Innovation to prevent sudden infant death: the wahakura as an Indigenous vision for a safe sleep environment

The bassinet-like wahakura is an Indigenous initiative for the prevention of Sudden Unexpected Death in Infancy (SUDI). It was developed by New Zealand Māori in 2005 when Māori were rejecting the ‘stop bedsharing’ SUDI prevention message and the SUDI disparity between Māori and non-Māori had become entrenched. Made of native flax, the wahakura was promoted as a culturally resonant, in-bed safe sleep device that would disrupt the SUDI risk associated with ‘bedsharing where there was smoking in pregnancy’ without relying on smoking cessation. A significant movement of weavers and health professionals grew around the wahakura program. A body of research, including infant care surveys, retrospective case review, qualitative enquiry and a randomised controlled trial comparing wahakura and bassinet safety demonstrated the device’s public health plausibility, acceptability to Māori women and its essential safety. This facilitated the distribution, by District Health Boards, of safe sleep devices, including a related device called the Pēpi-Pod, and safe sleep education to high-risk, mainly Māori, mothers. Infant mortality in New Zealand fell by 29%, primarily among Māori infants, over the period 2009–15, suggesting that Māori cultural concepts, traditional activities and community engagement can have a significant effect on ethnic inequities in infant mortality.

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Sudden infant death syndrome (SIDS) and the routine otoacoustic emission infant hearing screening test: an epidemiological retrospective case–control study

BMJ Open ◽

10.1136/bmjopen-2019-030026 ◽

2019 ◽

Vol 9 (7) ◽

pp. e030026 ◽

Cited By ~ 1

Author(s):

Peter S Blair ◽

Daniel Rubens ◽

Anna Pease ◽

Diane Mellers ◽

Jenny Ingram ◽

...

Keyword(s):

Case Control Study ◽

Otoacoustic Emission ◽

Sudden Infant Death ◽

Case Control ◽

Sudden Infant ◽

Unexpected Death ◽

Retrospective Case ◽

Bed Sharing ◽

The Right ◽

Control Study

ObjectivesTo investigate whether decreased otoacoustic emission (OAE) signal recordings in the right ear are associated with an increased risk of sudden infant death syndrome (SIDS) and to monitor any temporal changes in risk factors.DesignRetrospective case–control study.SettingTelephone interviews with families recruited in England between July 2016 and October 2017 who experienced the unexpected death of a child <4 years old since 2008 and control families recruited from maternity wards in Bristol and Birmingham.ParticipantsWe recruited 91 (89%) of the 102 bereaved families who made initial contact, 64 deaths were under 1 year (sudden unexpected death in infancy) of which 60 remained unexplained (SIDS). Of the 220 control families, 194 (88%) follow-up interviews were conducted. We had analysable hearing data for 24 SIDS infants (40%) and 98 controls (51%).ResultsOAE signals were marginally increased rather than decreased among SIDS infants for the right ear, especially at lower frequencies, but not significantly so. The strongest predictors of SIDS were bed-sharing in hazardous (infant sleeping next to a carer who smoked, drank alcohol or slept on a sofa) circumstances (35% vs 3% controls, p<0.0001), infants found prone (33% vs 3% controls, p<0.0001) and infants whose health in the final week was ‘not good’ (53% vs 9% controls, p<0.0001). The prevalence of maternal smoking during pregnancy among both SIDS mothers (20%) and controls (10%) was much lower than previous studies.ConclusionsHearing data were difficult to obtain; larger numbers would be needed to determine if asymmetrical differences between the right and left ear were a marker for SIDS. A national prospective registry for monitoring and a renewed campaign to a new generation of parents needs to be considered underlining the initial message to place infants on their backs for sleep and the more recent message to avoid bed-sharing in hazardous circumstances.

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Formal retrospective case review and sudden infant death

Acta Paediatrica ◽

10.1111/j.1651-2227.1997.tb15191.x ◽

1997 ◽

Vol 86 (9) ◽

pp. 1011-1012 ◽

Cited By ~ 10

Author(s):

RW Byard ◽

J MacKenzie ◽

SM Beal

Keyword(s):

Infant Death ◽

Sudden Infant Death ◽

Sudden Infant ◽

Case Review ◽

Retrospective Case

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International comparison of sudden unexpected death in infancy rates using a newly proposed set of cause-of-death codes

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-308239 ◽

2015 ◽

Vol 100 (11) ◽

pp. 1018-1023 ◽

Cited By ~ 40

Author(s):

Barry J Taylor ◽

Joanna Garstang ◽

Adele Engelberts ◽

Toshimasa Obonai ◽

Aurore Cote ◽

...

Keyword(s):

New Zealand ◽

The Netherlands ◽

International Comparison ◽

International Comparisons ◽

Sudden Infant Death ◽

Sudden Unexpected Death ◽

Sudden Infant ◽

Unexpected Death ◽

Icd 10 ◽

Over Time

BackgroundComparing rates of sudden unexpected death in infancy (SUDI) in different countries and over time is difficult, as these deaths are certified differently in different countries, and, even within the same jurisdiction, changes in this death certification process have occurred over time.AimsTo identify if International Classification of Diseases-10 (ICD-10) codes are being applied differently in different countries, and to develop a more robust tool for international comparison of these types of deaths.MethodsUsage of six ICD-10 codes, which code for the majority of SUDI, was compared for the years 2002–2010 in eight high-income countries.ResultsThere was a great variability in how each country codes SUDI. For example, the proportion of SUDI coded as sudden infant death syndrome (R95) ranged from 32.6% in Japan to 72.5% in Germany. The proportion of deaths coded as accidental suffocation and strangulation in bed (W75) ranged from 1.1% in Germany to 31.7% in New Zealand. Japan was the only country to consistently use the R96 code, with 44.8% of SUDI attributed to that code. The lowest, overall, SUDI rate was seen in the Netherlands (0.19/1000 live births (LB)), and the highest in New Zealand (1.00/1000 LB). SUDI accounted for one-third to half of postneonatal mortality in 2002–2010 for all of the countries except for the Netherlands.ConclusionsThe proposed set of ICD-10 codes encompasses the codes used in different countries for most SUDI cases. Use of these codes will allow for better international comparisons and tracking of trends over time.

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‘It looks like a breadbox’: a pilot study investigating implementation of the Pepi-Pod® program with Aboriginal families in metropolitan South Australia

Primary Health Care Research & Development ◽

10.1017/s1463423621000293 ◽

2021 ◽

Vol 22 ◽

Author(s):

Julian Grant ◽

Nina Sivertsen ◽

Janiene Deverix ◽

Alice Steeb

Keyword(s):

South Australia ◽

Sudden Infant Death ◽

Research Process ◽

Infant Mortality Rate ◽

Sudden Infant ◽

Culturally Appropriate ◽

Unexpected Death ◽

Safe Sleep ◽

Team Members ◽

Field Notes

Abstract Aims: To collaboratively explore the cultural acceptance of the Pepi-Pod® program as an alternate safe sleep space and to explore the process of implementing the Pepi-Pod® program in a mainstream health service for Aboriginal families living in urban South Australia. Background: Aboriginal and Torres Strait Islander infants continue to die from sudden infant death syndrome (SIDS) and sudden unexpected death in infancy (SUDI) at rates three to four times greater than other infants born in Australia despite Council of Australian Governments commitment to halve the gap in the Indigenous infant mortality rate by 2018. The Pepi-Pod® program is evidenced in New Zealand and Queensland to provide a culturally appropriate safe sleep alternative that contributes to the reduction of SIDS and SUDI. We have no evidence of acceptability or feasibility when offered through mainstream services in metropolitan South Australia. Methods: With a focus on decolonizing the research process through a two-way process for mutual learning between Aboriginal and non-Aboriginal team members and community, a novel qualitative design was employed including photo elicited yarning sessions (n = 7), focus groups (n = 2), and field notes (n = 15). Results: Four themes emerged: ‘you don’t have to worry’; ‘a way of sharing knowledge’; ‘it looks like a bread box?’ and ‘need for consistent safe sleep messages’. The findings suggest that participants believe the Pepi-Pod® program may enrich Aboriginal families’ lives evoking feelings of comfort and safety; however, the design could be improved to make them more culturally appropriate. There was confusion around safe sleep processes and education with a call for streamlining safe sleep messaging.

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Ten Percent of SIDS Cases are Murder — or are They?

Academic Forensic Pathology ◽

10.23907/2017.018 ◽

2017 ◽

Vol 7 (2) ◽

pp. 163-170 ◽

Cited By ~ 2

Author(s):

Christopher M. Milroy ◽

Charis Kepron

Keyword(s):

Sudden Infant Death ◽

Current Data ◽

Aquaporin-1 and aquaporin-9 gene variations in sudden infant death syndrome

International Journal of Legal Medicine ◽

10.1007/s00414-020-02493-9 ◽

2021 ◽

Author(s):

Siri Hauge Opdal ◽

Linda Ferrante ◽

Torleiv Ole Rognum ◽

Arne Stray-Pedersen

Keyword(s):

Sudden Infant Death Syndrome ◽

Infant Death ◽

Brain Function ◽

Sudden Infant Death ◽

Sudden Infant ◽

Unexpected Death ◽

Aquaporin 9 ◽

Genes Encoding ◽

External Risk ◽

The Brain

AbstractSeveral studies have indicated that a vulnerability in the development and regulation of brain function is involved in sudden infant death syndrome (SIDS). The aim of this study was to investigate the genes encoding the brain aquaporins (AQPs) AQP1 and AQP9 in SIDS. The hypothesis was that specific variants of these genes are part of the genetic vulnerability predisposing infants to sudden unexpected death. The study included 168 SIDS cases with a median age of 15.5 (range 2–52) weeks and 372 adolescent/adult deceased controls with a median age of 44 (range 11–91) years. In the AQP1 gene, the rs17159702 CC/CT genotypes were found to be associated with SIDS (p = 0.02). In the AQP9 gene, the combination of a TT genotype of rs8042354, rs2292711 and rs13329178 was more frequent in SIDS cases than in controls (p = 0.03). In the SIDS group, an association was found between genetic variations in the AQP1 gene and maternal smoking and between the 3xTT combination in the AQP9 gene and being found lifeless in a prone position. In conclusion, this study adds further evidence to the involvement of brain aquaporins in SIDS, suggesting that specific variants of AQP genes constitute a genetic predisposition, making the infant vulnerable to sudden death together with external risk factors and probably other genetic factors.

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Infant Safe Sleep Promotion: Increasing Capacity of Child Protective Services Employees

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084227 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4227

Author(s):

Carolyn R. Ahlers-Schmidt ◽

Christy Schunn ◽

Ashley M. Hervey ◽

Maria Torres ◽

Cherie Sage ◽

...

Keyword(s):

Infant Death ◽

Child Protective Services ◽

Sudden Infant Death ◽

Sudden Infant ◽

Protective Services ◽

Safe Sleep ◽

Train The Trainer ◽

Baseline Knowledge ◽

One Year ◽

The Impact

Sleep-related infant deaths, including Sudden Infant Death Syndrome (SIDS), are the number one cause of death in infants between 28 days and one year of life. Nearly half of families experiencing a sleep-related infant death in Kansas were involved with the Department of Children and Families Child Protective Services (CPS), making CPS staff a priority for safe sleep training. This study assessed the impact of the two-day Kansas Infant Death and SIDS (KIDS) Network Safe Sleep Instructor (SSI) train-the-trainer program on CPS staffs’ knowledge of the American Academy of Pediatrics safe sleep recommendations. Training was attended by 43 participants, 27 (63%) of whom were employed by CPS. CPS staff had significantly lower baseline knowledge on the 10-item pretest (t = 3.33, p = 0.002), but both CPS and other attendees showed significant improvement by posttest (t = 8.53, p < 0.001 and t = 4.44, p < 0.001, respectively). Following SSI certification, CPS SSIs provided more safe sleep training to professionals than other SSIs (1051 vs. 165, respectively), and both groups of SSIs were able to significantly increase the knowledge of their trainees. Overall, the KIDS Network SSI training was successful. The innovative partnership with CPS allowed for provision of training to a group not historically targeted for safe sleep education.

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