SIDS Rate Dips, but Prevention Efforts Continue

As seen in Advance for Respiratory Care Practitioners
Published Febraury 26, 2009
By Mike Bederka

Any unexpected death causes chaos and pain.

"It's bad when adults die from myocardial infarction or motor vehicle crashes," said Robert Beckerman, MD, FAAP, FCCP, medical director of the sleep disorders center at Children's Mercy Hospitals and Clinics in Kansas City, Mo.

However, a child slipping away in the night from sudden infant death syndrome (SIDS) thrusts the sorrow to new levels.

"This is the worst," said Beckerman, who has spent much of his career investigating SIDS cases. "The grief is overwhelming. If it isn't, the parents are numb with paralysis."

Fortunately, through awareness campaigns and research, the U.S. SIDS rate has plummeted. Yet each year, about 2,500 tiny children still die across the country from the mysterious condition, according to the American SIDS Institute.

Causes and Risks

The Centers for Disease Control and Prevention (CDC) defines SIDS as the sudden death of an infant younger than 1 year old that cannot be explained after a thorough investigation, including a complete autopsy, examination of the death scene and review of the clinical history. It is the third leading cause of infant mortality.

Theories abound about the exact trigger "but nobody has the answer," said Patti DeJuilio, BS, RRT-NPS, a 25-year neonatal intensive care unit vet and clinical practice specialist in the respiratory care department at Central DuPage Hospital, Winfield, Ill.

Leading researchers speculate SIDS may be caused by the combination of a biological vulnerability, like a heart or brain defect, and an environmental stressor-notably babies sleeping on their stomachs.

Infants who sleep prone have a significantly greater risk of SIDS. As a result, a host of organizations, including the National Institute of Child Health and Human Development and the American Academy of Pediatrics (AAP), embarked on a major public awareness effort in 1994, dubbed "Back to Sleep."

From the release of the first AAP recommendations in 1992 through 2003, the number of U.S. SIDS cases dropped from 1.3 per 1,000 live births to .52, according to the CDC. The number of children sleeping supine jumped from 13 percent to 72.8 percent during that same time period.

In addition to prone sleeping, babies at risk for SIDS are those:

• born pre-term (they have five to 10 times the chance of SIDS versus full-term babies)
• who previously experienced a life-threatening episode that required vigorous intervention, like CPR
• whose mothers smoked during pregnancy
• exposed to nicotine in their nurseries.

"Nicotine will delay the body's normal respiratory response to low oxygen levels," Beckerman elaborated. An infant who experiences hypoxic stress caused by airway occlusion won't wake up, take deep breaths and resuscitate himself. Instead, there will be a delayed or dulled response to the hypoxia.
"If you're not gasping because you're not sensing the low oxygen, then you really can't do anything to help yourself," he said.
Additional SIDS risk factors include: co-sleeping with a parent; baby sleeping on a couch, pillow or other soft surface; mother drinking alcohol during pregnancy; parents over-dressing the child; and a family history of SIDS.

The RT's Role

Despite all the known risk factors for SIDS, no effective screening tool exists, Beckerman said. That includes use of full polysomnography and the much-talked-about home apnea monitors and alarms.

"There is no evidence that the presence of apnea and/or bradycardia identifies a group at increased risk of SIDS, that home cardiorespiratory monitoring can provide warning in time for intervention to prevent sudden death, or that intervention would be successful in preventing unexpected death," reads a policy statement from the AAP.1Beckerman cites the inability of monitors to detect obstructive apneas (they may just sound for central) and the high number of false alarms as two major strikes against their use.

"The increased anxiety for the parents is tremendous," DeJuilio added.

With equipment being of little help to circumvent SIDS, respiratory therapists can play a larger role in prevention, she said.

RTs at her facility focus in particular on parents of babies in the NICU, DeJuilio noted. These infants are at increased risk for SIDS and they stay in the hospital longer than healthy kids.
Therefore, staff members have a greater opportunity to do some teaching and reinforce by example, she said.

While adjusting the vent or drawing a blood gas, therapists can describe behaviors that increase the likelihood of SIDS, like prone sleeping and smoking around the crib, agreed Anatoly Belilovsky, MD, medical director of Belilovsky Pediatrics in New York.

"It's the perfect place for them to be educated," he said. "You have a captive audience."

Reference

1. Committee on Fetus and Newborn. American Academy of Pediatrics. Apnea, sudden infant death syndrome, and home monitoring. Pediatrics. (2003; 111: 914-7).

Mom Helps Other SIDS Parents

Kristen Marr's son, Colton, died from SIDS at 8 weeks old. Instead of "just letting everything go," she sought to continue his memory.

"The hardest thing as a parent is not having an answer," said Marr, of Little Rock, Ark. "I wanted an answer. I wanted to know why."

Following Colton's death in 1999, she spearheaded small private fundraisers, with proceeds going toward SIDS research.

Her efforts soon expanded. Marr became a board member of the American SIDS Institute and a source of hope and guidance for families impacted by SIDS.

"I found that it was my forte to help other parents," said the 44-year-old mother of two healthy children.

With the American SIDS Institute, she helped create Spring for SIDS (www.springforsids.org), a national event dedicated to SIDS research and prevention. Last year, they collected more than $115,000; the next fundraiser will be April 24.

Colton's memory also lives on with a personal touch. After his birth, Marr and her husband cast his feet on a slide piece for a bracelet. When he died, the jewelry took on a special meaning.
People often praised the unique piece, so in 2002 with some urging from a friend, she started her own jewelry line in his honor. Marr donates a portion of the profits from BabyFeet (www.babyfeetjewelry.com) to the American SIDS Institute.

"It's not really a memorial piece," she explained. "It's a celebration of the lives of all children."