Friday, October 10, 2008

Ceiling fan may help prevent SUID/SIDS

We would all think it great to come up with another “simple” intervention to further lower the risk of SIDS (better termed SUID: Sudden Unexplained Infant Death). A recent study may have come up with such an intervention. The study showed that circulating the air in the infant’s bedroom with a ceiling fan (but not just having a window open) lowered the risk of SIDS death

So remember (and tell all new parents): “Back to Sleep”; firm mattress; minimal, non-downy blankets; no bumper pads, pillows or soft toys; keep them cool at night; and (apparently) install a ceiling fan.


Anonymous said...

Ceiling fan or any fan is not the problem with SUIDI. The education of parents is don't sleep with your child! Bedsharing and overlay is the main problem as well as unsafe sleeping position.
Many Coroner/ME offices are not properly doing the investigation that needs to include doll reennactment!

Dr. Richard Keller said...

I would agree that bed sharing and overlay are huge problems that are not often talked about (I have written about them before and likely will again).

We have found the doll re-enactment to be incredibly important as part of our investigations. Adding the visual and tactile cues/feedback improves recollection immensely. It is much easier for folks who were at the scene to place the doll properly, than to recall and describe the scene appropriately.

Anonymous said...

SIDS deaths in the U.S. decreased from 4,895 in 1992 to 2,247 in 2004. But, during a similar time period, 1989 to 2004, SIDS being listed as the cause of death for sudden infant death (SID) decreased from 80% to 55%. According to Dr. John Kattwinkel, chairman of the Center for Disease Control (CDC) Special Task Force on SIDS "A lot of us are concerned that the rate (of SIDS) isn't decreasing significantly, but that a lot of it is just code shifting”.

In a 2006 letter to the editor in the Journal of Pediatrics Dr. Rafael Pelayo, Dr. Judith Owens, Dr. Jodi Mindell, and Dr. Stephen Sheldon asked the following question of the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome after their Pacifier and Co-sleeping report was published:
"...from the perspective of the field of pediatric sleep medicine, the policy statement's laudable but narrow focus on SIDS prevention raises a number of important issues that need to be addressed. In particular, the revised recommendations regarding cosleeping and pacifier use have the potential to lead to unintended consequences on both the sleep and the health of the infant. The potential implications of a SIDS risk-reduction strategy that is based on a combination of maintaining a low arousal threshold and reducing quiet (equivalent to Delta or slow-wave sleep) in infants must be considered. Because slow-wave sleep is considered the most restorative form of sleep and is believed to have a significant role in neurocognitive processes and learning, as well as in growth, what might be the neurodevelopmental consequences of chronically reducing deep sleep in the first critical 12 months of life?"

In a currently utilized model that explains the process in which slow wave sleep is involved in memory consolidation the hippocampus acts as a temporary storage facility for new memories which are then transferred to the neocortex during slow wave sleep (SWS) [8]. In this model, acetylcholine acts a feedback loop inhibitor inside the hippocampus during REM sleep and wakefulness. The activity during the high cholinergic wakefulness period is believed to provide an environment which allows for the encoding within the hippocampus of new declarative memories. The low cholinergic environment during SWS is thought to then allow these memories to be transferred from the temporary storage of the hippocampus to their permanent storage environment in the neocortex and for memory consolidation [9, 10].
A significant way of decreasing slow wave sleep in infants is by changing their sleeping position from prone to supine. It has been shown in studies of preterm infants [11, 12], full-term infants [13, 14], and older infants [15], that they have greater time periods of quiet sleep and also decreased time awake when they are positioned to sleep in the prone position.

8. Hasselmo, M.E. 1999. Neuromodulation: Acetylcholine and memory consolidation. Trends Cogn. Sci. 3: 351–359.
9. Buzsáki, G. 1989. Two-stage model of memory trace formation: A role for “noisy” brain states. Neuroscience 31: 551–570.
10. Hasselmo, M.E. 1999. Neuromodulation: Acetylcholine and memory consolidation. Trends Cogn. Sci. 3: 351–359.
11. Myers MM, Fifer WP, Schaeffer L, et al. Effects of sleeping position and time after feeding on the organization of sleep/wake states in prematurely born infants. Sleep 1998;21:343–9.
12. Sahni R, Saluja D, Schulze KF, et al. Quality of diet, body position, and time after feeding influence behavioral states in low birth weight infants. Pediatr Res 2002;52:399–404.
13. Brackbill Y, Douthitt TC, West H. Psychophysiologic effects in the neonate of prone versus supine placement. J Pediatr 1973;82:82–4.
14. Amemiya F, Vos JE, Prechtl HF. Effects of prone and supine position on heart rate, respiratory rate and motor activity in full term infants. Brain Dev 1991;3:148–54.
15. Kahn A, Rebuffat E, Sottiaux M, et al. Arousal induced by proximal esophageal reflux in infants. Sleep 1991;14:39–42.

D. Caufield said...

Could someone help me find a good article on the doll reenactment in SUIDI. We are trying to incorporate this into our SUIDIs and would like any information that might be available.
Thank you