Posts Tagged ‘Sids’
Tuesday, August 23rd, 2011
Smoking during pregnancy is a well known risk factor for increased morbidity and mortality for the fetus. Smoking has been associated with premature birth, intrauterine growth retardation and congenital malformations. Knowing that active smoking presents an increased health risk, the question arises as to whether there are also any increased health risks to the fetus when a pregnant woman inhales smoke generated by others?
What is second hand smoke?
This is the passive or second-hand smoke that may be present in an office setting, restaurant, or home environment. Secondhand smoking exposes a pregnant woman to all of the same toxins and carcinogens, but at lower dosages than smoke inhaled directly.
Sidestream smoke is the major component of second hand smoke that is considered most harmful. This is the smoke coming off the end generated by a cigarette, cigar, or pipe. Sidestream smoke is considered four times more toxic than than directly inhaled smoke due to its higher content of carcinogens. Some of the carcinogens include tar, nicotine, ammonia, benzene, vinyl chloride, arsenic, acetaldehyde, formaldehyde, lead, carbon monoxide, phenol, styrene, butane and toluene.
What harm can second hand smoke present to the fetus?
A recent study published in the March, 2011 issue of Pediatrics by Leonardi-Bee, claims to be the first world review to examine the effects of second hand smoke exposure during pregnancy. They did a combined review of 19 other studies from North America, South America, Asia, and Europe and found a 23% increased risk of stillbirth, 13% increased risk of having a child with congenital anomalies and a higher risk of having a decreased birth weight in newborns by 33 gm.
Spontaneous abortion (miscarriage before 20 weeks gestation) and perinatal and neonatal death (20 weeks to within the first 28 days of life) was not significantly increased by second hand smoke.
How much second hand smoke is dangerous? Currently available studies do not tell us. The effects of second hand smoke at the various stages of a woman’s pregnancy have not been definitively studied and conclusions are not available.
What type of congenital anomalies were found with second hand smoking?
The congenital anomalies that are associated include heart defects, clubfoot, cryptorchidism (failure of descent of the testes), neural tube defects, anencephaly (defect in formation of part of the brain), spina bifida (defect in spinal formation), cleft palate and craniosynostosis (premature closure of the sutures of the skull).
Some of the defects may be due to the exposure of the fetus to toxins through inhalation of sidestream smoke. Other theories have implicated the father’s active smoking causing damage to the genetic material at the time of conception.
Conclusion:
Preventing second hand smoke exposure is important for women both before and during pregnancy. There is no doubt that second hand smoke has deleterious effects on the fetus with both higher risks of stillbirth and congenital malformations. This blog stresses the importance of obstetricians asking and advising, not only the direct smoking history of a patient, but also the passive smoking exposure that a patient experiences during the pregnancy. This includes emphasis on paternal smoking habits, with all efforts being made to suggest programs for smoking cessation and maintaining smoke free workplace and home environment.
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Tags: birth defects, cigarettes and pregnancy, damage to the fetus, health, healthy baby, healthy pregnancy, passive smoke exposure, safe, safety, second hand smoke and pregnancy, Sids, smoking, smoking and pregnancy, smoking while pregnant, Sudden Infant Death Syndrome
Posted in Birth Defects & Infant Disorders | 3 Comments »
Monday, November 29th, 2010
 Young parents who want to provide the very best care for their new baby are often bombarded with conflicting recommendations regarding product safety. These products come and go, sometimes end in manufacturer recalls… but often remain in the stores because no definitive studies have been performed regarding their safety.
That’s why today I thought it important to discuss one particular controversial infant product; sleep bolsters for the crib or bassinet which have recently received a warning from the FDA. These bolsters are still on the market but should be researched very carefully before taking any action or making any purchase.
SIDS Prevention
In a previous newsletter, dated November 3rd 2009, I described the risks of SIDS in newborns and what parents might do as a measure of prevention. One of the most important suggestions was to always keep sleeping infants on their backs.
This theory prevails because a major risk factor for SIDS is sleeping a newborn on their side or face down on the baby’s stomach. Because of this information, companies have designed infant sleep positioners as a means of forcing a child to sleep in a certain position. These sleep positioners are usually flat mattresses with side bolsters or wedge mattresses that elevate the head of the baby. However, no scientific studies have been presented to the FDA to verify the claims that these positioners actually work to prevent SIDS.
Sleep positioners are also sold to ease colic, prevent gastroesophageal reflux and prevent plagiocephaly or flat head syndrome where pressure has been placed on a particular aspect of the baby’s skull causing a bony deformation. However the FDA and Consumer Product Safety Commission have recently issued warnings to stop using these products.
Sadly, several reports have now surfaced in which infants have died of suffocation because of these devices. As a matter of fact, a total of 12 infants have died in the past 13 years due to these products. It seems that infants have managed to change their positions from being initially on their backs to their sides or abdomens and have been unable to self-correct. This places them in one of several potentially dangerous situations or positions.
As stated in our previous blog, parents should also avoid pillows, comforters and quilts in a baby’s crib for the same reasons.
During this holiday season, please remember to be particularly vigilant regarding gifts that are received from well-intentioned, but not fully informed, relatives and friends. If you know anyone who may benefit from reading this article, please feel free to forward them this email.
Tags: baby, crib death, crib products, FDA warning, infant bolsters, safety, Sids, sleep positioners, sleeping psition, Sudden Infant Death Syndrome
Posted in Infant & Pregnancy Safety | No Comments »
Tuesday, November 3rd, 2009
 Sudden infant death syndrome, commonly known as SIDS, refers to the sudden unexplained death of an apparently healthy infant under the age of one. It is the most common cause of death in infants between the ages of one month and one year in developed countries. The risk in the United States is .57 per 1000 births. Families that have lost one child from SIDS have a higher risk of recurrence.
Interesting facts about SIDS:
- More common in boys than girls (60:40 ratio)
- Peaks between 2 to 4 months and generally occurs before 6 months of age
- Blacks, American Indians, and Native Alaskans have 2 to 7 times the risk over the national average
- Japan and Netherlands have the lowest incidence; New Zealand has the highest; USA and UK are intermediate risk
- Risk is declining worldwide
- Premature infants with low birth weights have four times the risk of SIDS compared to full term infants.
Risk factors for SIDS
- Sleep position
Numerous studies have shown that the supine position reduces the risk of SIDS by a factor of 20. Both side position and prone position have similar risks and should be avoided.
- Maternal smoking
Prenatal and postnatal smoking both increase the risk of SIDS. Findings show that smoking decreases lung volume and heart rates in the infant. Nicotine also causes detrimental effects on the infants ability to respond to low oxygen levels.
- Soft bedding and accessories
Pillows, quilts, comforters, and porous mattresses all increase risk of SIDS. Infants should not sleep on a couch or armchair. The American Academy of Pediatrics recommends that infants sleep on a firm surface without accessories.
- Warm room temperatures
Overheating of infants with multiple blankets, clothing layers, in a warm room increases the risk of SIDS, especially when infants are placed in the prone position.
- Bed sharing
Co-sleeping increases SIDS risk especially for infants under 11 weeks of age, when the mother smokes, drinks, or is overtired and the infant shares the bed for the entire night. Half the infants who die of SIDS in the United States co-share beds. The ideal environment is in a crib or bassinet separate but near the mother’s bed.
- Pacifiers
Risk of SIDS is reduced with use of pacifiers. These infants have been found to have improved ability to breathe with their mouth and have less of a chance of oropharyngeal obstruction.
What Causes SIDS?
The cause of SIDS is due to three important factors occurring coincidentally
- Vulnerable infant—the theory is that children that succumb to SIDS have abnormalities in their arousal system and are unable to compensate for low oxygen levels. This ability is controlled by certain parts of the brainstem and hypothalamus. There are probably genetic differences that involve serotonin transport activity in the brain and the autonomic nervous system.
- Critical developmental period—the child must be within the first year of life
- Exogenous source—an outside stress like prone sleeping or nicotine exposure.
What Are Some Misconceptions About SIDS?
- Apnea monitor—There is no evidence that they are useful in preventing SIDS
- Immunizations—There is no evidence that immunizations increase the risk of SIDS
- Breast feeding—there is no evidence that it protects an infant from SIDS
Conclusions:
SIDS is due to an interaction between genetic and environmental factors. Teaching parents safe sleeping practices for their infants is essential in reducing the risk of this disease. In particular, sleeping children on their backs, avoiding tobacco and alcohol use, avoid overheating the infant, sleeping children on a firm mattress in a separate bed without accessories , and use of a pacifier can reduce the risk of this problem.
Tags: Sids
Posted in Birth Defects & Infant Disorders, Infant & Pregnancy Safety | 1 Comment »
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