Prematurity and Sudden Infant Death

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Prematurity and Sudden Infant Death

• Its A Bigger Problem Than You Think
• Betty Connal, RN, MS
• SIDS Mid-Atlantic
• bconnal_at_aol.com

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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

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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)

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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
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Selected Leading Causes of Infant Mortality
United States, 1990 and 2000
2000 Rank
Rate per 100,000 live births
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2
3
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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
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Preterm Delivery (lt37 wks) Virginia and US,
1990-2000
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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 (lt17 and gt35 years)
• black race
• low SES
• unmarried
• previous fetal or neonatal death
• 3 spontaneous terminations
• uterine abnormalities
• incompetent cervix
• genetic predisposition

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Prematurity in Virginia12,572 preemies in 2004,
12.1 of all live birthsincreased by 5 since
19949038 were late pretermbetween 34 and 37
weeks gestationincreased 10 since 2004
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Multiple Birth Ratios Virginia and US, 1996-2000
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Multiple Birth Ratios Map by Counties in
Virginia, 1996-2000
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March of Dimes

www.marchofdimes.com 1-888-MODIMES 703-824-0111
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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

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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

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INCREASING THE ODDS

• A preterm infant lt37 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

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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.

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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

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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. 

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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. 
•  

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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.

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Bedsharing Not a safe practice
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Please tell parents

• No Positioning devices
• Memory foam body conforms to shape of baby
• Can Cause suffocation

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Swaddling or SleepSacks much better than
positioners for any baby
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Twins

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

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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_at_aol.com
• www.sidsma.org