aap revises sids prevention recommendations
TRANSCRIPT
444 AWHONN Lifelines Volume 9 Issue 6
In the NHS, 5,145 cases of type 2 diabetes
were diagnosed between 1986 and 2002, and in
the NHS II, 1,132 cases were diagnosed
between 1989 and 2001. In analyses restricted
to women who reported a birth in the past 15
years and controlled for current body mass
index and other relevant risk factors for type 2
diabetes, there was a 15 percent reduced risk of
diabetes in the NHS and 14 percent reduced
risk in the NHS II per additional year of
breastfeeding. Among women who reported
their last birth more than 15 years ago, there
was no association between duration of lacta-
tion and type 2 diabetes in the NHS II and a
substantially reduced association in the NHS.
“In conclusion, increased duration of breast-
feeding was associated with reduced risk of
type 2 diabetes in 2 large cohorts of women.
Together with clinical evidence of improved
glucose homeostasis [equilibrium] in lactating
women, these data suggest that lactation may
reduce the risk of type 2 diabetes in young and
middle-aged women. Further clinical studies
are needed to confirm this finding and to elu-
cidate the physiologic mechanisms for an
inverse association between duration of breast-
feeding and risk of type 2 diabetes,” the authors
wrote (JAMA 2005;294:2601-2610).
AAP Revises SIDS PreventionRecommendations
Despite major decreases in the incidence
of sudden infant death syndrome (SIDS)
during the past decade, SIDS is still responsible
for more infant deaths beyond the newborn
period in the U.S. than any other cause of
death during infancy. In an updated policy
statement, “The Changing Concept of Sudden
Infant Death Syndrome: Diagnostic Coding
Shifts, Controversies Regarding the Sleeping
Environment, and New Variables to Consider
in Reducing Risk,” the American Academy of
Pediatrics (AAP) addresses several issues that
have become relevant since they last published
a statement in 2000.
The AAP no longer recognizes side sleeping
as a reasonable alternative to fully supine (lying
on back) sleeping. Studies have found that the
side sleep position is unstable and increases the
chances of the infant rolling onto his or her
stomach. Every caregiver should use the back
sleep position during every sleep period.
Bed sharing is not recommended during
sleep. Infants may be brought into bed for
nursing or comforting, but should be returned
to their own crib or bassinet when the parent is
ready to return to sleep. However, there is
growing evidence that room sharing (infant
sleeping in a crib in parent’s bedroom) is asso-
ciated with a reduced risk of SIDS. The AAP
recommends a separate but proximate sleeping
environment.
Research now indicates an association
between pacifier use and a reduced risk of
SIDS, which is why the revised statement rec-
ommends the use of pacifiers at nap time and
bedtime throughout the first year of life. The
evidence that pacifier use inhibits breastfeeding
or causes later dental complications is not
compelling enough to discredit the recommen-
dation. However, it is recommended that paci-
fier introduction for breastfed infants be
delayed until one month of age to ensure that
breastfeeding is firmly established. In addition,
if the infant refuses the pacifier, it should not
be forced. There is a slight increased risk of ear
infections associated with pacifier use, but the
incidence of ear infection is generally lower in
the first year of life, especially the first six
months, when the risk of SIDS is the highest.
The following have been consistently identi-
fied as risk factors for SIDS: prone (lying on
stomach) sleep position, sleeping on a soft sur-
face, maternal smoking during pregnancy,
overheating, late or no prenatal care, young
maternal age, pre-term birth and/or low birth
weight, and male gender. Consistently higher
rates of SIDS are found in black and American
Indian/Alaska Native children at two to three
times the national average.
The policy recommendations include:
• 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 surfaceCarolyn Davis Cockey,
MLS, is executive editor
of AWHONN Lifelines
in New Castle, CO.
• 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
• 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
• 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 has
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
• Ensure that others caring for the
infant (child care provider, relative,
friend, babysitter) are aware of these
recommendations
December 2005 | January 2006 AWHONN Lifelines 445
9/11 Panel CallsFor DNA-BasedIdentificationAfter MassDisasters
Only days after the
Sept. 11, 2001,
attacks on the World
Trade Center, the National
Institutes of Justice con-
vened a panel of experts to
develop a process to iden-
tify victims using DNA
collected at the site of the
tragedy. Now, in an article
published in the journal
Science, the panel reports
that DNA-based efforts led
to the identification of more than one-quarter of those reported missing.
The article also makes recommendations to improve DNA identification in
the event of future terrorist attacks or mass disasters.
In their Science paper, panel members report that they have been able to
identify about 850 of the 2,749 people reported missing after the World
Trade Center attacks based solely on DNA results. In conjunction with New
York City’s chief medical examiner, the panel has determined that no fur-
ther identifications can be made at this time using the DNA samples
collected.
The Kinship and Data Analysis Panel (KADAP) included two senior
investigators from the National Human Genome Research Institute, part of
the National Institutes of Health (NIH). Leslie G. Biesecker, MD, a medical
geneticist and the first author of the paper, provided expert advice about
kinship analysis, communicating relevant information about genetic testing
to the families, and human subject issues. Joan E. Bailey-Wilson, PhD, a sta-
tistical geneticist, furnished the team with the statistical expertise necessary
to reduce the risk of misidentifications.
“This effort presented the group with some overwhelming challenges in
the face of such an unprecedented tragedy, but they came together at this
time of national crisis and developed a process that provided better results
than many would have expected. We owe them a debt of gratitude for pro-
viding the scientific expertise and compassion needed to help families and
friends identify their loved ones,” said NIH Director Elias A. Zerhouni, MD.
KADAP was organized and funded by the National Institute of Justice, an
agency of the U.S. Department of Justice, based on a request from New York
City’s chief medical examiner. The New York State Police Forensics Identifi-
cation Center was responsible for analyzing any reference DNA samples, and
several private laboratories tested samples from the World Trade Center site.
The final identifications were made by the Office of Chief Medical Examiner
of New York City. The panel included experts in forensics, bioinformatics,
molecular and medical genetics and statistical and population genetics.