Smoking and Bed Sharing Combined Top SIDS Causes
Maori Community Slow to Heed Warning About SIDS Risk Factors
Dr David Barry, a paediatric specialist of more than 30 years and a member of the New Zealand Cot Death Research Group in the 1990s, was giving evidence during a 2006 inquest into the death of a one month old baby girl. The baby was Maori (the indigenous people of New Zealand).
The inquest heard that the baby's mother had been bed sharing with the baby and one of her toddler sons. She woke in the morning to find the baby dead beside her. She could not accept that SIDS was the reason for the death, instead questioning the standard of care she had received from Maori midwives and the way they had previously dealt with her baby's premature and breached birth.
The woman told the court that her baby had briefly stopped breathing two days before it died. At the time of that episode, she herself had successfully resuscitated her baby. While she did not report the incident directly to her midwife or any other medical practitioner , she believed she had mentioned it to a Maori welfare worker. She had expected that person would inform appropriate medical authoritities but apparently they had not.
Apparent Life Threatening Episode ALTE Not a Known SIDS Risk
Dr Barry, who told the court he believed the baby's death was due to SIDS, said the reported incident of the baby stopping breathing could be categorised as an Apparent Life Threatening Episode (ALTE).
"... and while uppermost in the parents' minds, studies during the past decade had failed to show a relationship between pre-existing sleep apnoea (stopping breathing) and SIDS," Dr Barry said.
He pointed to research about bed sharing and smoking as contributing to causes of SIDS.
"Bed sharing was found to increase the SIDS risk very considerably and the combination of bed sharing and smoking was the factor that was most likely to be associated with higher rates of cot death... bed sharing among non-smokers was not as dangerous," Dr Barry said.
Sudden Infant Death Syndrome Information Shows SIDS Risk Factors High in Maori Community
Dr Barry said SIDS was still unfortunately prevalent in large Maori communities. Educational campaigns after the 1990 Cot Death Research Group study had slashed the national rate by 50 percent but the reduction was not as dramatic in the Maori community, where rates were sometimes four times higher than the national level.
The high rate of smoking among Maori women could not be overlooked, Dr Barry said.
Smoking and SIDS - Cot Death Research Group Study Show Smoking is a High SIDS Risk
The cot death study showed a certain level of SIDS deaths occurred if the mother smoked, Dr Barry said. If the father also smoked, the rate went up again. However, if the father smoked but the mother did not, there seemed to be no increased risk.
"We don't know what it is about cigarette smoking that has this effect but the most popular theory is that these babies do have a subtle abnormality in the mid brain... there are some findings to suggest that the centres controlling breathing and heart rate are slightly abnormal and that probably the risk factors act in some way on these centres and that many of the risk factors end up on this common pathway," Dr Barry said.
Other SIDS Risk Factors Include Prematurity, Temperature Extremes and Infant's Age
Some of the known additional SIDS risk factors included prematurity and extremes of temperature, Dr Barry said. Age seemed to be another related factor, with deaths from SIDS peaking between one and four months.
Other major SIDS risks factors included having an additional smoker in the home (not just the mother), bed sharing, and sleep position - particularly side lying of the baby, Dr Barry said.
In a reserved decision, District Court judge Neil McLean - who heard the inquest as a coroner - ruled that the baby had died from SIDS and said there was no need for any adverse comment.
The judge cleared midwives of any responsibility for the death. He said there was no basis for concluding that the apparent life threatening incident ALTE in which the baby had stopped breathing and was revived by its mother, was in any way linked with its death.
Due to a number of factors, including the complainant's lack of confidence in the system generally, non-acceptance of blunt advice being given, and concern that the authorities might intervene in her existing childcare arrangements, it was unlikely that the complainant had in fact reported the ALTE incident to any outsider, the judge said. It was impossible to say whether reporting the ALTE would have made a difference to the outcome but it seemed highly unlikely, he said.
sudden infant death syndrome information
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