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

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.

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.

Cultural variation in factors associated with sudden infant death during sleep

Background Despite the significant reduction decades ago in sudden unexpected death in infancy (SUDI), decline of rates has slowed and stalled in some countries, including the USA. This led to an appreciation of ethnic variations in SUDI rates and the need to increase cultural sensitivity regarding sleep practices and circumstantial factors of SUDI. The study explored SUDI-related factors, in journal articles from two geo-cultural regions (Asian and Western countries), particularly for factors related to infant sleep practices. Methods A systematic review was conducted to identify SUDI-related factors in articles from PubMed, Scopus, and the Korean Citation Index from January 1992 to April 2019. From each article, SUDI-related factors were retrieved and categorized through the identification, aggregation, and categorization of factors into the areas of the triple risk model (TRM) of SUDI by their meanings and commonality. Significant trends in the frequency of factors were analyzed across time and between the two geo-cultural regions (Asian and Western countries) of article. Results From a review of 218 articles (38 Asian and 180 Western articles), 84 SUDI-related factors were identified: 39 factors for TRM 1, 44 factors for TRM 2, and one factor for TRM 3. Four of the top-ranked 10 factors were found in both cultural zones: sleep position, male sex, bed-sharing, and genetics. Both cultural zones identified sleep position (44.0%), bed-sharing (22.0%), and rooming-in (16.5%) as the three most important sleep-related factors for SUDI. Variations between the cultural zones were observed in the place of SUDI occurrence, overheating, swaddling or bedding standards, and smoking. Conclusions Regardless of the urgent need to identify SUDI-related factors in low-SUDI societies, Asian cultures showed a significant lack of articles on SUDI. Several sociocultural issues were recognized such as the meaning of bed-sharing and rooming-in, along with residential styles and traditional health beliefs on sleep-related SUDI factors. Particularly little attention towards smoking was found in Asian articles in terms of frequency, suggesting the need to enhance SUDI reduction strategies by incorporating gender-sensitive smoking cessation interventions. This review of SUDI factors requests child health professionals to be alert to sociocultural variations in sleep practices and SUDI factors.

Sicherer Babyschlaf: Europäische Empfehlungen auf dem Prüfstand

Liebe Leserinnen und Leserdas „Bed-sharing“, mitunter auch als „Co-sleeping“ bezeichnet, also der gemeinsame Schlaf von Mutter/Vater und Kind (<1 Jahr) im gleichen Bett, gilt – unter anderem wegen der drohenden Behinderung der freien Atmung – als Risikofaktor für den plötzlichen Säuglingstod, sodass in vielen Empfehlungen zum „sicheren Babyschlaf“ mehr oder weniger pauschal davon abgeraten wird. Dies steht in gewissem Kontrast zu der Tatsache, dass das Bed-sharing weltweit enorm verbreitet ist, und lässt vielleicht auch andere Faktoren, wie die Rolle des kindlichen Alters oder die Auswirkungen auf die mütterliche Stillbereitschaft, zu sehr außer Acht. In einer interessanten Übersichtsarbeit im „Fokus Hebammenwissenschaft“ dieser Zeitschrift werden daher die Empfehlungen zur Prophylaxe des Sudden Infant Death Syndrome (SIDS) in Europäischen Ländern mit besonders niedriger (Griechenland, Italien, Niederlande) und besonders hoher SIDS-Inzidenz (UK, Österreich, Frankreich) analysiert und der aktuellen Evidenzlage gegenübergestellt. Es zeigt sich, dass, was empfohlen bzw. nicht empfohlen wird, nicht immer der wissenschaftlichen Evidenz entspricht, und dass ein sorgfältigerer Abgleich, so zumindest die Folgerung der Autorinnen, auch differenziertere Empfehlungen gerade zum Thema Bed-sharing erlauben würde.

Does Bed Sharing with an Infant Influence Parents’ Sexual Life? A Scoping Review in Western Countries

Bed sharing—the sharing of a sleeping surface by parents and children—is a common, yet controversial, practice. While most research has focused on the public health aspect of this practice, much less is known regarding its effect on the marital relationship. The aim of the present study was to conduct a scoping review on the impact of parent–infant bed sharing sleeping practices on the sexual and marital relationship of couples. The qualitative synthesis of six studies on this topic suggests that overall, bed sharing does not exert a significant negative impact on family functioning; when it does, it appears to be related to incongruent parental beliefs and expectations, especially when bed sharing is not an intentional choice of sleep arrangement, and there are other confounding factors such as fatigue and psychological distress. Suggestions for future studies and clinical implications are discussed.

An evaluation of factors associated with safe infant sleep practices among perinatal home visiting participants in Florida, United States

Sleep-related deaths are a leading cause of infant mortality in Florida. The American Academy of Pediatrics recommends placing infants to sleep on their back, alone, and without soft bedding. Compliance with these guidelines varies among parents. This evaluation examined the rates of safe infant sleep practices and associated factors among 1985 participants enrolled in Florida Maternal, Infant, and Early Childhood Home Visiting (FL MIECHV) programs during 2017–2019. Participant- and program-level variables were examined in relation to three sleep practices: infant position, bedding, and bed-sharing at 2–3 months to determine which factors were associated with high rates of safe sleep outcomes. Analyses included univariate descriptive statistics, bivariate statistics, and multivariable logistic regression. Most caregivers (70%) reported always placing their babies to sleep on their back, alone, and without soft bedding. Factors such as primary language, race, education, housing situation, and year the Safe Baby™ curriculum implemented were significantly associated with safe infant sleep practices. Bearing this in mind, FL MIECHV can tailor safe sleep education, messaging, and strategies to support participants at highest risk. Recent adoption of the Safe Baby™ curriculum, and associated staff training, was an important factor influencing parents’ infant sleep practices.

639 An exploratory study of parents-child co-sleeping in Korea

Introduction Asian cultures, including Korea, are known to have a higher proportion of parent-child co-sleeping than Western cultures. While recent studies have shown that bed-sharing increases the mother’s depression and causes sleep problems for children, there has never been a study in Asia on the sleep problems of parents and children caused by co-sleeping. Therefore, we aim to investigate the types of sleep problems in children and their mothers’ insomnia severity due to co-sleeping. Methods This study was conducted in 79 mothers (mean age 33.65 ±3.98 years) who reported having insomnia due to their children. All participants had children between 6 to 36 months old. Participants were asked to answer the survey includes demographics, sleep environment, child’s sleep problems, child’s health status items and the mother’s insomnia (measured by the Insomnia Severity Index; ISI). Children’s age was divided into 5 age groups (6 – 11, 12 - 17, 18 - 23, 24 - 29, and 30 to 36 months). Frequency analysis and independent t-test were conducted. Results Of the total respondents, 72.2% (n=57) reported co-sleeping with their children. The most reported sleep problem in children was waking up in the middle of the night 51.9% (n=41), followed by difficulty in sleep initiation 12.7% (n=10), looking for mother or an attachment object 12.7% (n=10), sleep-limiting problems 7.5% (n=6), multiple problems 12.7% (n=10), and none 2.5% (n=2). An independent t-test results for determining whether co-sleeping caused a difference in the severity of maternal insomnia was significant in the 6 to 11 months group only (t=-2.336, p&lt;.05). The co-sleeping mother’s ISI average score (M=18.28) was significantly higher than mother who slept separate from her child (M=14.31). Conclusion Co-sleeping in Asian cultures is prevalent, and may require attention and intervention for mothers who report having insomnia due to their children’s sleep disturbance. Support (if any):