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Prematurity and Sudden Infant Death. It’s A Bigger Problem Than You Think Betty Connal, RN, MS SIDS Mid-Atlantic [email protected] March of Dimes Prematurity Campaign 2003-2010. 5 Campaign Aims: 1. Raise public awareness 2. Educate women as to signs of premature labor

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Prematurity and Sudden Infant Death

It’s A Bigger Problem Than You Think

Betty Connal, RN, MS

SIDS Mid-Atlantic

[email protected]

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March of Dimes Prematurity Campaign 2003-2010

5 Campaign Aims:

1. Raise public awareness

2. Educate women as to signs of premature labor

3. Assist practitioners

4. Invest to identify causes and promising interventions

5. Seek guaranteed access to health care

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Preterm Birth/Prematurity

  • Single most important cause of perinatal (28 weeks gestation through 6 days of life) mortality in U.S. (about 75% of these losses)

  • Leading cause of neonatal mortality (0-27 days) in U.S.

  • Second leading cause of infant mortality in U.S.

  • Leading cause of black infant mortality in U.S.

  • Major determinant of neonatal and infant illness:

    • Neurodevelopmental handicaps (CP, mental retardation)

    • Chronic respiratory problems

    • Intraventricular hemorrhage

    • Periventricular Leukomalacia

    • Infection

    • Retrolental fibroplasia

    • Necrotizing enterocolitis

    • Neurosensory deficits (hearing, visual)

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Prematurity Generates Enormous Health Care Costs

  • Average newborn hospital charges: $4,300 vs. $58,000 for a preterm baby*

  • Total U.S. hospital charges for infant stays due to prematurity/low birth weight: $11.9 Billion*

  • Maternity & related expenses:

    • Often the largest cost to employers’ health care plans

* Source: Agency for Healthcare Research and Quality, 2000 Nationwide Inpatient Sample

Prepared by March of Dimes Perinatal Data Center, 2003

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Selected Leading Causes of Infant Mortality United States, 1990and 2000



Rate per 100,000 live births





Source: National Center for Health Statistics, 1990 final mortality data and 2000 linked birth/infant death data

Prepared by March of Dimes Perinatal Data Center, 2002

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Preterm Delivery (<37 wks) Virginia and US, 1990-2000

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Risk Factors for Preterm Labor/Delivery

  • The best predictor of having a preterm birth is a history of preterm labor/delivery or prior low birthweight

  • Other risk factors:

  • low pre-pregnant weight

  • obesity

  • infections

  • bleeding

  • anemia

  • major stress

  • lack of social supports

  • tobacco use

  • illicit drug use

  • alcohol abuse

  • folic acid deficiency

  • multifetal pregnancy

  • maternal age (<17 and >35 years)

  • black race

  • low SES

  • unmarried

  • previous fetal or neonatal death

  • 3+ spontaneous terminations

  • uterine abnormalities

  • incompetent cervix

  • genetic predisposition

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Prematurity in Virginia12,572 preemies in 2004, 12.1% of all live birthsincreased by 5% since 19949038 were late preterm—between 34 and 37 weeks gestationincreased 10% since 2004

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Multiple Birth Ratios Virginia and US, 1996-2000

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Multiple Birth Ratios Map by Counties inVirginia, 1996-2000

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March of Dimes

1-888-MODIMES 703-824-0111

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  • The lower the gestational age the higher the risk of SIDS

  • The lower the birthweight the higher the risk of SIDS

  • A combination of these increases the risk by more than each factor alone

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Sudden Infant Deaths

  • 4500 annually in United States

  • Half SIDS, half sudden unexpected infant death

  • 90 SIDS in Virginia in 2005

  • 13 undetermined sudden infant deaths

  • 23 accidental sudden infant deaths

  • 777 total infant deaths in Virginia 2005

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  • A preterm infant <37 weeks sleeping prone is 85 times more likely to die of SIDS

  • A preterm infant sidelying is 40 times more likely to die of SIDS

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  • SIDS can occur between 21 days and 9 months of age

  • Peak incidence between 2 and 4 months.

  • More SIDS deaths occur in fall & winter months.

  • The risk is higher and the incidence could potentially extend beyond year for premature infants.

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Current Research

  • Abnormalities in serotonin system

  • Medulla oblongata

  • Regulation of heart rate, respiration, blood pressure and temperature

  • Babies have abnormal response to hypoxia

  • Smoking compounds the problem

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New Guidelines from AAP

  • Back to sleep: Infants should be placed for sleep in a supine (wholly on back position) for every sleep.

  • Use a firm sleep surface: A firm crib mattress, covered by a sheet, is the recommended sleeping surface. 

  • Keep soft objects and loose bedding out of the crib: Pillows, quilts, comforters, sheepskins, stuffed toys and other soft objects should be kept out of an infant's sleeping environment. 

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New Guidelines

  • Do not smoke during pregnancy: Also avoiding an infant's exposure to second-hand smoke is advisable for numerous reasons in addition to SIDS risk.

  • A separate but proximate sleeping environment is recommended such as a separate crib in the parent's bedroom.  Bed sharing during sleep is not recommended. 

  • Consider offering a pacifier at nap time and bedtime: The pacifier should be used when placing infant down for sleep and not be reinserted once the infant falls asleep.  

  • Avoid overheating: The infant should be lightly clothed for sleep, and the bedroom temperature should be kept comfortable for a lightly clothed adult. 

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New Guidelines

  • Avoid commercial devices marketed to reduce the risk of SIDS: Although various devices have been developed to maintain sleep position or reduce the risk of rebreathing, none have been tested sufficiently to show efficacy or safety. 

  • Do not use home monitors as a strategy to reduce the risk of SIDS: There is no evidence that use of such home monitors decreases the risk of SIDS.

  • Avoid development of positional plagiocephaly (flat back of head): Encourage "tummy time." 

  • Avoid having the infant spend excessive time in car-seat carriers and "bouncers.“

  • Place the infant to sleep with the head to one side for a week and then changing to the other. 

  • Assure that others caring for the infant (child care provider, relative, friend, babysitter) are aware of these recommendations.

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Please tell parents

  • No Positioning devices

  • Memory foam body conforms to shape of baby

  • Can Cause suffocation

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Twins baby

  • Recommendation is for twins and multiples to each sleep in his own crib

  • Cribs for Kids Program

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  • Betty Connal, RN, MS

  • Executive Director

  • SIDS Mid-Atlantic

  • 2700 S. Quincy St Suite 220

  • Arlington VA 22206

  • 703-933-9100

  • [email protected]