Abstract not available

Title from PDF of title page. / Document formatted into pages; contains 62 pages. / Thesis (M.S.P.H.)--University of South Florida, 2003. / Includes bibliographical references. / Text (Electronic thesis) in PDF format. / ABSTRACT: Sudden Infant Death Syndrome (SIDS) is the third leading cause of infant mortality between birth and the first year of life in the United States. Along with the identication of various maternal risk factors, the role of fetal hypoxia has been hypothesized to be one of many causal factors associated with SIDS. The purpose of this study was to develop a profile of the SIDS infant and assess whether six pregnancy complications consistent with fetal hypoxia were associated with the increased outcome of SIDS. The secondary data analysis of Florida linked birth to death certificate data specific to Hillsborough County and Duval County were analyzed retrospectively for the period of time between 1998 and 2000. Of the 86, 342 births, 69 SIDS cases were identified, 34 in Hillsborough County and 35 in Duval County. / A majority of the infants were White males with an average age of death of 80 days. The Chi-Square test for Independence with Cramer's V, odds ratios and 95% confidence intervals were calculated to determine if an association existed between pregnancy complications, specific maternal risk factors and SIDS. Eclampsia was the only statistically significant prenatal complication found in this cohort (OR=4.67: 95% CI 1.49, 14.57). Maternal tobacco use (OR= 3.13: 95% CI 1.83, 5.36) and late initiation into prenatal care were also found to be significant in the SIDS cases, with the greatest risk occuring in women who did not receive prenatal care (OR=4.37: 95% CI 1.38, 13.89). These findings will assist with the development of a profile of infants who are at greater risk of dying of SIDS in Hillsborough County and Duval County as well as contribute to what is currently known about the association between fetal hypoxia and SIDS. / System requirements: World Wide Web browser and PDF reader. / Mode of access: World Wide Web.

Essa tese aborda dois tópicos pouco explorados na literatura científica brasileira: a síndrome da morte súbita do lactente (SMSL) e o coleito. O objetivo principal foi avaliar o impacto de uma intervenção educativa individual para mães na maternidade, em relação ao posicionamento para dormir da criança. Secundariamente, verificou-se a prevalência de coleito e os fatores associados a esse arranjo para dormir. Realizou-se um ensaio clínico randomizado com 228 duplas de mães e seus filhos. A intervenção consistia em uma sessão individual de orientação na maternidade sobre a importância da posição supina para a criança dormir na prevenção da SMSL. O desfecho principal foi a posição de dormir da criança aos três e seis meses de idade, registrada durante visitas domiciliares. Regressão de Poisson foi utilizada para identificar os fatores associados ao coleito. Em relação ao posicionamento de dormir da criança, conforme relatado pela mãe. 42,9% das mães do grupo intervenção e 24,0% das mães do grupo controle colocavam seus filhos para dormir na posição supina na visita aos três meses (p= 0,009). A intervenção no hospital foi a única variável que influenciou as práticas maternas em relação à posição de dormir da criança (RC= 1,35; IC 95% = 1,08 - 1,64). A prevalência de coleito aos três e seis meses foi de, respectivamente, 31,2% e 28,5%. Aos três meses, o coleito estava associado a mãe sem companheiro (RP= 1,56; IC= 1,01-2,39) e a coabitação com a avó materna da criança (RP= 1,70; IC= 1,09-1,65). Concluindo, uma sessão educativa individual na maternidade aumentou significativamente a prevalência da posição supina para dormir no terceiro mês de vida da criança, mas não foi suficiente para garantir que a maioria das mães colocasse seus filhos para dormir nessa posição. Quanto ao coleito, ele se mostrou comum nos primeiros seis meses, estando associado à mãe sem companheiro e a coabitação com a avó materna da criança. / This study addresses two that issues have been little studied in the Brazilian scientific literature: sudden infant death syndrome (SIDS) and bedsharing. The main objective of this study was to evaluate the impact of an individual educational intervention given to mothers in the maternity ward regarding the infant sleep position. Secondarily we verified the prevalence of bedsharing and the variables associated to with this sleep arrangement. A randomized clinical trial was performed, in which 228 pairs of mothers-infants were included. The intervention consisted in an individual educational session for mothers in the maternity ward, concerning the recommendation of the supine position for infant sleep to prevent SIDS. The main outcome was the position in which the infant slept at night at three and six months, registered during home visits. The Poisson regression was applied to identify the factors associated with bedsharing. Regarding the infant sleep position, according to mothers' report, 42.9 percent of the mothers in the intervention group and 24.0 percent of the control group put their infants to sleep in the supine position at three months' visit (p= 0.009). The intervention in the hospital was the only variable that influenced maternal practices concerning the infant sleep position (OR= 1.33; CI 95% = 1.08 - 1.64). The prevalence of bedsharing at three and six months was, respectively, 31.2 and 28.5 percent. At three months bedsharing was associated to mother without partner (prevalence ratio [PR] 1.56; CI 1.01-2.39) and mother sharing the home with infant's maternal grandmother (PR= 1.70; CI= 1.09 - 1.65). We conclude that an individual educational session in the maternity ward significantly increased the prevalence of the infant's supine sleep position at three months. However, the intervention was not sufficient to assure the majority of the mothers would put their infants to sleep at this position. Bedsharing was common at the first six months of life and was associated with single mothers and sharing the home with infant's maternal grandmother.

Essa tese aborda dois tópicos pouco explorados na literatura científica brasileira: a síndrome da morte súbita do lactente (SMSL) e o coleito. O objetivo principal foi avaliar o impacto de uma intervenção educativa individual para mães na maternidade, em relação ao posicionamento para dormir da criança. Secundariamente, verificou-se a prevalência de coleito e os fatores associados a esse arranjo para dormir. Realizou-se um ensaio clínico randomizado com 228 duplas de mães e seus filhos. A intervenção consistia em uma sessão individual de orientação na maternidade sobre a importância da posição supina para a criança dormir na prevenção da SMSL. O desfecho principal foi a posição de dormir da criança aos três e seis meses de idade, registrada durante visitas domiciliares. Regressão de Poisson foi utilizada para identificar os fatores associados ao coleito. Em relação ao posicionamento de dormir da criança, conforme relatado pela mãe. 42,9% das mães do grupo intervenção e 24,0% das mães do grupo controle colocavam seus filhos para dormir na posição supina na visita aos três meses (p= 0,009). A intervenção no hospital foi a única variável que influenciou as práticas maternas em relação à posição de dormir da criança (RC= 1,35; IC 95% = 1,08 - 1,64). A prevalência de coleito aos três e seis meses foi de, respectivamente, 31,2% e 28,5%. Aos três meses, o coleito estava associado a mãe sem companheiro (RP= 1,56; IC= 1,01-2,39) e a coabitação com a avó materna da criança (RP= 1,70; IC= 1,09-1,65). Concluindo, uma sessão educativa individual na maternidade aumentou significativamente a prevalência da posição supina para dormir no terceiro mês de vida da criança, mas não foi suficiente para garantir que a maioria das mães colocasse seus filhos para dormir nessa posição. Quanto ao coleito, ele se mostrou comum nos primeiros seis meses, estando associado à mãe sem companheiro e a coabitação com a avó materna da criança. / This study addresses two that issues have been little studied in the Brazilian scientific literature: sudden infant death syndrome (SIDS) and bedsharing. The main objective of this study was to evaluate the impact of an individual educational intervention given to mothers in the maternity ward regarding the infant sleep position. Secondarily we verified the prevalence of bedsharing and the variables associated to with this sleep arrangement. A randomized clinical trial was performed, in which 228 pairs of mothers-infants were included. The intervention consisted in an individual educational session for mothers in the maternity ward, concerning the recommendation of the supine position for infant sleep to prevent SIDS. The main outcome was the position in which the infant slept at night at three and six months, registered during home visits. The Poisson regression was applied to identify the factors associated with bedsharing. Regarding the infant sleep position, according to mothers' report, 42.9 percent of the mothers in the intervention group and 24.0 percent of the control group put their infants to sleep in the supine position at three months' visit (p= 0.009). The intervention in the hospital was the only variable that influenced maternal practices concerning the infant sleep position (OR= 1.33; CI 95% = 1.08 - 1.64). The prevalence of bedsharing at three and six months was, respectively, 31.2 and 28.5 percent. At three months bedsharing was associated to mother without partner (prevalence ratio [PR] 1.56; CI 1.01-2.39) and mother sharing the home with infant's maternal grandmother (PR= 1.70; CI= 1.09 - 1.65). We conclude that an individual educational session in the maternity ward significantly increased the prevalence of the infant's supine sleep position at three months. However, the intervention was not sufficient to assure the majority of the mothers would put their infants to sleep at this position. Bedsharing was common at the first six months of life and was associated with single mothers and sharing the home with infant's maternal grandmother.

Essa tese aborda dois tópicos pouco explorados na literatura científica brasileira: a síndrome da morte súbita do lactente (SMSL) e o coleito. O objetivo principal foi avaliar o impacto de uma intervenção educativa individual para mães na maternidade, em relação ao posicionamento para dormir da criança. Secundariamente, verificou-se a prevalência de coleito e os fatores associados a esse arranjo para dormir. Realizou-se um ensaio clínico randomizado com 228 duplas de mães e seus filhos. A intervenção consistia em uma sessão individual de orientação na maternidade sobre a importância da posição supina para a criança dormir na prevenção da SMSL. O desfecho principal foi a posição de dormir da criança aos três e seis meses de idade, registrada durante visitas domiciliares. Regressão de Poisson foi utilizada para identificar os fatores associados ao coleito. Em relação ao posicionamento de dormir da criança, conforme relatado pela mãe. 42,9% das mães do grupo intervenção e 24,0% das mães do grupo controle colocavam seus filhos para dormir na posição supina na visita aos três meses (p= 0,009). A intervenção no hospital foi a única variável que influenciou as práticas maternas em relação à posição de dormir da criança (RC= 1,35; IC 95% = 1,08 - 1,64). A prevalência de coleito aos três e seis meses foi de, respectivamente, 31,2% e 28,5%. Aos três meses, o coleito estava associado a mãe sem companheiro (RP= 1,56; IC= 1,01-2,39) e a coabitação com a avó materna da criança (RP= 1,70; IC= 1,09-1,65). Concluindo, uma sessão educativa individual na maternidade aumentou significativamente a prevalência da posição supina para dormir no terceiro mês de vida da criança, mas não foi suficiente para garantir que a maioria das mães colocasse seus filhos para dormir nessa posição. Quanto ao coleito, ele se mostrou comum nos primeiros seis meses, estando associado à mãe sem companheiro e a coabitação com a avó materna da criança. / This study addresses two that issues have been little studied in the Brazilian scientific literature: sudden infant death syndrome (SIDS) and bedsharing. The main objective of this study was to evaluate the impact of an individual educational intervention given to mothers in the maternity ward regarding the infant sleep position. Secondarily we verified the prevalence of bedsharing and the variables associated to with this sleep arrangement. A randomized clinical trial was performed, in which 228 pairs of mothers-infants were included. The intervention consisted in an individual educational session for mothers in the maternity ward, concerning the recommendation of the supine position for infant sleep to prevent SIDS. The main outcome was the position in which the infant slept at night at three and six months, registered during home visits. The Poisson regression was applied to identify the factors associated with bedsharing. Regarding the infant sleep position, according to mothers' report, 42.9 percent of the mothers in the intervention group and 24.0 percent of the control group put their infants to sleep in the supine position at three months' visit (p= 0.009). The intervention in the hospital was the only variable that influenced maternal practices concerning the infant sleep position (OR= 1.33; CI 95% = 1.08 - 1.64). The prevalence of bedsharing at three and six months was, respectively, 31.2 and 28.5 percent. At three months bedsharing was associated to mother without partner (prevalence ratio [PR] 1.56; CI 1.01-2.39) and mother sharing the home with infant's maternal grandmother (PR= 1.70; CI= 1.09 - 1.65). We conclude that an individual educational session in the maternity ward significantly increased the prevalence of the infant's supine sleep position at three months. However, the intervention was not sufficient to assure the majority of the mothers would put their infants to sleep at this position. Bedsharing was common at the first six months of life and was associated with single mothers and sharing the home with infant's maternal grandmother.

La mort subite du nourrisson (MSN) est un phénomène imprévisible et mal compris. Elle est définie par « le décès d’un nourrisson âgé de moins d’un an dont les causes restent inexpliquées malgré des investigations approfondies, incluant une autopsie et un examen de la scène du décès ». Si l’incidence est en décroissance depuis 1994 et le début des campagnes de prévention, la MSN reste la première cause de décès post-néonatale. La MSN est un phénomène multifactoriel qui survient préférentiellement chez des enfants vulnérables exposés à des facteurs de risques environnementaux. Ainsi, le fait d’identifier ces enfants à risque est un enjeu majeur dans la prévention de cette pathologie. La réponse vagale exacerbée, exprimée biologiquement par une surexpression des récepteurs muscariniques de sous-types M2 (RM2), pourrait être un facteur de risque de MSN. Nous avons déjà constaté cette anomalie biologique dans notre modèle animal d’hyperréactivité vagale et dans des cœurs de nourrissons décédés de MSN. Le but de ces travaux est d’analyser l’expression sanguine des RM2 en tant que paramètre biologique reflétant une hyperactivité vagale chez l’Homme, dans des cas de malaises vagaux et de malaises sévères inexpliqués du nourrisson. L’implication de la génétique a également été étudiée dans une famille présentant plusieurs cas de MSN. Une surexpression des RM2 a été observée chez des patients présentant des malaises vagaux. Pour la première fois, des anomalies biologiques ont été identifiées dans cette pathologie. Si l’on parvenait à valider ce paramètre biologique en tant que marqueur de risque, cela pourrait permettre d’aider au diagnostic différentiel et à la prise en charge thérapeutique de ces syncopes vagales. Les mêmes anomalies ont été observées chez des enfants de moins d’un an présentant des malaises sévères idiopathiques. Après une première analyse des données du séquençage haut débit d’exomes issus d’une famille présentant plusieurs cas de MSN, nous avons pu identifier 3 gènes pouvant être impliqués dans la MSN. Néanmoins, le scénario et le mode de transmission sont difficiles à définir. Les premières hypothèses s’orientent vers un digénisme ou même un trigénisme. La surexpression des RM2 chez les 2 parents et chez certains enfants est un premier élément suggérant la transmission du caractère « hyperactivité vagale » chez l’Homme.Nos travaux ont permis de mettre en évidence une anomalie biologique commune entre les malaises vagaux, les malaises inexpliqués du jeune enfant et la MSN, à savoir la surexpression des RM2. Ce paramètre, facilement dosable dans le sang, pourrait être un élément complémentaire dans le diagnostic différentiel et la prise en charge de ces pathologies, notamment chez les jeunes enfants pour lesquels ces malaises peuvent être très délétères. L’avancée dans le séquençage du génome permettra peut-être l’identification de facteurs de risque génétiques impliqués dans les malaises inexpliqués ou les MSN. / Sudden Infant Death Syndrome (SIDS) is an unpredictable and poorly understood phenomenon. It is defined as the "sudden unexpected death of a child younger than one year during sleep that cannot be explained after a postmortem evaluation including autopsy, a thorough history, and scene evaluation". Although the incidence has been decreasing since 1994 and the start of prevention campaigns, SIDS remains the leading cause of post-neonatal death. SIDS is a multifactorial phenomenon that occurs preferentially in vulnerable infants exposed to environmental risk factors. Thus, identifying these children at risk is a major challenge in the prevention of this pathology. The exacerbated vagal response, biologically expressed by overexpression of muscarinic M2 receptors (M2R), may be a risk factor for SIDS. We have already observed this biological abnormality in our animal model of vagal hyperreactivity and in hearts of SIDS. The aim of this work is to analyze the blood expression of M2R as a biological parameter reflecting vagal hyperreactivity in humans, in cases of reflex syncope and idiopathic apparent life-threatening events (iALTE) of infants. The involvement of genetics has also been studied in a family with several cases of SIDS (SIDS family). Overexpression of M2R has been observed in patients with reflex syncope. For the first time, biological abnormalities have been identified in this pathology. If this biological parameter could be validated as a risk marker, it could help for differentially diagnosis and treatment of these vagal syncopes. The same abnormalities were observed in children under one year old with iALTE. After a first analysis of the data of the “next generation sequencing” of the exomes of our “SIDS family”, we were able to identify 3 genes that could be involved in SIDS. However, the scenario and the mode of transmission are difficult to define. The first hypotheses are oriented towards a digenism or even a trigenism. The overexpression of M2R in both parents is a first element suggesting the genetic transmission of the character "vagal hyperactivity" in humans. Our work highlights a biological abnormality which is common to reflex syncope, iALTE and SIDS, namely the overexpression of M2R. These results confirm the hypothesis of the involvement of the vagal system overactivity in these pathologies. This parameter, easily measurable in the blood, could be a complementary assessment useful in the differential diagnosis and the management of these pathologies, in particular in infants for whom syncope can be very harmful. The development of the sequencing of human genome will probably allow the identification of genetic risk factors involved in iALTE or SIDS.

No description available.

No description available.

Doctor of Public Health / For many years the major cause of infant mortality in NSW has been the result of Sudden Infant Death Syndrome (SIDS). Statistics show the area defined as 'Western Sydney' is no exception, and in 2002, a report prepared by the Epidemiology, Indicators, Evaluation and Research Unit (EIRE) in Western Sydney presented data indicating SIDS rates in the area were higher than the state average. In particular, two Local Government Areas (LGAs) had clusters of SIDS deaths. Previous Australian research identified a higher risk of SIDS and other causes of infant mortality in Aboriginal and Torres Strait Islander populations. The areas of Western Sydney where SIDS rates were higher than expected were home to Aboriginal, Torres Strait Islander and Pacific Island residents. The number of SIDS deaths in Aboriginal infants did not explain the higher than expected rate of SIDS in the areas under investigation. Studies undertaken in New Zealand and the Pacific Islands have identified higher than expected risk of SIDS in Maori and Pacific Island communities in those countries, although this has never been studied in Pacific Island residents living in Australia. The reasons for these communities exhibiting a higher than normal SIDS rate is not completely understood, but can be partially explained by behavioural practices which are known to impact adversely on the risk of SIDS. This study sought to investigate the level of knowledge concerning the prevention of sudden and unexpected death in infants (SUDI) in three key groups of infant caregivers: general practitioners, nurses and parents living or working in the area geographically defined by Sydney West Area Health Service (WSAHS). In addition, the study sought to identify any variation in knowledge of SIDS reduction strategies in the three groups under study, and to investigate factors influencing knowledge and practice in these participants. The study findings were then used as a basis on which to develop strategies and recommendations to enhance the delivery of safe sleeping messages through the health care system. Using a combination of qualitative and quantitative methods, this cross-sectional study highlights a number of issues around infant care practices and the major influences on new parents living in a multicultural community. Results of the study showed there is a large variation in knowledge around safe sleeping practices (including SIDS reduction strategies) in all the groups studied. Although educational campaigns are conducted regularly, many general practitioners and parents are confused about the key SIDS reduction messages and still place infants in sleeping positions considered unsafe. While nurses and midwives were aware of the SIDS reduction strategies, they still occasionally used infant sleeping positions considered unsafe. General practitioners born overseas in a country where English is not the first language were less likely to be familiar with safe sleeping messages, including SIDS reduction strategies. Families from a Culturally and Linguistically Diverse (CALD) background were less likely to have seen SIDS information in their own language than families who spoke English, and as a result were more likely to use traditional methods of infant care, including co-sleeping with siblings and parents and side or tummy sleeping. CALD parents were more likely to rely on herbal remedies and friends and family for assistance, than English speaking parents who accessed health professionals as the first point of call when infants were unwell. The study identified a relatively recent practice, which until reported in this study, has not been documented in the literature. The practice of draping infant prams with blankets originated from the Cancer Council of Australia guidelines which recommend covering a pram with a light muslin wrap to protect infants’ skin from the sun. It appears parents have misinterpreted this message and are covering infant prams with blankets to encourage sleep, even when sun exposure is not an issue. Research suggests that poor air quality around the head of an infant may affect an infant’s arousal response. While no research has been conducted on the air quality around an infants head when covered by a heavy blanket in a pram, it is possible based on research into air quality around infants, that that this practice may increase the risk of sudden and unexpected death in an infant. In conclusion, this study found that multiple changes to the SIDS reduction messages since the initial ‘Reduce the Risks’ Campaign have led to confusion about ways of preventing SIDS in GPs, nurses and parents in Western Sydney. The study makes seven recommendations aimed at improving knowledge of safe sleeping practices in these groups, and optimizing health outcomes for infants using a collaborative approach to service delivery and future initiatives.

In addition to fetal alcohol syndrome and fetal alcohol spectrum disorders, prenatal alcohol exposure is associated with many other adverse pregnancy and birth outcomes. Research suggests that alcohol use during pregnancy may increase the risk of miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. This research has some inherent difficulties, such as the collection of accurate information about alcohol consumption during pregnancy and controlling for comorbid exposures and conditions. Consequently, attributing poor birth outcomes to prenatal alcohol exposure is a complicated and ongoing task, requiring continued attention to validated methodology and to identifying specific biological mechanisms.