March 30, 2018

Why hasn't the newborn SUIDs death rate fallen in 20 years?

Daily Briefing

    While the U.S. rate of sudden unexpected infant deaths (SUIDs) among first year infants fell from 1995 to 2014, a recent study in the Journal of Pediatrics found the SUIDs rate among newborns remained unchanged—and some experts say a popular care practice could be the reason.

    For the study, researchers from Newton-Wellesley Hospital and Massachusetts General Hospital examined data on SUIDs spanning from 1995 to 2014. The researchers divided the data on SUIDs into two age groups:

    • Deaths occurring during the first 28 days of a newborn's life; and
    • Deaths occurring between one and 12 months of an infant's life.

    The researchers defined SUIDs as deaths that occur in infants under one-year old who are otherwise healthy and for which the cause of death was not immediately apparent.

    Findings

    The researchers found the rate of SUIDs among infants in their first 28 days of life in 1995 was 11 per 100,000 births and remained unchanged in 2014. In comparison, the researchers found the rate of SUIDs among infants between one- and 12-months old fell from 101 deaths per 100,000 births in 1995 to 78 deaths per 100,000 in 2002, representing a nearly 23% decline. That rate held steady from 2002 to 2014.

    According to the researchers, a recent push for so-called "skin-to-skin care," in which a woman places her naked infant on her chest soon after she gives birth, could explain why SUIDs among infants in their first 28 days of life has not decreased. The researchers said skin-to-skin contact is beneficial within the first one or two hours after an infant is born—but only if it is closely observed. The researchers said such contact can become dangerous if the new mother falls asleep with her baby against her chest, as it could potentially lead to suffocation or a respiratory death.

    Joel Bass, a co-author of the study and chair of the pediatrics department at Newton-Wellesley Hospital, said skin-to-skin contact has also been associated with sudden unexpected postnatal collapse, which occurs in full-term infants and leads to respiratory and cardiac arrest because of a breathing obstruction, and could account for some newborn SUIDs cases. According to the Wall Street Journal, several studies have shown a link between a rise in such deaths when hospitals in countries such as Australia and Spain have instituted skin-to-skin care policies. 

    Reaction

    Although it is positive that the rates have not trended up, Bass said the study found that SUID rates were still surprisingly high. "That's more than one newborn baby dying of SUID a day" he said. Bass said recommendations issued by the American Academy of Pediatrics in 1992 on how to position infants for sleep might have helped reduce SUIDs among infants between one-month and 12-months old, but newborns did not benefit.

    But other experts say skin-to-skin contact alone might not be to blame for SUIDs, and caution against making such connections without clear evidence.

    Lori Feldman-Winter, a pediatrics professor at Cooper Medical School of Rowan University, said, "There are reports that have drawn attention to the fact that there are babies either dying or requiring resuscitation while in skin-to-skin care, and it doesn't mean the skin-to-skin care is causing it." She said factors leading to newborn deaths in such instances could include unsafe sleeping environments, as well as a rising share of babies being born prematurely.

    Melissa Bartick, an assistant professor of medicine at Cambridge Health Alliance and Harvard Medical School, said it is "ridiculous" to draw the conclusion that there is an association between newborn deaths and skin-to-skin care.  

    Bartick noted that 40% of SUID deaths that occurred during the first six days of an infant's life affected premature babies, and said several health complications could have contributed to the deaths. Other factors not examined by the study, such as smoking or drug use among pregnant women, also could have led to the deaths, Bartick said (Reddy, Wall Street Journal, 3/26).

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