Risk and Preventive Factors for SUDI: Need We Adjust the Current Prevention Advice in a Low-Incidence Country

Background: The incidence of Sudden Unexpected Death in Infancy (SUDI) is low in the Netherlands, with an incidence rate of 0.18 per 1,000 live births. Therefore, prevention advice may receive less attention, potentially leading to increasing incidence rates. It is currently unknown whether the risks for SUDI changed in the Netherlands, and if other risk factors might be present. The aim of this study was to examine the current risks and preventive factors for SUDI in Dutch infants, in order to determine if it is necessary to adapt the prevention advice toward the current needs.Methods: A case-control study was conducted comparing SUDI cases aged <12 months from 2014–2020 in the Netherlands (n = 47), to a Dutch national survey control group from 2017 including infants <12 months of age (n = 1,192).Results: Elevated risks for several well-known factors were observed, namely: duvet use (aOR = 8.6), mother smoked during pregnancy (aOR = 9.7), or after pregnancy (aOR = 5.4) and the prone sleeping position (aOR = 4.6). Reduced risks were observed for the well-known factors: room-sharing (aOR = 0.3), sleep sack use (aOR = 0.3), breastfeeding (aOR = 0.3), and the use of a pacifier (aOR = 0.4). For infants <4 months, the risk for SUDI was higher when bed-sharing (aOR = 3.3), and lower when room-sharing (aOR = 0.2) compared to older infants. For older infants, the sleep sack was found to be more protective (aOR = 0.2). A high risk for SUDI when bed-sharing was found when mother smoked, smoked during pregnancy, or if the infant did not receive any breastfeeding (respectively aOR = 17.7, aOR = 10.8, aOR = 9.2).Conclusions: Internationally known factors related to the sudden unexpected death of infants were also found in this study. Relatively new findings are related to specific groups of infants, in which the strengths of these risk factors differed. In a low-incidence country like the Netherlands, renewed attention to the current prevention advice is needed. Furthermore, additional attention for prevention measures in low educated groups, and additional advice specifically targeting high-risk groups is recommended.

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Renewed Attention Needed for Prevention of Sudden Unexpected Death in Infancy in the Netherlands

Frontiers in Pediatrics ◽

10.3389/fped.2021.757530 ◽

2021 ◽

Vol 9 ◽

Author(s):

Floortje Kanits ◽

Monique P. L'Hoir ◽

Magda M. Boere-Boonekamp ◽

Adèle C. Engelberts ◽

Edith J. M. Feskens

Keyword(s):

The Netherlands ◽

Risk Groups ◽

Infant Care ◽

Developed Countries ◽

Sudden Unexpected Death ◽

Sudden Infant ◽

Unexpected Death ◽

Sleeping Position ◽

Smoking During Pregnancy ◽

Bed Sharing

Background: The incidence of sudden unexpected death in infancy (SUDI), which includes sudden infant death syndrome (SIDS), has declined in developed countries since the 1980s, including the Netherlands. To identify improvement opportunities in SUDI prevention, we monitored the adherence of parents to the prevention advice on infant care habits over the past 20 years, especially in relation to the SUDI incidence over time. Potential changes in parental adherence between the latest surveys are of specific interest, as these indicate where current focus is needed.Methods: Description of the prevalence of infant care factors related to the risk of SUDI, assessed from five Dutch national surveys from 1999 to 2017 among parents of infants under 12 months, and analysis of the potential differences in these prevalences between the two latest surveys in 2010/11 and 2017 with a z-test.Results: Supine sleeping position decreased from the highest prevalence of 92% in 2010/11, to 83% in 2017. Sleep sack use has increased to 55%, the highest prevalence up to now. Avoiding a duvet has remained reasonably stable since 2002/03 and now 95% of parents do not use a duvet. The prevalence of room-sharing, without sharing the bed, increased from 14% in 1999 to the highest prevalence in 2017 (31%). However, also bed-sharing almost doubled from 5.6% in 2010/11 to 10% in 2017. Breastfeeding decreased between 1999 and 2010/11, but increased from 34% in 2010/11 to 42% in 2017. An increased prevalence of mothers who abstained from smoking during pregnancy, as well as both parents not smoking, was observed, although mostly higher educated parents showed this beneficial behavior.Discussion and Conclusion: Much has already been achieved first by decreasing prone sleeping since the 80's, and subsequently promoting supine as the safest sleep position. The decrease in duvet use and smoking, and an increase in breastfeeding have also had impact. Indications of a recent decreased prevalence of the supine sleeping position and higher prevalence of bed-sharing might relate to the slightly increasing SUDI incidence in the Netherlands. Renewed attention for prevention of SUDI and specific advice targeting high-risk groups is needed. Modern, picture driven information via internet is recommended.

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Sudden Unexpected Death of Two Infants in Baby Carriers

Klinische Pädiatrie ◽

10.1055/a-1545-4590 ◽

2021 ◽

Author(s):

Dennis Storz ◽

Christof Dame ◽

Anke Wendt ◽

Alexander Gratopp ◽

Christoph Bührer

Keyword(s):

Risk Factors ◽

Infant Development ◽

Sudden Infant Death ◽

Developed Countries ◽

Bottle Feeding ◽

Sudden Unexpected Death ◽

Sudden Infant ◽

Unexpected Death ◽

Sleeping Position ◽

Prone Sleeping Position

Sudden unexpected death in infancy (SUDI), previously termed sudden infant death syndrome (SIDS), is the second leading cause of death in infants beyond the neonatal period in Germany, and a major cause of infant mortality in economically well developed countries (OECD Health Statistics, 2019). The risk of SUDI peaks at the age of 2–4 months and then decreases continuously till the end of the first year. A complex multifactorial cause, rather than a single characteristic factor, may cause SUDI within a critical period of infant development (Guntheroth WG et al., Pediatrics 2002; 110: e64–e64). Risk factors include prematurity, male gender, bottle-feeding, prone sleeping position, overheating, as well as exposure to smoke amongst others (Carpenter RG et al., Lancet 2004; 363: 185–191). Thus, health professionals consistently advise and educate parents about avoidable risk factors of SUDI at routine well-baby examinations. Since the advent of SUDI prevention strategies in the 1980s, the incidence has decreased 10fold, from 1,55/1.000 live births in 1991 to 0,15/1000 in 2015. This number seems to have reached a steady state (Statistisches Bundesamt Germany, 2015).

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Sudden unexpected death in epilepsy: A search for risk factors

Epilepsy & Behavior ◽

10.1016/j.yebeh.2006.11.010 ◽

2007 ◽

Vol 10 (1) ◽

pp. 138-141 ◽

Cited By ~ 96

Author(s):

Nikolas Hitiris ◽

Suraya Suratman ◽

Kevin Kelly ◽

Linda J. Stephen ◽

Graeme J. Sills ◽

...

Keyword(s):

Risk Factors ◽

Sudden Unexpected Death ◽

Unexpected Death

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Practice Guideline Summary: Sudden Unexpected Death in Epilepsy Incidence Rates and Risk Factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society

Epilepsy Currents ◽

10.5698/1535-7511.17.3.180 ◽

2017 ◽

Vol 17 (3) ◽

pp. 180-187 ◽

Cited By ~ 25

Author(s):

Cynthia Harden ◽

Torbjörn Tomson ◽

David Gloss ◽

Jeffrey Buchhalter ◽

J. Helen Cross ◽

...

Keyword(s):

Risk Factors ◽

Guideline Development ◽

Evaluation Process ◽

Incidence Rates ◽

Sudden Unexpected Death ◽

Dissemination And Implementation ◽

Seizure Freedom ◽

High Confidence ◽

Unexpected Death ◽

Assessment Development

Objective: To determine the incidence rates of sudden unexpected death in epilepsy (SUDEP) in different epilepsy populations and address the question of whether risk factors for SUDEP have been identified. Methods: Systematic review of evidence; modified Grading Recommendations Assessment, Development and Evaluation process for developing conclusions; recommendations developed by consensus. Results: Findings for incidence rates based on 12 Class I studies include the following: SUDEP risk in children with epilepsy (aged 0–17 years) is 0.22/1,000 patient-years (95% CI 0.16–0.31) (high confidence in evidence). SUDEP risk increases in adults to 1.2/1,000 patient-years (95% CI 0.64–2.32) (low confidence in evidence). The major risk factor for SUDEP is the occurrence of generalized tonic-clonic seizures (GTCS); the SUDEP risk increases in association with increasing frequency of GTCS occurrence (high confidence in evidence). Recommendations: Level B: Clinicians caring for young children with epilepsy should inform parents/guardians that in 1 year, SUDEP typically affects 1 in 4,500 children; therefore, 4,499 of 4,500 children will not be affected. Clinicians should inform adult patients with epilepsy that SUDEP typically affects 1 in 1,000 adults with epilepsy per year; therefore, annually 999 of 1,000 adults will not be affected. For persons with epilepsy who continue to experience GTCS, clinicians should continue to actively manage epilepsy therapies to reduce seizures and SUDEP risk while incorporating patient preferences and weighing the risks and benefits of any new approach. Clinicians should inform persons with epilepsy that seizure freedom, particularly freedom from GTCS, is strongly associated with decreased SUDEP risk.

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Dysfunctional Brain Networking among Autonomic Regulatory Structures in Temporal Lobe Epilepsy Patients at High Risk of Sudden Unexpected Death in Epilepsy

Frontiers in Neurology ◽

10.3389/fneur.2017.00544 ◽

2017 ◽

Vol 8 ◽

Cited By ~ 27

Author(s):

Luke A. Allen ◽

Ronald M. Harper ◽

Rajesh Kumar ◽

Maxime Guye ◽

Jennifer A Ogren ◽

...

Keyword(s):

High Risk ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Sudden Unexpected Death ◽

Unexpected Death

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Automated detection of sudden unexpected death in epilepsy risk factors in electronic medical records using natural language processing

Epilepsia ◽

10.1111/epi.15966 ◽

2019 ◽

Cited By ~ 2

Author(s):

Kristen Barbour ◽

Dale C. Hesdorffer ◽

Niu Tian ◽

Elissa G. Yozawitz ◽

Patricia E. McGoldrick ◽

...

Keyword(s):

Risk Factors ◽

Natural Language Processing ◽

Natural Language ◽

Electronic Medical Records ◽

Language Processing ◽

Medical Records ◽

Automated Detection ◽

Sudden Unexpected Death ◽

Unexpected Death

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Possible Use of Blood Tryptophan Metabolites as Biomarkers for Coronary Heart Disease in Sudden Unexpected Death

Metabolites ◽

10.3390/metabo10010006 ◽

2019 ◽

Vol 10 (1) ◽

pp. 6 ◽

Cited By ~ 1

Author(s):

Kobchai Santisukwongchote ◽

Yutti Amornlertwatana ◽

Thanapat Sastraruji ◽

Churdsak Jaikang

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Picolinic Acid ◽

Sudden Unexpected Death ◽

Control Group ◽

Xanthurenic Acid ◽

Unexpected Death ◽

Tryptophan Metabolites ◽

Hydroxyindoleacetic Acid ◽

The Relationship

Coronary heart disease (CHD) is the major cause of death in sudden unexpected death (SUD) cases. Tryptophan (TRP) and its metabolites are correlated with the CHD patient but less studies in the SUD. The aim of this study was to evaluate the relationship of TRP and its metabolites with the CHD in the SUD cases. Blood samples and heart tissues were collected from CHD subjects (n = 31) and the control group (n = 72). Levels of kynurenine (KYN), kynurenic acid (KYA), xanthurenic acid (XAN), 3-hydroxyanthranillic acid (HAA), quinolinic acid (QA), picolinic acid (PA) and 5-hydroxyindoleacetic acid (HIAA) were determined by HPLC-DAD. A severity of heart occlusion was categorized into four groups, and the relationship was measured with the TRP metabolites. The HIAA and The KYN levels significantly differed (p < 0.01) between the CHD group and the control group. Lower levels of QA/XAN, PA/KA, HAA/XAN, KYN/XAN and KYN/TRP were found in the CHD group. However, PA/HAA, PA/HIAA, PA/KYN and XAN/KA values in the CHD group were higher than the control group (p < 0.05). This study revealed that the values of PA/KA and PA/HAA provided better choices for a CHD biomarker in postmortem bodies.

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