Hi Diane,

There are so many unknowns in the SIDS studies that it is almost impossible
in many cases to tease all of it out. The first part of the puzzle depends
on what happens at the scene and shortly thereafter - is the baby moved
(often yes), how well is the death scene evaluated, what is the skill of
the medical examiner/coroner to deal with infant death, how good is the
autopsy - the list goes on and on. We see mention of babies dying from
overlying in the Bible, but were they suffocated or was it some other
unknown malady? In some locales, the diagnosis now is not much better than
it was thousands of years ago.

In order to tease all this out, there needs to be a standard practice for
handling infant death that is taught nation-wide to first responders,
health care providers, coroners, pathologists. If the postmortem studies,
including autopsies, are not well performed, cause of death cannot be
properly determined. If the exact sleeping environment is not documented in
each case and in any studies linked to that case, then the data is flawed
from the beginning.

And why did infant deaths decrease with the back to sleep campaign? Was it
simply a decrease in suffocation due to elevated c02
levels in susceptible infants or was there some other factor involved? I
don't think we know yet. What is the actual definition of suffocation? Does
it mean complete obstruction of the babies nose and mouth or it is
something more subtle? How are those distinctions made during an autopsy?
Don't know that either.

Until we get some standardization, it will be impossible to evaluate many
of the studies related to SIDS. I think that in many ways it would be
easier for parents to understand how to avoid suffocation rather than how
to avoid SIDS. How do you breastfeed your baby in an environment that
decreases the possibility of suffocation? That is more realistic than
saying that it will prevent SIDS when nobody even really know what that
means. I think in the end that SIDS will be shown to be a spectrum of rare
conditions that some babies are born with and that make them more
vulnerable to sudden death during sleep. With expert investigation and
postpartum studies, there should be a way pinpoint most infant deaths
without relegating them to the SIDS or "unknown cause" category.

Sharon Knorr, IBCLC
Loveland, Colorado



On Mon, Aug 20, 2012 at 5:51 PM, Diane Wiessinger <[log in to unmask]> wrote:

> I'm getting more and more interested in the SIDS/suffocation confusion,
> which almost all the researchers seem to share in.  A quote from Krouse et
> al, Bed-sharing influences, attitudes, and practices: Implications for
> promoting safe infant sleep. J Child Health Care 2012:
>
> "Bed-sharing has been suggested in the literature to increase the infant
> risk for SIDS due to the risks of overlaying or entrapment, wedging,
> falling or strangulation (Mesich, 2005)."
>
> Not one of those risk factors is SIDS.  They're all suffocation.
>
> The same confusion - I *think* - has happened with the obesity issue.  I
> know of only one study on obesity and infant death, Chen A, Feresu SA,
> Fernandez C, Rogan WJ.  Maternal obesity and the risk of infant death in
> the United States.  Epidemiology 2009; 20(1): 74-81.
>
> My reading of it is that SIDS is the issue with obesity, not suffocation.
>  So the obese woman has set her child up for it prenatally and would do
> well to breastfeed, to help compensate for a risk factor that she can no
> longer do anything about.  And separate sleep tends to shorten
> breastfeeding duration, so she's actually better off bedsharing than not!
>
> It's really important for all of us to keep the two issues separate.  I
> get tripped up over and over again, and obviously the researchers do too.
>  But mixing them leads to misinterpretations like the obesity one (if I'm
> right about it, and I'm not positive that I am).
>
> And now policy-makers want to drop the distinction altogether and talk
> about SUID/SUDI.  They still haven't agreed on the term, but it's sudden
> unexpected infant death, and it includes everything from infanticide to
> metabolic disorders to poisoning, along with suffocation and SIDS.  It
> makes the studies a whole lot easier and the results a whole lot less
> valuable.  What a mess!  It's like combining car crashes and poisoning as
> the same cause of death.  Prevent poisoning by wearing your seatbelt!!
>
> Diane Wiessinger, MS, IBCLC, LLLL Ithaca, NY  USA
>
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