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Deficient hypoxia awakening response in infants of smoking mothers: Possible relationship to sudden infant death syndrome
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Editor’s Comment: Due to the different mechanism of injury, an isolated EDH does not carry the same significance in terms of abuse.
0 RISK FACTORS FOR SUDDEN INFANT DEATH SYNDROME: FURTHER CHANGE IN 1992-3. Hiley CM, Morley CJ. BMJ. 1996;312:1397. An infant care survey was sent to randomly selected mothers of babies born without complication when infants were 6 months old in 1992. A similar survey was sent to mothers of 6-month-old infants who were born in December 1993, 2 years after a television campaign to decrease crib death. Ninety percent of mothers surveyed in 1992 responded and 85% surveyed in 1993 responded. When results of the two surveys were compared, there were significant decreases seenin the number of infants reported to be sleeping on their side and front. Use of quilts and duvets also significantly decreased. Fewer parents were concerned about the infant getting too cold, and there was a higher percentageof parents using wall thermometers. More babies slept in their parents’ bed and were older when they began sleeping in a crib. No change was noted in maternal smoking or breast-feeding patterns. These changes coincided with a falling incidence of crib death. Thus, the authors conclude that the crib-deathprevention campaign continues to have a positive effect on infant care practices. Further decreasesin crib death may be achieved by reducing maternal smoking, continuing to discourage sleeping on the front, and increased vigilance over the baby. [Catherine M. Hurt]
0 SEASONALITY OF THE SUDDEN INFANT DEATH SYNDROME DURING 1987-9 AND 1991-3 IN AUSTRALIA AND BRITAIN. Douglas AS, Allan TM, Helms PJ. BMJ. 1995;311:1381. A retrospective review of monthly mortality data collected for sudden infant death syndrome prior to (19871989) and after (1991-1993) widespread adoption of “face upwards” sleeping position was performed to determine if seasonality persists despite the falling incidence of sudden infant death syndrome. The Office of Population Censuses and Surveys provided data on 2401 deaths in Australia and 6630 deaths in Britain attributed to sudden infant death syndrome. When the 1987-1989 data and 1991-1993 data were compared, rates fell in every month in the 1991-1993 data set. Although rates fell relatively more in the winter than in the summer, seasonality remained a distinctive feature of sudden infant death syndrome. Results in Britain and Australia were similar despite the 6-month shift in hemispheric phase. The authors conclude that seasonal variation continues to be an unexplained epidemiological feature that warrants further studies to determine its relation to the etiology of sudden infant death [Catherine M. Hurt] syndrome.
Abstracts
Cl DEFICIENT HYPOXIA AWAKENING RESPONSE IN INFANTS OF SMOKING MOTHERS: POSSIBLE RELATIONSHIP TO SUDDEN INFANT DEATH SYNDROME. Lewis KJ, Bosque EM. J Pediatr. 1995; 127:691699. Because the exact mechanism of how smoking increases the risk for sudden infant death syndrome (SIDS ) is unclear, this study sought to examine possible differences in control of ventilation and awakening responsesin infants of smoking and nonsmoking mothers. Infants of 34 nonsmoking and 13 smoking mothers participated in the study. The maternal exposure to nicotine was determined by blood nicotine levels. Eight to 12-week-old infants were studied for ventilation and awakening responsesto hypoxia and hypercapnia. The changes in alveolar ventilation due to hypoxia or hypercapnia were similar in the two groups. All infants awakened from hypercapnia, and there was no difference in the arousal threshold for CO* (p = 0.28). However, 54% of infants of smokersdid not awaken with hypoxic challenge, in comparison with 15% of the control infants (p = 0.006). Failure to awaken in response to hypoxia may then contribute to the increased risk of SIDS in infants of smoking mothers. [Susan J. Lewis, MD] Editor’s Comment: These studies suggest that we do not know the cause of SIDS. 0 THE PAPERCUFF, A NEW DISPOSABLE BLOOD PRESSURE CUFF. Alpert BS, Cohen ML. Am J Cardiol. 1996;77:531-532. This prospective study evaluated the accuracy of a new disposable blood pressurecuff by comparing Blood Pressure (BP) readings from three experimental cuffs. Cuffs were all attachedin sequenceto a CAS OscilloMate 9300 BP monitor with an auscultation reading by two blinded observerson the contralateral arm using a standard Baum cuff of appropriate size and a mercury sphygmomanometer. The experimental cuffs were the Critikon Dura-Cuff, the Baum cloth cuff, and the PAPERCUFF, developed by CAS Medical Systems (Branford, CT). One hundred eighty-four subjectsfrom childhood to late adulthood were recruited by advertisements. Three width sizes of BP cuffs were tested (over 40% of the circumference of the arm). An equal number of readings from each arm were sought. The order of the three cuffs differed according to a randomization table, and five inllation cycles were performed with each experimental cuff. After exclusion for incomplete data, 182 patients’ data were analyzed: 12-cm cuffs (n = 60), 14cm cuffs (n = 63), and 16-cm cuffs (n = 59). Statistical analyses showed that few of the comparisons between the PAPERCUFF and the other experimental or standard cuffs were significant. However, the authors still conclude that, because the PAPERCUFF values were closer to the reference standardthan were the other experimental cuffs, the CAS PAPERCUFF should provide accurate clinical data to the physician and limit the possibility of the spread of infection, especially of HIV and hepatitis. [Christy M. Rosa, MD] Editor’s Comment: However, there is minimal infectious risk from a blood pressure cuff.
Editor’s Comment: Due to the different mechanism of injury, an isolated EDH does not carry the same significance in terms of abuse.
0 RISK FACTORS FOR SUDDEN INFANT DEATH SYNDROME: FURTHER CHANGE IN 1992-3. Hiley CM, Morley CJ. BMJ. 1996;312:1397. An infant care survey was sent to randomly selected mothers of babies born without complication when infants were 6 months old in 1992. A similar survey was sent to mothers of 6-month-old infants who were born in December 1993, 2 years after a television campaign to decrease crib death. Ninety percent of mothers surveyed in 1992 responded and 85% surveyed in 1993 responded. When results of the two surveys were compared, there were significant decreases seenin the number of infants reported to be sleeping on their side and front. Use of quilts and duvets also significantly decreased. Fewer parents were concerned about the infant getting too cold, and there was a higher percentageof parents using wall thermometers. More babies slept in their parents’ bed and were older when they began sleeping in a crib. No change was noted in maternal smoking or breast-feeding patterns. These changes coincided with a falling incidence of crib death. Thus, the authors conclude that the crib-deathprevention campaign continues to have a positive effect on infant care practices. Further decreasesin crib death may be achieved by reducing maternal smoking, continuing to discourage sleeping on the front, and increased vigilance over the baby. [Catherine M. Hurt]
0 SEASONALITY OF THE SUDDEN INFANT DEATH SYNDROME DURING 1987-9 AND 1991-3 IN AUSTRALIA AND BRITAIN. Douglas AS, Allan TM, Helms PJ. BMJ. 1995;311:1381. A retrospective review of monthly mortality data collected for sudden infant death syndrome prior to (19871989) and after (1991-1993) widespread adoption of “face upwards” sleeping position was performed to determine if seasonality persists despite the falling incidence of sudden infant death syndrome. The Office of Population Censuses and Surveys provided data on 2401 deaths in Australia and 6630 deaths in Britain attributed to sudden infant death syndrome. When the 1987-1989 data and 1991-1993 data were compared, rates fell in every month in the 1991-1993 data set. Although rates fell relatively more in the winter than in the summer, seasonality remained a distinctive feature of sudden infant death syndrome. Results in Britain and Australia were similar despite the 6-month shift in hemispheric phase. The authors conclude that seasonal variation continues to be an unexplained epidemiological feature that warrants further studies to determine its relation to the etiology of sudden infant death [Catherine M. Hurt] syndrome.
Abstracts
Cl DEFICIENT HYPOXIA AWAKENING RESPONSE IN INFANTS OF SMOKING MOTHERS: POSSIBLE RELATIONSHIP TO SUDDEN INFANT DEATH SYNDROME. Lewis KJ, Bosque EM. J Pediatr. 1995; 127:691699. Because the exact mechanism of how smoking increases the risk for sudden infant death syndrome (SIDS ) is unclear, this study sought to examine possible differences in control of ventilation and awakening responsesin infants of smoking and nonsmoking mothers. Infants of 34 nonsmoking and 13 smoking mothers participated in the study. The maternal exposure to nicotine was determined by blood nicotine levels. Eight to 12-week-old infants were studied for ventilation and awakening responsesto hypoxia and hypercapnia. The changes in alveolar ventilation due to hypoxia or hypercapnia were similar in the two groups. All infants awakened from hypercapnia, and there was no difference in the arousal threshold for CO* (p = 0.28). However, 54% of infants of smokersdid not awaken with hypoxic challenge, in comparison with 15% of the control infants (p = 0.006). Failure to awaken in response to hypoxia may then contribute to the increased risk of SIDS in infants of smoking mothers. [Susan J. Lewis, MD] Editor’s Comment: These studies suggest that we do not know the cause of SIDS. 0 THE PAPERCUFF, A NEW DISPOSABLE BLOOD PRESSURE CUFF. Alpert BS, Cohen ML. Am J Cardiol. 1996;77:531-532. This prospective study evaluated the accuracy of a new disposable blood pressurecuff by comparing Blood Pressure (BP) readings from three experimental cuffs. Cuffs were all attachedin sequenceto a CAS OscilloMate 9300 BP monitor with an auscultation reading by two blinded observerson the contralateral arm using a standard Baum cuff of appropriate size and a mercury sphygmomanometer. The experimental cuffs were the Critikon Dura-Cuff, the Baum cloth cuff, and the PAPERCUFF, developed by CAS Medical Systems (Branford, CT). One hundred eighty-four subjectsfrom childhood to late adulthood were recruited by advertisements. Three width sizes of BP cuffs were tested (over 40% of the circumference of the arm). An equal number of readings from each arm were sought. The order of the three cuffs differed according to a randomization table, and five inllation cycles were performed with each experimental cuff. After exclusion for incomplete data, 182 patients’ data were analyzed: 12-cm cuffs (n = 60), 14cm cuffs (n = 63), and 16-cm cuffs (n = 59). Statistical analyses showed that few of the comparisons between the PAPERCUFF and the other experimental or standard cuffs were significant. However, the authors still conclude that, because the PAPERCUFF values were closer to the reference standardthan were the other experimental cuffs, the CAS PAPERCUFF should provide accurate clinical data to the physician and limit the possibility of the spread of infection, especially of HIV and hepatitis. [Christy M. Rosa, MD] Editor’s Comment: However, there is minimal infectious risk from a blood pressure cuff.