is thought to reflect the impact of infants placed on their back as primary sleep position, along with bedding that is tight fitting to prevent rebreathing.

Usually, SIDS occurs from October through April, with males being 62.3% of SIDS deaths and females 37.7%. Native Americans and Blacks are most affected, with whites and Hispanics being least affected. Chicago is the city with the highest rate of SIDS.

Intrauterine growth retardation and prematurity are risk factors for SIDS. Maternal factors include: not finishing high school, single status, high parity for low maternal age, poor or no prenatal care, cigarette smoking during pregnancy, poor weight gain, low socioeconomic status and short inter-pregnancy interval.

Cigarette smoking in the household is the single most important factor for high risk of SIDS.

Neonatal risk factors are higher high heart rates, lower low heart rates and prolonged newborn and neonatal nursery stays. This suggests that these infants have some problem in the newborn period that caused them to be more closely monitored.

At risk groups are: Native Americans, NICU babies, teen moms, Maternal smoking during pregnancy and inhaling passive smoke, opiate addiction and (despite recent media discussion) sibling with history of SIDS, although the risk factor is small.

The current research shows that maternal cigarette smoking pre-disposes these infants to fail to awaken from hypoxia. Smoking than 10 per day increases the risk three times. Breast feeding is considered a great benefit to decrease this risk of SIDS, however smoking cancels out that benefit. Smoking in the presence of anemia increases the risk by threefold.

Physical findings on autopsy include: magalencephaly (increased weight of the brain) delayed myelination, delayed dendrite development and brain stem astrogliosis, which is found in the areas crucial to respiratory control.

In summation, Dr. Valdes-Dapena theorizes that SIDS is a Biphasic mechanism, that is an event in fetal life, such as maternal anemia, viruses, smoking, decreased oxygenation, poor nutrition and drug abuse, combined with a post natal physiologic trigger to set the stage for SIDS. What is most striking is that with all the research and knowledge in this field, we come up with more questions than answers for parents and ourselves.

Our role as educators of the childbearing population is to present all the risk factors to women of childbearing age and to support them in making correct health care decisions for themselves and their children.

The SIDS Network has recently started an outreach project to disseminate SIDS information to women of childbearing age before delivery, when health care choices can have a profound effect on fetal outcome. If you would like more information, the SIDS Network web site is at:

http:\\sids-network.org