Maternal and Child Health Library

MCH Alert: Focus on Infant Mortality is developed by the Maternal and Child Health Library in collaboration with the National Sudden and Unexpected Infant/Child and Pregnancy Loss Resource Center at Georgetown University. This and past issues are available online at http://www.mchlibrary.info/alert/archives.html and http://www.sidscenter.org/alert/archives.html.

November 25, 2009

1. BIBLIOGRAPHIES FEATURE ARTICLES ON FETAL MOVEMENT MONITORING AND ON SUDDEN INFANT DEATH SYNDROME AND AIR POLLUTION, RACE AND ETHNICITY, AND SMOKING

The National Sudden and Unexpected Infant-Child Death and Pregnancy Loss Resource Center's Web site contains recently updated bibliographies on the topics of air pollution, fetal movement monitoring, and smoking, as well as on sudden infant death syndrome (SIDS) in selected communities. Each bibliography presents definitions and lists recent citations and abstracts from peer-reviewed journals. The bibliographies also include a customized tool that can be used to search PubMed for additional articles from MEDLINE and life science journals. The bibliographies are available as follows:

* Air Pollution and Sudden Infant Death Syndrome (SIDS): A Selected Annotated Bibliography is available at http://www.sidscenter.org/TopicalBib/AirPollution.html.

* Fetal Movement Monitoring: A Selected Annotated Bibliography is available at http://www.sidscenter.org/TopicalBib/FetalMovementMonitoring.html.

* Smoking and Sudden Infant Death Syndrome (SIDS): A Selected Annotated Bibliography is available at http://www.sidscenter.org/TopicalBib/Smoking.html.

* Sudden Infant Death Syndrome (SIDS) in the African American Community: A Selected Annotated Bibliography is available at http://www.sidscenter.org/TopicalBib/AfricanAmerican.html.

* Sudden Infant Death Syndrome (SIDS) in American Indian-Alaska Native Communities: A Selected Annotated Bibliography is available at http://www.sidscenter.org/TopicalBib/AmericanIndians.html.

* Sudden Infant Death Syndrome (SIDS) in the Hispanic Community: A Selected Annotated Bibliography is available at http://www.sidscenter.org/TopicalBib/Hispanic.html.

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• Ensure that a thorough history, physical, laboratory, and diagnostic evaluation is completed.
• Deliver the information about pregnancy loss as soon as possible, using patient-centered language that avoids the term "abortion."
• Encourage both the woman and significant others to grieve. Listen and respond to immediate concerns.
• Warn women about the "anniversary phenomenon," that is, the increased likelihood of experiencing depressive symptoms at the same time of year as the loss or the expected delivery date.
• Counsel women to communicate their feelings of loss to family and friends.
• In addition to providing an obstetric clinic referral for follow-up, when possible, connect women with counselors who specialize in pregnancy loss. Recognize that significant others may also have emotional reactions that differ from the reactions of the woman who experienced the loss.
• Identify how and where the woman gets her care and, if follow-up care has not been set up, schedule an appointment for her within the first week, or supply providers' names and phone numbers.
• Encourage the woman to write down what she wants to discuss at the follow-up visit.
• Provide clear discharge instructions on normal signs of recovery and a list of abnormal signs signaling that the woman should return to the ED.
• Inform women and their families about the importance of connecting with social networks such as church groups, support organizations, or grief support groups. Provide resources and handouts, as needed.

• Forty-four of the 102 infant deaths were due to natural causes, including 21 SIDS cases. Fifteen deaths were the result of accident, and 7 were homicide. The manner of death could not be determined in more than one-third of the cases.
• Of the 102 cases, 46 were found cosleeping. Fifteen cosleeping infants were white, and 29 were black.
• A majority of the cosleeping infants had a crib or bassinet available at home.
• Only 24 infants were found sleeping alone in a crib or bassinet. Infants were found on a sleep surface not designed for infants in 76 percent of cases. Forty-five infants were cosleeping at the time when they were found unresponsive.
• Of the 21 SIDS infants, 11 were found unresponsive in a crib or bassinet alone, 3 were sleeping alone in an adult bed, 4 were cosleeping in an adult bed, 1 was sleeping alone on a couch, 1 was sleeping in an infant swing, and 1 was sleeping in a mother's arms.
• Ten of the 11 asphyxia infants and 28 of 35 sudden unexplained death in infancy (SUDI)/undetermined infants were cosleeping.
• Between 1993 and 2003, there was a sharp rise in accidental asphyxia deaths in cosleeping infants in Maryland, rising from an average of two cases per year before 2003 to 10 cases in 2003.