SIDS: New insight into cot deaths points to lack of oxygen

Research at the University of Adelaide has shed new light onto the possible causes of sudden infant death syndrome (SIDS), which could help to prevent future loss of children's lives.

In a world-first study, researchers in the University's School of Medical Sciences have found that telltale signs in the brains of babies that have died of SIDS are remarkably similar to those of children who died of accidental asphyxiation.

"This is a very important result. It helps to show that asphyxia rather than infection or trauma is more likely to be involved in SIDS deaths," says the leader of the project, Professor Roger Byard AO, Marks Professor of Pathology at the University of Adelaide and Senior Specialist Forensic Pathologist with Forensic Science SA.

The study compared 176 children who died from head trauma, infection, drowning, asphyxia and SIDS.

Researchers were looking at the presence and distribution of a protein called â-amyloid precursor protein (APP) in the brain.

This "APP staining", as it's known, could be an important tool for showing how children have died. This is the first time a detailed study of APP has been undertaken in SIDS cases.

"All 48 of the SIDS deaths we looked at showed APP staining in the brain," Professor Byard says.

"The staining by itself does not necessarily tell us the cause of death, but it can help to clarify the mechanism.

"The really interesting point is that the pattern of APP staining in SIDS cases - both the amount and distribution of the staining - was very similar to those in children who had died from asphyxia."

Professor Byard says that in one case, the presence of APP staining in a baby who had died of SIDS led to the identification of a significant sleep breathing problem, or apnoea, in the deceased baby's sibling.

"This raised the possibility of an inherited sleep apnoea problem, and this knowledge could be enough to help save a child's life," Professor Byard says.

"Because of the remarkable similarity in SIDS and asphyxia cases, the question is now: is there an asphyxia-based mechanism of death in SIDS? We don't know the answer to that yet, but it looks very promising."

This study was conducted at the University of Adelaide by visiting postdoctoral researcher Dr Lisbeth Jensen from Aarhus University Hospital, Denmark, and was funded by SIDS and Kids South Australia.

The results have been published in the journal Neuropathology and Applied Neurobiology.

"This work also fits in very well with collaborative research that is currently being undertaken between the University of Adelaide and Harvard University, on chemical changes in parts of the brain that control breathing," Professor Byard says.

'Back to sleep' does not affect baby's ability to roll

Baby, keep on rolling. A campaign to put babies to bed on their backs to reduce the risk of sudden infant death syndrome (SIDS) has not impaired infants' rolling abilities, according to University of Alberta research.

Johanna Darrah

Johanna Darrah, a professor of physical therapy in the Faculty of Rehabilitation Medicine, says infants develop the ability to roll much the same today as they did 20 years ago when the "back to sleep" campaign was introduced and successfully reduced the occurrence of SIDS.

Her research answers fears that the back to sleep campaign, which recommends putting babies to bed on their back instead of their stomach, would hurt an infant's gross motor development, specifically the ability to roll from tummy to back and vice versa.

"Infant gross motor development hasn't changed that much in 20 years," says Darrah.

"The thought that babies first roll from their tummy to their back, before they go from their back to their tummy, does not appear to be the case. For most babies, they happen very close together."

Darrah first studied infant motor development in the early 1990s as a graduate student of former dean Martha Cook Piper when the pair published the Alberta Infant Motor Scale, an observational assessment scale used throughout the world to measure infant motor skill development from birth to walking.

More than 20 years later, Darrah revisited the work, studying the rolling abilities and motor skills development of 725 Canadian infants ranging in age from one week to eight months.

One of her goals was to see whether the norms identified and developed 20 years ago still represent the age of emergence of gross motor skills.

Darah notes there is some concern in the physical therapy community that babies develop movement skills like rolling from tummy to back at later ages because of reduced time spent on their stomachs.

Those concerns appear to be unfounded, she says, explaining that her results are particularly valuable for health-care practitioners specializing in early childhood development.

"Our results would suggest that gross motor skills emerge in the same order and at the same ages as 20 years ago. The environment is of course important to gross motor development, but the change in a sleeping position hasn't made much difference as to when babies roll from stomach to back."

Secondhand Smoke + Bed Sharing RaiseSudden Infant Death (SID) Risk

US Health officials claimed to have helped halve cases of Sudden Infant Death Syndrome (SIDS) with a campaign that warned parents to keep their babies from sleeping face down.

The SIDS rate didn't decline further, however, indicating that other causes exist, and a new study points to secondhand smoke and bed sharing as significant risk factors.

SIDS causes more than 2,000 deaths each year in the U.S. and is the leading cause of death in children between one month and one year, according to the Centers for Disease Control and Prevention.

Remembering that the cause of SIDS is still unknown, a strong correlation has been found between putting a baby to sleep on its stomach and SIDS.

The US National Institute of Child Health and Human Development started the "Back to Sleep" campaign in 1994 to warn parents of the dangers of putting babies to sleep on their stomachs, which helped reduce the rate of SIDS by more than 50 percent since 1988, according to the US federal agency.

The campaign also led to identification of other SIDS risk factors, according to the study. Researchers found that babies who slept in a bed with other people are twice as likely to die from SIDS. The younger the child is, the higher the risk.

"Bed-sharing leads to a 17 or 18 times increase in risk if the baby is less than two or three months old," Rachel Moon, a pediatrician and SIDS researcher at Children's National Medical Center who was not involved with the study, reported.

If the baby is exposed to smoke as well, the risk increases even further.

Other risk factors for SIDS include soft bedding or toys in the crib, sleeping on an adult mattress or couch, sleeping with a blanket or with the head covered. Three out of four SIDS cases had at least one risk factor and 57 percent had at least two, according to the study.

"Most babies had two or more risk factors," Henry Krous, lead author and paediatric pathologist at the San Diego SIDS Research Project, reported. "What that says to us is that 'Back to Sleep' should emphasize multiple risk factors."

Secondhand Smoke, Bed Sharing Raises Sudden Infant Death Risk

Warning that UK NHS Privatisation increases Risk of Cot deaths (SID)

Scottish Sudden Infant death charity for information and support on SIDS.

The number of babies dying from cot death will increase as austerity cuts force vulnerable families into unsuitable living conditions, the head of a Sudden Infant Death (SIDs) charity has warned.

The UK Government's healthcare privatisation will also put babies' lives at risk and vital services will be lost as the NHS is forced to restructure and make cost efficiency savings, according to Francine Bates, chief executive of the Foundation for the Study of Infant Deaths (FSID).

She also described the cynical axing of a UK Department of Health leaflet, "Reduce the Risk of Cot death" that was previously sent to every new parent as "very disappointing". The leaflet set out the risks to babies and advised parents on how to minimise the dangers of cot deaths.

Ms Bates said: "If the socio-economic conditions worsen for these vulnerable families then more babies will be at risk. London's Metropolitan Police working in this area [sudden infant death] are saying that the housing conditions some people are living in with their very small babies is atrocious."

The "Back to Sleep" campaign launched in 1991 urged parents to put their babies to sleep on their backs, overturning previous advice from childcare experts. Within five years of the launch of the campaign, unexplained sudden infant deaths had dropped by 70 per cent.

Smoking is now the biggest risk for cot death so Ms Bates has organised the first seminar for researchers and smoking-cessation experts who will meet on Thursday, chaired by Anne Milton, the UK Public Health minister.

Ms Bates said: "Smoking has a massive impact on the health of an unborn baby. If all smokers stopped immediately it would reduce the number of cot deaths by up to 50 per cent."

SIDS: 50% Infant Deaths occur during Co-Sleeping

An Adelaide pathologist calls on mothers to let their babies sleep in their cribs and avoid couches as well as other soft surfaces.

In an editorial published in the Medical Journal of Australia (MJA), University of Adelaide forensic pathologist Professor Roger Byard said research confirmed adults sleeping beside a baby could increase risk of infant suffocation.

When infants die in their sleep, pathologists look into the possibility of sudden infant death syndrome (SIDS) along with suffocation.

Prof Byard said half of all infants found unexpectedly dead were sleeping beside an adult at the time, which means the babies may have died from suffocation and not sudden infant death syndrome (SIDS).

"Accidental suffocation appears to be a more likely mechanism of death than subtle processes leading to SIDS," the professor said.

While many parents believe that sleeping next to their baby is related to establishing a more solid bond between them, Prof Byard said the risks far outweighed any of the perceived gains.

Prof Byard also raised the issue on letting babies sleep on couches and other soft surfaces, as these are also high risk factors for shared-sleeping death.

He explained that adults do not necessarily have to be lying over an infant completely for respiration to be compromised. He said surfaces and the immediate surroundings of a sleeping baby should be free from anything or anyone that could reduce oxygen flow for the baby.

Parental obesity and fatigue are also among the risk factors, he said.

"Some infants are particularly vulnerable to the effects of compromised breathing and there is often no clinical predictor of this vulnerability," Prof Byard wrote in his column.

Fixing the Problem
Apart from being dangerous to the young child, co-sleeping has a serious affect on the adults' lifestyle, their own sleep and their relationship with their partner, if present.

Co-sleeping can be used as a barrier between partners at a particularly difficult time in their relationship. The child is introduced into the bed to avoid addressing the real problem.

Do Not Despair
If you have gone down the route of co-sleeping and now find it is not working for you or is seriously affecting your relationship with your partner, do not despair, it is possible to teach your child to sleep on their own in their own bed.

Contact the Sleep Consultants at Dream Angus and they will be able to help you through the difficult transition of undoing your co-sleeping decision. And they will do this in a sensitive and thoughtful way so as to improve the family dynamics and partner relationships.

Email your questions and contact details to: info@dream-angus.com