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Background: In the United States, sudden infant death syndrome (SIDS) is the leading cause of death in children less than one year old, and the third leading case of death in infants. In 1992, the American Academy of Pediatrics (AAP) recommended to place infants supine for sleep, and the SIDS rate declined by 50%. Despite these efforts, the SIDS rate has plateaued since 2001. With the growing number of advanced practices nurses (APN) providing care to pregnant women and infants, APNs are in a position to educate new parents on preventing SIDS using the 2011 AAP safe sleep recommendations. Yet, knowledge, attitudes, and current practices of APNs regarding SIDS risk reduction are unknown in the State of Arizona. Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to assess the attitudes, knowledge, and current practices of APNs regarding risk reduction strategies. Methods: This study was a descriptive quantitative cross-sectional survey design. Target study participants included APNs that provided care to pregnant women and/or infants up to 12 months old. The study was conducted in the State of Arizona through online surveys using the Qualtrics software. The study participants' knowledge, attitudes, and current practices were assessed using an adapted validated survey tool that included multiple choice items and responses using Likert scales. Results: Twenty-three APNs completed the survey. Knowledge about SIDs was average, with a mean score of 74% correct. Although most APNs felt it was important to educate parents about SIDS, only three-quarters of APNs provided verbal education to parents, and less than half of participants provided written information to parents. To decrease the SIDS rate, it is necessary for APNs to gain more knowledge about current safe sleep recommendations.

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.

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[pt] Apesar de existirem argumentos simples e usuais de que reservas seriam uma proteção em sudden stops, encontramos poucos trabalhos sobre esse assunto na literatura. O objetivo deste estudo é justamente tentar identificar e quantificar os reais benefícios (ou custos) de se ter reservas nesse tipo de crise. Iniciamos construindo um modelo que, ao contrário do usual, permite que o estoque de reservas impacte a dinâmica do fluxo de capital, via expectativas. Ele sugere que reservas reduzem a probabilidade de ocorrência da crise, mas que, uma vez iniciada, ela tende a ser mais forte. Pesquisamos, então, essas relações empiricamente, com um painel de países. Não encontramos efeito sobre a probabilidade de sudden stop, mas, de fato, as regressões sugerem que reservas tendem a acentuar a queda do fluxo de capital nas crises. Ainda assim, não encontramos evidência de que esse instrumento afete o custo do sudden stop (medido como queda no produto). / [en] Although there are simple and usual arguments claiming that reserves might offer protection at sudden stops, few papers about this subject are found in the literature. The goal of this study is to try to identify and quantify the real benefits (or costs) of having reserves at this kind of crisis. We begin with the construction of a model that, contrary to what is usually done, allows the stock of reserves to impact the dynamics of capital flows, through expectations. It suggests that reserves reduce the probability of occurrence of crisis, but, once it is starts, it tends to be stronger. We therefore study these relations empirically, with a panel of countries. We don´t find effects upon the probability of sudden stop, but, indeed, the regressions suggest that reserves tend to increase the fall in capital flows at crises. Nevertheless, we find no evidence that this instrument affects the cost of the sudden stop (measured by the product fall).

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.

Includes bibliographic references. / 2 v. : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / A detailed description of possible aetiological mechanisms in sudden infant death syndrome and reports original work investigating a variety of causal mechanisms and pathological markers. / Thesis (M.D.)--University of Adelaide, Dept. of Paediatrics, 1994?

Thesis (M.S.)--University of Michigan, 1984. / "A research report submitted in partial fulfillment of the requirements for the degree ..."