Reducing risk for Aboriginal and Torres Strait Islander babies: trial of a safe sleep enabler to reduce the risk of sudden unexpected deaths in infancy in high risk environments.
SIDS and Kids provided a grant to support the first Australian trial of a sleep enabler to reduce the risk of sudden unexpected deaths in infancy in high risk environments.
The primary aim was to determine the acceptability of the Pepi-pod Program, a portable infant sleep space, amongst Aboriginal and Torres Strait Islander communities in Queensland.
The risk of SUDI is three times higher for Aboriginal and Torres Strait Islander babies compared with non-Indigenous infants. Co-sleeping is a common practice particularly for breastfeeding infants, and the cultural norm in many Indigenous communities. However infant deaths are associated with co-sleeping in hazardous circumstances.
The Pepi-Pod Program operated in Queensland with 10 governmental and NGO Aboriginal controlled medical organisations across over 20 communities from Queensland’s southeast corner, to the Cape, and across to Mt Isa.
Results indicated that parents perceived the enabler as safe, convenient and portable.
The program received two national awards in 2014: the Hesta Australian Nursing Award for Team Innovation and the National Lead Clinicians Group Award for the Indigenous Maternal and Child Health Category.
Kaarene Fitzgerald Fellowship
SIDS and Kids has funded the Kaarene Fitzgerald Fellowship, a three-year PhD scholarship allowing Dr Emily Cohen (pictured right) to pursue research into the underlying mechanisms of SIDS at The Ritchie Centre, Monash University in Melbourne.
Emily started medical school at Maastricht University in The Netherlands in 2006 and as part of her degree she undertook a research elective at The Ritchie Centre, Monash University in 2011. Her project was supervised by Prof. Rosemary Horne and Dr. Stephanie Yiallourou, who have an international reputation in research which aims to understand the physiological mechanisms which underlie the known risk factors for SIDS such as sleeping infant on their tummy and being exposed to maternal smoking.
After completion of her medical degree in 2012, Emily commenced working in the paediatric and neonatology department of the St. Antonius Hospital in The Netherlands. Emily has been able to return to The Ritchie Centre this year to pursue a PhD with the SIDS and Kids scholarship. In collaboration with Utrecht University she is investigating the effects of intra-uterine growth restriction on the heart and circulation.
Intra-uterine growth restriction (IUGR) is when a baby is born too small for its gestational age. It significantly increases the risk of SIDS and has also been linked to cardiovascular disease in adulthood, although the underlying mechanisms have not been elucidated. Intra-uterine growth restriction often results from placental insufficiency, which compromises the delivery of oxygen and nutrients to the fetus. To protect itself under these challenging conditions, the fetus adapts its circulation and although these changes seem beneficial during intra-uterine life, it is believed that they persist after birth and “programme” the baby for life-long cardiovascular morbidities.
Emily will be studying growth-restricted and appropriately grown babies longitudinally within the first six months of life when the risk of SIDS is greatest. She will be looking at a variety of parameters that define cardiovascular function, such as their blood pressure and blood pressure control. The results of this study will provide us with more understanding of the “fetal programming concept”, which could lead to early identification of infants at risk and allow targeted interventions to reduce the risk of SIDS and adult cardiovascular morbidity.
Sudden unexpected early neonatal death or collapse in previously healthy term infants in the first 7 days of life
The study aims to establish the current incidence of sudden unexplained death or collapse in the early neonatal period (first 7 days of life) in Australia.
The incidence of sudden unexpected and unexplained death or neonatal collapse is reported as between 0.035/1000 to 0.4/1000 live births. Greater than half of these infants die.
There is currently no national system available in Australia for investigating and reporting these cases.
The study also aims to document the risk factors and outcomes for such cases in Australia, as well as preventative strategies.
In the reported literature many of these infants are found face down on the mother’s breasts suggesting that airway compromise may be a contributing factor. Other risk factors include maternal analgesia, bed-sharing and prone sleeping.
Examination of neonatal sudden unexplained death in infants in NSW has found that the history, examination, and the death scene investigations are incomplete and under investigated.
A recent study using the British Paediatric Surveillance Unit, showed that in 30 of 45 cases there was no identified underlying disease/abnormality but in 24 there was clinical or pathological evidence of airway obstruction while breastfeeding or in a prone position. The authors called for development of guidelines for safe postnatal care of infants, especially for new mothers.
The failure to register on a population wide basis means national guidelines for safe sleeping are inadequate especially in this early postnatal group, as most definitions of SIDS commence after day 7 or 28 days of life.
It is anticipated that the information obtained as a result of this study will lead to the development and initiation of policy directives aimed at safe postnatal management of healthy newborns. Preventative strategies including education programs for parents and carers are important in reducing the incidence of these conditions.
Richard Goldstein, a pediatrician and medical researcher associated with Harvard Medical School, is conducting bereavement research on the grief-related experiences of mothers, and he is seeking participation in a survey from around the world.
Participation in the confidential survey can be done online. Participation is sought from mothers who have lost their babies suddenly and unexpectedly within the past 48 months. They will be asked to complete a 31-question online questionnaire and answer some background questions.
The survey website is www.bereavementstudy.com.
Published Research Lists
You can download a copy of the Research Lists in PDF format below: