The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk

Abstract

ABSTRACT. There has been a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed down for sleep in a nonprone position. Although the SIDS rate continues to fall, some of the recent decrease of the last several years may be a result of coding shifts to other causes of unexpected infant deaths. Since the AAP published its last statement on SIDS in 2000, several issues have become relevant, including the significant risk of side sleeping position; the AAP no longer recognizes side sleeping as a reasonable alternative to fully supine sleeping. The AAP also stresses the need to avoid redundant soft bedding and soft objects in the infant's sleeping environment, the hazards of adults sleeping with an infant in the same bed, the SIDS risk reduction associated with having infants sleep in the same room as adults and with using pacifiers at the time of sleep, the importance of educating secondary caregivers and neonatology practitioners on the importance of "back to sleep," and strategies to reduce the incidence of positional plagiocephaly associated with supine positioning. This statement reviews the evidence associated with these and other SIDSrelated issues and proposes new recommendations for further reducing SIDS risk. Pediatrics 2005;116:1245-1255; SIDS, sudden infant death syndrome, sudden unexpected infant death, infant mortality, supine position, infant sleep, infant bedding.

Is the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) effective for preterm infants with intrauterine growth restriction?

“…Although MRI studies have shown substantial differences between the brain structures of IUGR and AGA preterm infants who have reached term, 32–34 this methodology was not available for this study. The impact of care practice changes, including enforcement of ‘back to sleep’ recommendations, 35 increasing life stresses on young families (such as dual parent long work hours), and lack of affordable child care, warrant further investigations of their impact on IUGR preterm development. Replication with a larger sample, addition of brain structural measures, and follow-up to later ages is required for result validation and generalizability.…”

Effects of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) at Age 8 Years: Preliminary Data

“…As younger infants survive, ever more vulnerable infants must experience the NICU. Furthermore, changes in care practice that were not yet an issue at the time of this study such as enforcement of “back to sleep” recommendations for sudden infant death syndrome, 101 and the increasing life stresses of modern young families warrant further investigation and follow-up.…”

Role of chemoreceptors in mediating dyspnea

“…Certain consistent risk factors have been identified including maternal smoking, prone sleeping position, sleeping on soft surfaces, low birth weight and male sex (Task Force on Sudden Infant Death Syndrome, 2005). SIDS victims have been found to have abnormalities in the brainstem 5-HT system (Panigraphy et al, 2000) including an increase in the number of 5-HT neurons in the medulla.…”