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Prematurity and Sudden Infant Death

Prematurity and Sudden Infant Death. It’s A Bigger Problem Than You Think Betty Connal, RN, MS SIDS Mid-Atlantic bconnal@aol.com. March of Dimes Prematurity Campaign 2003-2010. 5 Campaign Aims: 1. Raise public awareness 2. Educate women as to signs of premature labor

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Prematurity and Sudden Infant Death

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  1. Prematurity and Sudden Infant Death It’s A Bigger Problem Than You Think Betty Connal, RN, MS SIDS Mid-Atlantic bconnal@aol.com

  2. March of Dimes Prematurity Campaign 2003-2010 5 Campaign Aims: 1. Raise public awareness 2. Educate women as to signs of premature labor 3. Assist practitioners 4. Invest to identify causes and promising interventions 5. Seek guaranteed access to health care

  3. Preterm Birth/Prematurity • Single most important cause of perinatal (28 weeks gestation through 6 days of life) mortality in U.S. (about 75% of these losses) • Leading cause of neonatal mortality (0-27 days) in U.S. • Second leading cause of infant mortality in U.S. • Leading cause of black infant mortality in U.S. • Major determinant of neonatal and infant illness: • Neurodevelopmental handicaps (CP, mental retardation) • Chronic respiratory problems • Intraventricular hemorrhage • Periventricular Leukomalacia • Infection • Retrolental fibroplasia • Necrotizing enterocolitis • Neurosensory deficits (hearing, visual)

  4. Prematurity Generates Enormous Health Care Costs • Average newborn hospital charges: $4,300 vs. $58,000 for a preterm baby* • Total U.S. hospital charges for infant stays due to prematurity/low birth weight: $11.9 Billion* • Maternity & related expenses: • Often the largest cost to employers’ health care plans * Source: Agency for Healthcare Research and Quality, 2000 Nationwide Inpatient Sample Prepared by March of Dimes Perinatal Data Center, 2003

  5. Selected Leading Causes of Infant Mortality United States, 1990and 2000 2000 Rank Rate per 100,000 live births 1 2 3 6 Source: National Center for Health Statistics, 1990 final mortality data and 2000 linked birth/infant death data Prepared by March of Dimes Perinatal Data Center, 2002

  6. Preterm Delivery (<37 wks) Virginia and US, 1990-2000

  7. Risk Factors for Preterm Labor/Delivery • The best predictor of having a preterm birth is a history of preterm labor/delivery or prior low birthweight • Other risk factors: • low pre-pregnant weight • obesity • infections • bleeding • anemia • major stress • lack of social supports • tobacco use • illicit drug use • alcohol abuse • folic acid deficiency • multifetal pregnancy • maternal age (<17 and >35 years) • black race • low SES • unmarried • previous fetal or neonatal death • 3+ spontaneous terminations • uterine abnormalities • incompetent cervix • genetic predisposition

  8. Prematurity in Virginia12,572 preemies in 2004, 12.1% of all live birthsincreased by 5% since 19949038 were late preterm—between 34 and 37 weeks gestationincreased 10% since 2004

  9. Multiple Birth Ratios Virginia and US, 1996-2000

  10. Multiple Birth Ratios Map by Counties inVirginia, 1996-2000

  11. March of Dimes www.marchofdimes.com 1-888-MODIMES 703-824-0111

  12. WHICH INFANTS ARE AT GREATEST RISK for SIDS? • The lower the gestational age the higher the risk of SIDS • The lower the birthweight the higher the risk of SIDS • A combination of these increases the risk by more than each factor alone

  13. Sudden Infant Deaths • 4500 annually in United States • Half SIDS, half sudden unexpected infant death • 90 SIDS in Virginia in 2005 • 13 undetermined sudden infant deaths • 23 accidental sudden infant deaths • 777 total infant deaths in Virginia 2005

  14. INCREASING THE ODDS • A preterm infant <37 weeks sleeping prone is 85 times more likely to die of SIDS • A preterm infant sidelying is 40 times more likely to die of SIDS

  15. WHEN DOES SIDS OCCUR? • SIDS can occur between 21 days and 9 months of age • Peak incidence between 2 and 4 months. • More SIDS deaths occur in fall & winter months. • The risk is higher and the incidence could potentially extend beyond year for premature infants.

  16. Current Research • Abnormalities in serotonin system • Medulla oblongata • Regulation of heart rate, respiration, blood pressure and temperature • Babies have abnormal response to hypoxia • Smoking compounds the problem

  17. New Guidelines from AAP • Back to sleep: Infants should be placed for sleep in a supine (wholly on back position) for every sleep. • Use a firm sleep surface: A firm crib mattress, covered by a sheet, is the recommended sleeping surface.  • Keep soft objects and loose bedding out of the crib: Pillows, quilts, comforters, sheepskins, stuffed toys and other soft objects should be kept out of an infant's sleeping environment. 

  18. New Guidelines • Do not smoke during pregnancy: Also avoiding an infant's exposure to second-hand smoke is advisable for numerous reasons in addition to SIDS risk. • A separate but proximate sleeping environment is recommended such as a separate crib in the parent's bedroom.  Bed sharing during sleep is not recommended.  • Consider offering a pacifier at nap time and bedtime: The pacifier should be used when placing infant down for sleep and not be reinserted once the infant falls asleep.   • Avoid overheating: The infant should be lightly clothed for sleep, and the bedroom temperature should be kept comfortable for a lightly clothed adult. 

  19. New Guidelines • Avoid commercial devices marketed to reduce the risk of SIDS: Although various devices have been developed to maintain sleep position or reduce the risk of rebreathing, none have been tested sufficiently to show efficacy or safety.  • Do not use home monitors as a strategy to reduce the risk of SIDS: There is no evidence that use of such home monitors decreases the risk of SIDS. • Avoid development of positional plagiocephaly (flat back of head): Encourage "tummy time."  • Avoid having the infant spend excessive time in car-seat carriers and "bouncers.“ • Place the infant to sleep with the head to one side for a week and then changing to the other.  • Assure that others caring for the infant (child care provider, relative, friend, babysitter) are aware of these recommendations.

  20. Bedsharing: Not a safe practice

  21. Please tell parents • No Positioning devices • Memory foam body conforms to shape of baby • Can Cause suffocation

  22. Swaddling or SleepSacks much better than positioners for any baby

  23. Twins • Recommendation is for twins and multiples to each sleep in his own crib • Cribs for Kids Program

  24. SUDDEN INFANT DEATH • Betty Connal, RN, MS • Executive Director • SIDS Mid-Atlantic • 2700 S. Quincy St Suite 220 • Arlington VA 22206 • 703-933-9100 • Sidsma27@aol.com • www.sidsma.org

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