Saturday, 29 January 2011

SIDS: Pennsylvania Experts Back placement is key to preventing SIDS

January 24, 2011
— It is considered the leading cause of death for babies, but the truth is, doctors don’t know the cause.

Sudden infant death syndrome, also called SIDS or crib death, is defined as a death that “cannot be explained after a thorough investigation.”
Instead of a cause, SIDS is a “diagnosis by exclusion.”
Even after a thorough autopsy and review of the scene, no cause can be pinpointed, the National SIDS/Infant Death Resource Center reports.
The unexpected, random nature of SIDS deaths is devastating for parents because it happens despite every precaution, said Dr. Andrew Garbarino of Pediatric Care Specialists, 1322 Eisenhower Blvd., Richland Township.
“Everything would have been normal when they put the baby in its crib,” Garbarino said. “There is no time for the family to prepare.”
There are, however, a few ways to reduce the risk, and a new state law was designed to make sure new parents know the simple steps.
The most important rule is to place babies on their backs.
“Everything we’ve tried to do with monitoring and other measures hasn’t done anything,” Garbarino said. “The only one thing that has been proven to decrease the incidence of SIDS is the positioning of the baby on the back.”
Thirty years ago, the SIDS death rate was between 1.5 and 2 for every 1,000 babies. Since Back to Sleep began in 1994 to promote infant back sleeping and other risk-reduction strategies, that rate has reduced by half, Garbarino said.
Like most hospitals across the nation, all those in the region have provided new parents with SIDS prevention instruction for several years. It is also part of many prenatal classes.
Now Pennsylvania’s Sudden Infant Death Syndrome Education and Prevention Program Act requires all hospitals and home-birth practitioners to give approved instruction. New parents must sign a form showing they understand the information.
“We’ve been educating all along,” Le Ann Kaltenbaugh, education coordinator, said from Windber Medical Center.
“The education is nothing new.”
What is new at Windber is a program to provide each newborn’s parents with a wearable blanket, trademarked the SleepSack, which wraps the baby snugly.
“There are no loose blankets in bed that the baby can be tangled with,” Kaltenbaugh said. “It is very simple. They keep the baby nice and tight. They can’t wiggle out of it.”
Doctors theorize that exhaled carbon dioxide can “pool” under blankets and on the mattress surface, where it is inhaled again by the baby. Doctors believe this can cause death, diagnosed as sudden infant death syndrome, Garbarino said.
It’s important to keep the crib free of stuffed toys or other items that can promote the collection of exhaled gasses, he added.
“No pillows or bumpers – anything that can come against a baby’s face and create pooling – we want to get all that stuff out of the crib now,” Garbarino said.
Despite widespread publicity in recent years, convincing new parents of the importance of back placement can be an uphill battle, Pam Harris, nursery coordinator, said at Memorial Medical Center in Johnstown.
“When we are teaching them, we will get the grandmother in the room saying, ‘I put all my babies on their bellies and they are fine.’ ”
It can be worse for new mothers if the grandparents don’t hear the hospital training, Kaltenbaugh said. It happens the first time Grandma sees her grandchild put to bed face-up.
“It’s a whole new process,” Kaltenbaugh said. “They are going to get from their parents, ‘You can’t do that.’”
In the past, placing babies on their belly or side was thought to reduce the chance of aspirating and choking on vomit, but Kaltenbaugh said research has shown babies naturally turn their heads if they throw up.
Another difficult lesson for new parents to grasp is the danger of letting a newborn sleep in bed with adults. Besides the additional risk of pooling gasses, it is possible for an adult to roll over on a baby without waking up.
“That’s very unwise and there have been bad outcomes,” Tiffany Pugh, nurse manager for obstetrics, said at Memorial.
“The safest for babies is to be in their own crib, rather than in bed with Mom and Dad,” Harris said.
Use of tobacco during pregnancy or around a newborn increases the risk of sudden infant death syndrome, while breast feeding, use of a pacifier and a firm crib mattress can reduce the risk.
But the best way to reduce the risk is putting newborns to sleep on their backs, Garbarino emphasizes, noting it isn’t just while sleeping at home.
One thing parents should do is check their day care centers,” Garbarino said. “A survey of day cares showed very few day care centers were positioning babies on their backs.”
There is one complication from back positioning that parents should watch, Garbarino said. They should alternate which end of the crib where the baby’s head is placed.
“Babies in the crib on the back look out toward the open room,” Garbarino said. If the baby is always put to bed in the same position, it can lead to uneven flattening of the skull and tight neck muscles.
“I tell people to make sure they change the position of the baby in the bed by 180 degrees,” Garbarino said.
Following all the expert advice reduces the risk of crib death, but it does not eliminate all deaths, Kaltenbaugh said.
“It is not something you ever, ever want to happen,” Kaltenbaugh said. “But if it does, you must know you are not responsible. There is nothing you could have done to prevent it.”

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