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A New Theory on Sudden Infant Deaths Divides Doctors
Researchers point to certain breast-feeding strategies used with newborn babies, but some medical experts disagree
The practice of encouraging skin-to-skin care between newborns may inadvertently be contributing to the sudden and unexpected deaths of infants, the authors of a recent study say. PHOTO: GETTY IMAGES/ISTOCK
By
Sumathi Reddy
March 26, 2018 10:54 a.m. ET
Doctors researching unexpected infant deaths have discovered a baffling trend: The rate of those deaths among newborns has remained unchanged even as the numbers in older infants have dropped over 20 years.
The finding on sudden and unexpected infant deaths (SUID) is surprising, says Joel Bass, chair of the pediatrics department at Newton-Wellesley Hospital in Newton, Mass., and first author of the study.
“That’s more than one newborn baby dying of SUID a day,” says Dr. Bass, whose team’s research appeared in the Journal of Pediatrics in February. “A normal newborn is not supposed to die.”
Experts believe efforts like the “back-to-sleep” recommendations by the American Academy of Pediatrics in 1992 helped drive down the unexpected death rate of infants between one month and 1 year of age. But “the newborn got no benefit” from the campaigns to have infants sleep on their backs, Dr. Bass says.
Among the possible causes some researchers point to is the promotion of certain hospital practices to encourage breast-feeding. But some doctors vehemently disagree with that theory. This delicate topic is further complicated by the many benefits breast-feeding provides newborns, including its role in the prevention of infant deaths.
Researchers from Newton-Wellesley and Massachusetts General hospitals reviewed 20 years of national SUID data between 1995 and 2014. SUID is defined as any death whose cause isn’t immediately apparent occurring in otherwise healthy infants under age 1.
They divided the deaths into two groups: those that took place in the first 28 days of life and those that took place between one and 12 months. The rate of these deaths in babies in the first group was 11 per 100,000 births in 1995. By 2014, the rate hadn’t changed. In the older group, the rate declined by nearly 23%, from 101 deaths per 100,000 births in 1995 to 78 per 100,000 in 2002, with no further decline after that.
The researchers also found that the rates of accidental suffocation went up in both groups at similar rates. The increase could be due to more reporting of such deaths, but also could stem from unsafe sleep practices, Dr. Bass says.
The Centers for Disease Control and Prevention reported 3,700 cases of SUID in 2015, the most recent year available.
One possible explanation: the promotion of “skin-to-skin care,” when naked infants are placed on the mother’s chest after birth. While beneficial in the first hour or two after birth when closely observed, skin-to-skin contact can turn dangerous later when not monitored or at home, the researchers say. If a parent falls asleep with a baby lying on their chest it could lead to respiratory death or suffocation.
Conflicting signals over pacifier use could also play a part, researchers say. Some hospitals now discourage pacifier use while first teaching babies to breast-feed with their mothers. Yet a study found that newborns exposed to pacifiers in the nursery are more likely to use them later—important because studies have found pacifiers reduce the risk of sudden infant death syndrome.
(SIDS deaths remain unexplained after an autopsy, unlike some other SUID deaths. SUID is a more recent term that also includes deaths by known causes like unsafe bedding that cause suffocation.)
About 500 U.S. hospitals designated as “baby-friendly” encourage skin-to-skin care and avoid pacifier use. A nonprofit called Baby-Friendly USA gives the designation to hospitals that encourage breast-feeding, which has also been shown to reduce the incidence of SIDS.
Breast-feeding experts say when newborns first learn breast-feeding, pacifiers and artificial nipples can confuse them and make them less apt to breast-feed. Studies have found skin-to-skin contact between a mother and child conveys important health benefits to newborns. Dr. Bass says the evidence is for the first hour or two of life only.
Others in the field have been quick to criticize the study. Among them is Lori Feldman-Winter, a pediatrics professor at Cooper Medical School of Rowan University in Camden, N.J., who has collaborated with Baby-Friendly USA.
“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,” says Dr. Feldman-Winter, who is a member of the American Academy of Pediatrics task force on SIDS and a lead author on the organization’s 2016 safe-sleep report.
Factors could include the high percentage of premature babies and continued unsafe sleeping environments or behaviors, she says.
The researchers speculate that many of the deaths that take place in the first week may be caused by sudden unexpected postnatal collapse. This occurs in full-term babies in the first week of life and often results in respiratory and cardiac arrest due to a breathing obstruction.
Dr. Feldman-Winter notes that often infants said to have died from this condition will later be diagnosed with a problem in their brain or heart.
However, Dr. Bass says such deaths are associated with skin-to-skin contact. Numerous studies have found a link between increased rates of such deaths when skin-to-skin policies were instituted in hospitals in countries including Spain and Australia. Dr. Bass says the studies are strong enough to show causation.
Melissa Bartick is an assistant professor of medicine at Cambridge Health Alliance and Harvard Medical School who volunteers to help hospitals become designated as baby-friendly. She called it “ridiculous” to draw the conclusion that there’s a link between newborn deaths and skin-to-skin care.
She noted that since 40% of the deaths in the first six days of life were in premature babies, there could have been other health complications. She also said there could have been other factors the study didn’t examine, like smoking or drug use by the mothers.