Sudden infant death syndrome (SIDS) is the devastating condition in which an infant suddenly and unexplainably passes away over the course of sleeping. This is an unfortunate situation that many new parents dread every night as they lay their newborns to rest. SIDS is the leading cause of death in infants aged from one month to one year, and the medical world still does not fully understand what causes it. However, the triple-risk theory is a new model that sets out to explain the pathology of this syndrome through the combination of genetic vulnerabilities, a critical time period, and external stressors. This thesis summarizes the current research in the realm of the central nervous system (specifically the cerebellum and brainstem) as a means of evaluating the validity of this new model. The analyzed literature concentrated on a few important topics, such as proven risk factors, evidence of homeostatic abnormalities, and significant associations with the occurrence of SIDS. It was found that there was central nervous system dysfunction on most levels, including: damaged Purkinje cells in the cerebellum, malformations of the human choroid plexus, decreased neuropeptide signaling (both orexin and brain-derived neurotrophic factors), malformations of the amino acid neurotransmitters (both excitatory glutamate and inhibitory GABA), and finally significant reductions in the receptor density and activity of the serotonin system. These irregularities were associated, in most studies, with either the prone sleeping position or known maternal nicotine use during pregnancy. In conclusion, the triple-risk model is currently the most accurate description of SIDS, given its reasonable three criteria and present-day research. This is because the studies, and real-life victims, were all concentrated within the critical time period of transition from intra-uterine to extra-uterine life, satisfying the first element of timing. The list of central nervous system dysfunctions found in SIDS cases was compelling enough to fulfill the second factor of inherent vulnerability. Finally, the associations between low oxygen rebreathing and the prone sleep position, or over-heating and tight swaddling displayed a strong relationship with the occurrence of SIDS and satisfied the third and final event, which was the induction of an exogenous stressor. These three factors of the triple-risk model allow for the variations in victim pathology, but still offers a compelling and coherent understanding of the sudden infant death syndrome.

ABSTRACT Objective The aim of this study was to determine if and what kind of scientific evidence there is for the advice that breast-feeding can reduce the risk of sudden infant death syndrome (SIDS). The aim was to investigate research on the subject published in the last 15 years. Method A systematic review without meta-analysis with relevant original articles published in the last 15 years. Main results After searching for articles 26 relevant articles were used for this study and two were excluded because of poor quality. Mixed results were shown on breast feeding and the risk of SIDS. Breast-feeding seems to have some protective effect but can’t be separated from known risk factors of SIDS. Plain language summary Breast feeding can be regarded as a preventive measure against SIDS. However socioeconomic factors may play a bigger part than breast feeding alone in the protection against SIDS. Mothers should be given the advice to breast feed as a preventive measure of SIDS. The authors suggest that more research is needed. / ABSTRACT Syfte Syftet med denna studie är att undersöka om och i så fall vilket vetenskapligt stöd det finns för rådet om amning som preventiv åtgärd mot plötslig spädbarnsdöd (sudden infant death syndrome, SIDS). Studien syftar till att undersöka de senaste 15 årens forskning i ämnet. Metod En systematisk litteraturstudie utan meta-analys med relevanta originalartiklar publicerade de senaste 15 åren. Resultat Antalet relevanta artiklar var 26, två artiklar exkluderades på grund av låg kvalitet. Sex kategorier relaterade till amning kunde identifieras. De granskade studierna har visat varierande resultat gällande amningens inverkan på risken för SIDS. Amningen har visats ha skyddande effekter som inte kan särskiljas från kända riskfaktorer för SIDS. Slutsats Amning kan fungera som en preventiv åtgärd mot SIDS. Dock verkar socioekonomiska faktorer ha en större roll än amning enskilt för att ge ett skydd mot SIDS. Rådet om att amning skyddar mot SIDS är adekvat och denna litteraturöversikt kan ge ökad kunskap om olika aspekter av amningens effekter. Författarna menar att det finns ett behov av ökad kunskap inom detta område.

There are currently 962 geographic sites in the world that have been classified as World Heritage. World Heritage is a unique concept, privy to and defined by UNESCO-- the United Nations, Educational, Scientific and Cultural organization, one of the specialized agencies and autonomous organizations established within the UN-United Nations system. World Heritage is governed by an international treaty called the Convention Concerning the Protection of the World Cultural and Natural Heritage, adopted by UNESCO in 1972 (The `Convention'). The inscription of a World Heritage Site or designation of World Heritage Status is highly coveted and considered in UNESCO parlance to be of "Outstanding Value to Humanity." There are only 4 heritage property sites of English-speaking islands in the Caribbean basin, one of which is located on the island of St. Lucia called The Pitons Management Area (PMA). The PMA comprises 2902 hectares of protected marine and terrestrial property inscribed in 2004. In 2008, the island faced the threat of placement on UNESCO's List of World Heritage in Danger (LWHD) for breaches of the Convention. The main purpose of this study was to evaluate the perceptions of World Heritage Status from three identified stakeholders: UNESCO, the St. Lucian national government and the local Soufrière township-home of the PMA. This was an exploratory attempt at gauging perceptions of local voices on World Heritage Status as it relates to the PMA and the island's classification as a small-island developing state (SIDS). Using political ecology as a theoretical framework for analyzing the role of power relationships in this case study, this research revealed that there is an overall lack of communication between the Soufrière community and the national government regarding education and sensitizing about the World Heritage program mandates and incorporating the local citizenry in the protection of their heritage. The majority of the local participants' support for World Heritage Status on the island of St. Lucia was dependent on perceptions of increased income and employment opportunities associated with World Heritage as a global construct and narrative. This research also showed concerns of UNESCO and the St. Lucian national government to be at odds with the 1972 Convention. Results indicated that the varied perceptions of the three stakeholder groups are based on the prioritized interests of each and incommensurate with the aims of protecting the PMA's heritage for posterity.

Introduction and Rationale: Sudden infant death syndrome (SIDS) continues to be the leading cause of death in infants 28 days to 12 months old and the third leading cause of infant mortality (CDC, 2014; Task Force on SIDS, 2011a). SIDS has no identifiable cause although many hypotheses have existed and there are many known risk factors. Nicotine use is the second most modifiable risk factor for SIDS and to date there is no national public education campaign. Formal education is needed. Written education materials, such as brochures, are an effective way to increase knowledge and awareness of a health topic. Purpose and Objective: The purpose of this DNP Project was to create an educational brochure about SIDS and nicotine as a significant modifiable risk factor. The brochure is directed towards pregnant women and women with infants less than 12 months of age. The objective was to educate and inform mothers about SIDS, nicotine and its relation to SIDS, and the importance of abstaining from nicotine during and after pregnancy. Methods: The brochure was created using the Health Belief Model (HBM) as a framework. The HBM was used to explain health behavior modifications and was used as a foundation for education interventions. The model has successfully been applied to explain other preventative health behaviors and provide health education in various contexts. Results: The brochure was evaluated by two subject matter experts who have published peer reviewed articles using the HBM. Both subject matter experts found the HBM applied to the brochure appropriately. In their opinion, the content of the brochure should have positive impact for health modification in women who use nicotine and are pregnant or have a child less than 12 months of age. Conclusions: This DNP Project demonstrated SIDS as a current significant health problem and identified maternal nicotine use as the second most modifiable risk factor. Due to lack of current public education, a brochure was created using the HBM as a framework. Subject matter experts stated the brochure was created based on the HBM and will likely a have positive health influence on the intended population.

Deaths among the pediatric population encompass a small percentage of the total number of fatalities across the United States. Since the deaths of infants, children, and adolescents are rare, there is little forensic literature concerning this age group. Autopsies, if performed completely, can reveal additional information surrounding circumstances of a case and leads to a determination of a cause of death or a diagnosis of exclusion. Yet studies report that nationwide autopsy rates are low, despite an increase of drugs in the environment and the prevalence of ill-defined causes of death. With the use of the Centers of Disease Control and Prevention (CDC) internet database Wide-ranging Online Data for Epidemiologic Research (WONDER), all deaths of individuals 19 years old and under were analyzed for years 2000, 2005, and 2010. The three main areas that were examined through the WONDER database were poisoning deaths for all ages, ill-defined causes of death for the infant age group, and overall autopsy rates for the three age groups with the highest crude rate of death. The crude death rate for all pediatric age groups have decreased within the examined decade. The infant age group comprised the majority of all pediatric fatalities and had the highest crude death rate. Individuals in the 15 to 19 year age group had the second highest crude death rate of the pediatric population. With a low number of total pediatric poisoning deaths, there has been a steady increase in crude death rate over the decade. The 15-19 age group encompassed the majority of these types of fatalities, with a total of 942 in 2010. It was also discovered that not every pediatric victim was autopsied when a death was diagnosed as a poisoning death when examined by a forensic pathologist. Infant ill-defined causes of death consisted of just over 12% nationwide for all years studied. However approximately 70% of all infant ill-defined causes of death were diagnosed as Sudden Infant Death Syndrome (SIDS) in 2000 and 2010. When examining autopsy rates for the year 2010, autopsies were performed for 32.9% of infant deaths, 55.1% of child deaths between 1-4 years of age, and 59.8% of teenage deaths between 15-19 years of age. In 2010, implementation of autopsies is uncertain for 2,454 deaths under 1 year, 255 deaths between 1 and 4 years, and 666 between 15 and 19 years. Measures need to be put in place nationwide to increase the rate of autopsies for the pediatric population and there needs to be strict accountability when it is not reported on a death certificate whether or not an autopsy was performed. Standard operating procedures should be applied for all autopsies of pediatric victims, with a toxicology examination always being included in an investigation.

Infant apnea is a widespread condition in which infants fail to effectively breathe, and can lead to death. Clinical solutions exist for continuous monitoring of respirations in a hospital setting and requiring constant skin contact. This thesis investigates the construction of a proof of concept device that performs in-home monitoring without skin contact and with commonly available off-the-shelf components. The device constructed used a directional microphone to detect breathing sounds, an omnidirectional microphone to detect ambient noise as a baseline to help isolate the breathing sounds, and LabVIEW software deployed on an inexpensive laptop computer to quantify incidents of apparent lapses in breathing meeting the clinical definition of apnea. Testing results indicate that these components are effective in capturing these events in pre-term infants as well as adults, which provides promising evidence that a low-cost system could be manufactured for home detection to assist in infant monitoring.

No description available.

Thesis (MScMedSc)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Sudden Unexpected Death in Infancy (SUDI) refers to any such sudden demise in a child. If the child dies while asleep within the first year of life, and if no conclusive cause of death can be ascertained by means of complete autopsy and investigation into the circumstances surrounding death, including visit of the death scene, such a case is classified as one of Sudden Infant Death Syndrome (SIDS). By South African law, a full medico-legal autopsy is mandated in cases where the cause of death is not evident – including cases of possible SIDS. There can be little doubt that viral infection can be a cause of death in cases of supposed SUDI. At the Tygerberg medico-legal (forensic) laboratory, the evaluation of lung tissue for the presence of fatal viral lung infections forms part of the institutional protocol for the examination of SUDI cases. Lung samples of these SUDI cases are routinely tested for the presence of Cytomegalovirus (CMV), adenovirus and respiratory syncytial virus (RSV) by means of shell vial cultures. In a retrospective pilot study of 366 SUDI case files from Tygerberg Hospital, Western Cape, from 2004 – 2006, it was evident that in only 13.9% of possible SIDS cases, positive results for one or more of the aforementioned viruses were obtained. We hypothesise that the current method of virus detection, together with other factors such as the interval between death and post mortem examination, transport time of the specimens to the laboratory etc. might not be optimal to give a realistic picture of death in infancy caused by viral pulmonary infection. As other test modalities exist for the diagnosis of pulmonary viral infections, these methods were compared in terms of positive yield and association with viral pneumonitis, keeping the cost and time needed for each assay in mind. A total of 82 samples were collected over an 8 month period and routine shell vial cultures were done, followed by real-time Polymerase Chain Reaction (PCR) and immunohistochemical (IHC) staining of the lung sections with consensus pathology opinion. As expected, the real-time PCR method was much more better suited for identifying positive samples than shell vials (35% vs. 3.7% respectively). IHC staining also aided the pathologist in diagnosing viral infections microscopically. We expect the findings to be instrumental in streamlining not only our institutional SIDS investigation protocol, but also the development of a standardised national SIDS investigation protocol. / AFRIKAANSE OPSOMMING: “Sudden Unexpected Death in Infancy” (SUDI) verwys na enige skielike sterfte van ‘n kind. Indien die kind sterf tydens sy/haar slaap periode en geen oortuigende oorsaak van dood bepaal kan word deur middel van ’n volledige nadoodse ondersoek en ondersoek na die omstandighede tydens die dood, insluitend ’n besoek aan die doodstoneel nie, word so ’n geval as Wiegiedood (SIDS) geklassifiseer. SuidAfrikaanse wetgewing vereis ’n volledige medies-geregtelike nadoodse ondersoek in gevalle waar die oorsaak van dood onbekend is – insluitend gevalle van moontlike Wiegiedood. Daar is min twyfel dat virusinfeksie ‘n oorsaak van, of bydraende faktor tot dood kan wees in gevalle van moontlike SUDI. By die Tygerberg forensiese laboratorium vorm die evaluasie van long weefsel vir die teenwoordigheid van dodelike virusinfeksies deel van die institusionele protokol vir die ondersoek van SUDI gevalle. Long monsters van hierdie SUDI gevalle ondergaan roetine toetse vir die teenwoordigheid van sitomegaalvirus, respiratoriese sinsitialevirus en adenovirus deur middel van selkulture (“shell vial cultures”). In ‘n retrospektiewe steekproef van 366 SUDI gevalle by Tygerberg Hospitaal, Wes-Kaap van 2004 – 2006, is bevind dat in slegs 13.9% van moontlike SUDI gevalle die teenwoordigheid van een of meer van bogenoemde virusse bevestig kon word. Ons hipotese is dat hierdie metode van virus deteksie, tesame met ander faktore soos die tydsinterval tussen dood en nadoodse ondersoek, tyd om monsters na die laboratorium te vervoer ens. moontlik nie optimaal is om ‘n realistiese beeld van dood in babas as gevolg van pulmonale virusinfeksie te gee nie. Aangesien ander toets modaliteite bestaan vir die diagnose van pulmonale virusinfeksies, is hierdie metodes vergelyk in terme van positiewe opbrengs en assosiasie met virale pneumonitis, teen ’n agtergrond van die koste en tyd benodig per toets. ’n Totaal van 82 monsters is oor ‘n 8 maande periode versamel en roetine selkulture is gedoen, gevolg deur “real-time” Polimerase Ketting Reaksie (PKR), asook immunohistochemiese (IHC) kleuring van long snitte met patologiese verslae. Soos vermoed, is gevind dat die real-time PKR metode baie meer akkuraat is om positiewe monsters te identifiseer as roetine selkulture (35% vs 3.7% onderskeidelik). IHC kleuring het ook mikroskopiese diagnose van virale infeksies deur die patoloog vergemaklik. Ons verwag dat hierdie bevindinge grootliks kan bydra in die vaartbelyning van ons institusionele SIDS ondersoek protokol, asook in die ontwikkeling van ’n gestandaardiseerde nasionale SIDS ondersoek protokol.

A review of the literature indicates that how infants are positioned is related to the risk of SIDS, the incidence and severity of plagiocephaly, torticollis, and developmental delays. A quantitative approach with survey methodology was used with 66 pediatric primary care providers responding to 26 questions. Overall, PCPs are educating caregivers about sleep positioning with a high frequency. There was a relationship between practice site, and the frequency of sleep positioning education is provided. While the participants provide education about awake positioning, and the use of positioning devices, it was with less frequency than they do about sleep positioning; there is limited education and awareness surrounding issues related to infants' prolonged use positioning devices among PCPs in this study. This information indicates there is room for further study of the long-term effects upon child development of extensive supine positioning, as well as potential areas for occupational therapy intervention in the area of preventative education.

Recent studies have shown that the Sudden Infant Death Syndrome (SIDS) is related to abnormal control of respiration (Ischemic degeneration of the brainstem may play an important role in altered respiratory control leading to death). In our studies we have examined brainstem ganglioside compositions in samples derived from SIDS victims and appropriate controls. Gangliosides are acidic glycosphingolipids that contain sialic acid. The high concentration of gangliosides in the central nervous system (CNS) implies that these lipids play an important role in CNS function. Some studies have indicated that gangliosides may function as receptor site determinants or modifiers, and in neural transmission. In our studies we used the Tettamanti, et al methodology to extract gangliosides, and High Performance Thin Layer Chromatography (HPTLC) and laser densitometry techniques for ganglioside analysis. The results of these analyses are being employed to establish lipid profile patterns to determine if there are significant variations in these lipid patterns between SIDS and control groups.