SIDS Not ‘cot death’

Definition Sudden death of an infant under 1 year Remains unexplained after –Case investigation –Autopsy –Examination of death scene –Review of clinical history Persistent rate since dramatic fall after 1991

Who’s at Risk? Boys>girls Multiple births Prematurity LBW Aged 6 wks to 6 months Minor illness Parental unemployment Young mother Lower SC Smoking in pregnancy Unsafe sleeping

Risk Factors Factors associated with an increased risk of SIDS Factors associated with an decreased risk of SIDS Unsafe sleeping position Room sharing SmokingBreast feeding Unsafe sleeping environments  Bed sharing & sofa sharing  Temperature  Bedding & mattresses Dummy use

Safe Sleeping Safe Sleeping Test, from Foundation of Sudden Infant Deaths Identify 7 risks of SIDS from the picture

Sleeping Position Babies placed to sleep on their front or side are at significant increased risk of SIDS 2 studies have shown that side sleeping is particularly risky if baby was born before 37 weeks gestation Babies who usually sleep on their back but are placed on their front or side are at high risk of SIDS (Lullaby Trust May 2013)

Unsafe Sleep Environments Meta analysis of studies published in 2012 showed an increased risk of SIDS in bed sharing infants Studies have found that sharing a sofa with an infant is also associated with an extremely high risk of SIDS Bed sharing with a baby if either parent is a smoker significantly increases the risk of SIDS (Lullaby Trust May 2013)

Other Recommendations Baby’s head should be uncovered while sleeping Babies should be placed on their back in the ‘feet to foot’ position Use of pillows, quilts & duvets should be avoided Babies should sleep on frim flat mattress which is clean & in good condition The safest place for the baby to sleep for the 1 st 6 months is in a cot/crib in the same room as the parents Medical advice should be sought if a baby shows signs of illness that persist for more than 24 hrs (Lullaby Trust May 2013)

Sudden Unexpected Deaths in Infancy Between April 2008 and March 2014 across Central Bedfordshire, Bedford Borough and Luton there have been a total of 26 deaths of babies which were sudden and unexplained. 16 of 26 babies who died were boys. This is in keeping with research which shows that boys appear to be more at risk than girls. (Epidemiology of SIDS and explained sudden infant deaths. CESDI SUDI Research Group.Leach CE, Blair PS, Fleming PJ, Smith IJ Platt MW, Berry PJ, Golding J.)

Age of Babies at Death Age range of deaths 2 weeks to 31 weeks 42% died between weeks

National statistics show that babies are more likely to die during cooler months however the data for Bedford Borough, Central Bedfordshire and Luton is fairly evenly spread throughout the year although a slight peak has been observed in the second quarter of the year.

Smoking 1 in 4 women smoke during part of their pregnancy Maternal smoking dramatically increases the rate of SIDS, miscarriage & stillbirth Estimated if all women stopped smoking in pregnancy the SIDS rate would be reduced by up to 40-50% Smoking 1-9 cigarettes a day in pregnancy= 4x more likely to have SIDS Risk of SIDS increased by bed sharing when either parent smokes Postnatal passive smoking also puts a baby at risk (Lullaby Trust May 2013)

Alcohol & Drugs & Bedsharing Risk of SIDS found to be increased when bed sharer has used alcohol or drugs or is overtired One study showed where mother had consumed 2 or more units of alcohol in last 24hrs there was substantial increase risk in SIDS when bed sharing Use of illegal drugs increased the risk 11 fold even when baby was room sharing. Risks when drug using mother is bed sharing is ‘inestimably large ’ (Lullaby Trust May 2013)

SIDS Cases Reviewed by CDOP Modifiable factors were identified in all of the sudden unexpected deaths reported to CDOP. These included: unsafe sleeping practices, majority of babies were not in a cot/Moses basket at the time of their final sleep. smoking (56% of cases) drug/alcohol misuse. In some cases there was more than one modifiable factor identified.