Prone sleeping promoted cortical arousal (CA) responses in healthy preterm infants throughout the first six months of post-term age. Previously suggested that in term infants enhanced CA represents a critical protection against a potentially harmful situation; for preterm-born infants the need for this protection is potentially greater than in term infants. Crown Horne 2013. PMID 23725788
4% of unselected cases had long QT mutations [NZ] – increased to 16% when cases guided by cardiac genetics. But poor uptake of screening!
36% of excess infant mortality in US South due to SUDI (90% of excess mortality in Kentucky! 59% due to non-hispanic black population).
A previous maltreatment report emerged as a significant predictor of SIDS and other SUID. After adjusting for baseline risk factors, the rate of SIDS was more than 3 times as great among infants reported for possible maltreatment (hazard ratio: 3.22; 95% CI: 2.66, 3.89). [US, PMID 24139442]
Recent NICE update [CG37, postnatal care]
Clarifies co-sleeping risks. Recognizes that co-sleeping can be intentional or unintentional. Parents/carers should be informed of association with SIDS. Plus –
- Inform that association likely to be greater when they smoke (incl partner)
- Inform that association may possibly be greater with recent alcohol, drug use, LBW or premature.
Quality standard (but England and Wales).
Note that the word risk is not used, just association! Boys as being at higher risk not mentioned!
PreBotzinger complex (preBotC) is a multi-functional network that is critically involved in the response to hypoxic and hypercapnic challenges.
Note increased brain oxygen requirement during “active sleep” cf quiet sleep. Only apparent between 2 weeks and 5 months. [Horne 2014].
New Dutch recommendations include: (a) pre-term neonates born after 32 weeks should be placed in a supine position; (b) twins should not sleep in the same bed (‘co-bedding’); (c) use of a pacifier is recommended once breastfeeding is well underway; and (d) use of stabilization pillows is not recommended [PMID 23425715]