Sudden deaths in newborns have not fallen in the last 25 years despite safe sleep guidelines, according to new research.
In fact, the rate of babies dying from suffocation has increased since safe-sleep recommendations were published in 1992.
Experts warn the stagnant figures are a sign that efforts to promote ‘safer’ sleeping positions have been futile.
Parents are advised to put babies to sleep on their fronts, and never to sleep with their babies in their beds to avoid cot deaths.
However, despite these recommendations, there has been barely any shift in the rate of sudden unexpected infant death, when children seemingly die inexplicably in the first 12 months of their life.
Rates of sudden unexpected infant deaths in the United States per 100,000 births
Senior author Professor Ronald Kleinman, a pediatrician at Harvard Medical School, said part of the reason could be that parents are more focused on other major concerns that they do not realize the gravity of something like a sleeping position.
He pinpoints the increase in public health campaigns promoting breastfeeding as a factor that may have led to more mothers sleeping with their babies in their beds.
‘Overall, we think it is possible certain neonatal practices resulting in unsafe sleep circumstances both during and after the birth hospitalization, along with pacifier avoidance, may have inadvertently interfered with the implementation of safe-sleep messages and prevented a decrease in the death rate,’ he said.
SUID is the shock death of an apparently healthy, full term infant under the age of one for no immediately apparent reason.
It includes cot death, or SIDS (sudden infant death syndrome) and deaths found to result from accidental strangulation or suffocation caused by unsafe bedding, becoming trapped between a mattress and a wall, or sleeping with a parent or another adult who inadvertently blocks the infant’s airway.
In 1992 the American Academy of Pediatrics (AAP) released its ‘back to sleep’ recommendations but a drop in tragedies did not occur in infants in the first month of life.
Lead author Prof Joel Bass, chair of the Newton-Wellesley Hospital department of pediatrics in Massachusetts, said: ‘The frequency of SUID in the first month of life is higher than generally recognized, at an average of 444 cases per year in the US, of which 66 per year occur on the first day and 130 occur in the first week of life.
‘There actually has been a dramatic and unexpected increase in deaths attributed to suffocation and asphyxiation in both newborns and infants up to one year old, and these deaths are potentially preventable.’
Using Centers for Disease Control and Prevention records of births and infant deaths from 1995 through 2014, the researchers analysed deaths occurring in the neonatal (first 27 days of life) and postneonatal (28 days to one year) periods.
While the rates of postneonatal SUID declined nearly 23 percent from 1995 to 2002, after which they remained stable, rates during the neonatal period remained unchanged.
There has been an uptick in the percentage of neonatal sudden unexpected infant deaths despite a decline in postneonatal SUID
During that 20-year period the percentage of SUID cases attributed to suffocation or strangulation increased in both age groups – from around 2 percent to nearly 23 percent in the neonatal period and from 3.4 percent to almost 25 percent in the postneonatal period.
Almost 30 percent of neonatal deaths occurred during the first six days of life.
Prof Bass said many may be the result of sudden unexpected postnatal collapse (SUPC).
This is a sudden collapse – sometimes with full respiratory and cardiac arrest – of an apparently healthy newborn born at more than 35 weeks gestation.
SUPC leads to death in around half the cases and serious neurological consequences in half of survivors.
The researchers believe several recommended practices designed to promote breastfeeding, the importance of which they fully support, may inadvertently contribute to the risks.
The practice of skin-to-skin care, in which an infant is placed in a prone position on the mother’s chest has been noted in other reports to have a strong association with SUPC.
If the mother is also exhausted or sedated, she may even fall asleep with the infant on her chest resulting in co-bedding, an established risk factor for SIDS.
Another recommendation that may have unintended consequences is avoiding the use of pacifiers, which some breastfeeding advocates suggest eliminating and the AAP advises should not be used until breastfeeding is well established.
As pacifier use is strongly associated with a reduced risk of SIDS, the authors feel that recommendation should be reconsidered.
Since breastfeeding is also associated with a reduced risk of SIDS, the authors recommend that safe-sleep education be integrated with lactation advice.
Professor Kleinman added: ‘Future research is needed to more fully explore the best messaging during the birth hospitalization that will enhance safe-sleep practices recommended by both the National Institutes of Health and the AAP and help to prevent SUID.’