FEATURE PAEDIATRICS
and infants worldwide continue to die from this medical phenomenon.
BACKGROUND Scientific theories continue to be explored in an attempt to explain and identify the causes of SIDS. Recent publications suggest that infants who die from SIDS are often found to have serotonin abnormalities. This irregularity may result in atypical alertness and poor breathing stimulation during sleep and may be linked to an increased risk of SIDS. Genetic trends have also been identified, revealing that boys are statistically at a greater risk of SIDS, than girls. Even though the direct cause of SIDS remains unclear, what is evident is the prevalence of SIDS peaks at 2-3 months of age. Research by Kinney and Thach (2009) and Jaafar et al. (2011) continue to highlight that SIDS may be attributed to multiple intrinsic and extrinsic factors and that a single cause cannot currently be identified. What we do know is that genetic, developmental and environmental factors have a role to play in SIDS. What is evident is that the overall
worldwide trend of SIDS is declining however it still accounts for a proportion of infant deaths in industrialized countries. Developed countries such as the United Kingdom have observed a reduction in SIDS from 1.77 per 1000 live births (1234 deaths) in 1990 to a low of 0.39 per 1000 live births (312 deaths) in 2008. These international reductions in SIDS have largely been attributed to public awareness campaigns and research continues to advocate the importance of public ‘Back To Sleep’ and ‘Reduce The Risk’ educational programmes as being instrumental in reducing the incidence of SIDS.
CONTRIBUTING AND PROTECTIVE FACTORS Due to the pure definition of SIDS, the exact prevalence of SIDS within the UAE is still unclear, as autopsies are not performed. Research from Turkey suggests a similar situation, with the true occurrence of SIDS unknown. However, what is evident is that education of both parents and healthcare professionals is key in reducing the risk of SIDS.
PARENTAL AND PROFESSIONAL EDUCATION Research by Yikilkan et al. (2011) has suggested that healthcare professionals give variable and inaccurate information
to families regarding SIDS prevention; such failures include 83% of healthcare professionals recommending incorrect sleeping positions for infants and some 39% of mothers unaware of SIDS on hospital discharge. Even though evidence- based guidelines are readily available worldwide, I found limited resources within The Middle East. However, such websites as ‘The Baby Center’ offer parental guidance in both Arabic and English. Research examining multiple countries has concluded that public education is paramount in reducing and preventing the incidence of SIDS.
HOSPITAL PRACTICES AND IMPLICATIONS FOR THE PROFESSIONAL As identified by the AAP (2005), Moon et al. (2007) and Crawford (2010) there is strong evidence to suggest that male infants born before 37 weeks and that weigh less then 2.5kg at birth are at a greater risk of SIDS. What is also known is that preterm babies are twice as likely to be placed prone at one month after hospital discharge compared to their term counterparts. Preterm infants require the prone position whilst in the neonatal intensive care unit and as such these infants and parents become habituated to use this position. There is strong evidence to suggest that mothers copy practices that they have observed within the hospital setting and therefore as healthcare professionals we must be vigilant about endorsing SIDS risk reduction recommendations. Simultaneously it is current practice to use positioning aids and swaddling to ‘nest’ babies in the neonatal intensive care unit, to aid developmental care. Once again, if not informed of the contraindications, mothers may take these practices home with them, exposing their infant to unnecessary risks.
«There is emerging and conflicting evidence to suggest that pacifiers not only reduce the incidence of SIDS, but they play no role in reducing breastfeeding rates»
LIFESTYLE Worldwide research has observed an undeniable link with smoking during pregnancy and passive smoking to SIDS. Winickoff et al. (2003) and The AAP (2005) highly recommends that smoking must not take place in the same environment as the infant. Current research from Turkey suggests that cigarette, cigar, medwakh and Shisha smoke exposure still continues, with these social activities occurring due to lack of SIDS prevention awareness and education of the wider population.
PACIFIER USAGE AND BREAST FEEDING As part of a BFHI (Baby Friendly Hospital Initiative) in Abu Dhabi, Corniche Hospital follows strict and global criteria set by WHO (1992) to ensure that our hospital’s BFHI status is maintained. As part of these global criteria it clearly states that infants should not be allowed to suck on pacifiers, as it can potentially alter the infant’s oral dynamics and interfere with breastfeeding (WHO 1992). Multiple research studies examined by the WHO (1998) have revealed a significant link with pacifier usage and the reduction in breastfeeding rates and duration. However, there is emerging and conflicting evidence to suggest that pacifiers not only reduce the incidence of SIDS, but they play no role in reducing breastfeeding rates. This controversy and contradiction leaves institutions reluctant to recommend the use of pacifiers due to the conflicting evidence that is now seen. The biological mechanisms and the protective effect of pacifiers are still unclear, yet the evidence is compelling with research continuing to identify a strong correlation between sleep time pacifier
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