Sudden infant death syndrome

What it is, and what you can do to prevent it

Baby Child kid Infant
The most significant risk factors for sudden infant death syndrome are sleep practices. Before the age of one year, it is important to ensure your baby sleeps fully on their back and not on their side or stomach. (Photo: Unsplash)
Having a child can be stressful, especially for first-time parents. Every parent wants their child to be healthy and happy. Unfortunately, infancy, typically defined as the first 365 days after birth, can be the scariest time for parents, as children at this age are at risk of a condition known as sudden infant death syndrome (SIDS). اضافة اعلان

According to statistics published in 2010, SIDS is the third leading cause of infant mortality. It is estimated that roughly 8.6 percent of infant deaths in the US are caused by SIDS. To date, the most useful tool we have to help combat this is education and spreading awareness, in hopes of reducing incidences.

Unexpected, unexplained
SIDS is the sudden, unexpected, and often unexplained death of a seemingly healthy infant. It is the most common cause of death for infants between the ages of one month and one year old, but most frequently occurs between the ages of two and four months. It also occurs most often during sleep, and is sometimes referred to as crib death as a result.

The cause of SIDS is still unknown, but many theories exist. The leading theory is that an infant who dies as a result of SIDS lacks the necessary neurotransmitters in sufficient levels to wake up. Neurotransmitters are small chemicals that help send messages, and the one in question is acetylcholine (Ach). Ach belongs to a system known as the cholinergic system, which plays a role in many life sustaining functions such as heart rhythm and breathing. It has also been found to play a significant role in waking. Any deficits in Ach and the cholinergic system as a whole could result in an infant not being able to wake up.

This theory has gained further support after a study published this year found that infants who died as a result of SIDS had lower levels of butyrylcholinesterase (BChE) compared to living infants and infants who died of other causes. BChE is an enzyme that helps regulate Ach, and lower levels of this enzyme may suggest a cholinergic deficit. However, it should be noted that low levels of BChE only serve as an indicator, not a cause.

The triple-risk model
Additionally, it is believed that SIDS is not caused by deficits or abnormalities alone. Instead, it has been proposed that SIDS is the result of three risk factors that can lead to SIDS only when all of them are present. This is referred to as the triple-risk model. The first risk factor is infant vulnerability. This factor covers underlying conditions such as cholinergic deficits, and can also include potential genetic disorders.

The second risk factor is that the infant is within the critical developmental period, which is generally considered to be the first six months of life, but can last up until the first year. The final factor is the presence of external environmental stressors. These environmental stressors are not considered to be a definitive cause, but instead greatly reduce the chance of a vulnerable infant overcoming other risks.

Environmental stressors
Many household and caregiving practices have been used for centuries, but that does not mean that they are all healthy or safe. As the understanding of SIDS has improved, so too has the identification of potentially harmful practices. These practices are considered environmental stressors and may negatively contribute to an infant’s odds of survival.

The most significant risk factors for SIDS are sleep practices. Before the age of one year, it is important to ensure your baby sleeps fully on their back and not on their side or stomach. Similarly, it has been found that having the infant sleep in the same room as you reduces the risk of SIDS. However, the infant should be in the crib by themselves, since sharing a bed with a parent, sibling, or pet can increase the level of risk.

Additionally, swaddling an infant can help reduce the risk of SIDS, but it must be done properly, or the risk will increase. Infants should not be wrapped in multiple layers, even in the winter, and their heads should not be wrapped or covered. This is because improper swaddling can cause overheating, which can raise the risk of sudden, unexpected death. Lastly, the crib should be safe and have a firm mattress, and toys, pillows, blankets, and sleep positioners/bumpers should be removed.

Furthermore, infants born premature (at less than 37 weeks) or those with low birthweight have up to a four times greater risk. Another factor that can increase the danger of SIDS occurring is a recent respiratory infection, particularly in babies that are older than three months. Lastly, smoking can have a serious impact on the risk of SIDS. Mothers who smoke during pregnancy place their child at a three times greater risk of SIDS. Similarly, smoking near an infant (also referred to as second-hand smoke) doubles the risk of SIDS.

SIDS in Jordan
The incidence of SIDS in Jordan is minimal, and this holds true for the entire Middle East. However, depending on the source, the Middle East may have a higher incidence compared to Western nations. According to the Institute for Health Metrics and Evaluation’s Global Burden of Disease 2017 data, sudden infant death accounts for 4.4 percent of infant deaths. However, a 2005 study conducted in Irbid found that SIDS occurs in 1.3 infants per every 1,000. Meanwhile, the US reported in the same year that SIDS occurred in an average 0.54 per every 1,000 infants, meaning that Jordan has an incidence rate nearly 2.5 times greater. Another study found Jordan to have a nearly 13 times greater rate of SIDS than the Netherlands.

It has been suggested that the cause for the higher incidence rate is not due to inherent genetic differences between the Middle East and Western nations, but instead, cultural practices. A 2016 study conducted in Jordan looked at several household practices that mothers use to care for their infants. The study found that the majority of Jordan’s mothers do follow important, proper methods to reduce the risk of SIDS. For example, it was found that 92 percent of mothers do not lay their infants on their stomachs to sleep, and 90 percent keep their infants in their room to be supervised during the night.

However, it was also found that 88 percent of mothers place their infants on their sides, and 50 percent do this most of the time. Additionally, 81 percent of mothers reported using multiple layers of quilts during the winter to cover their babies, and 84 percent indicated that they cover their infants’ heads. Lastly, 73 percent reported using kerosene, wood, or gas heaters in a closed room during the winter, while only 10 percent regularly ventilate the room (about every two hours). It was concluded that Jordanians frequently participate in practices that place their infants at a higher risk for SIDS.

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