Infant Suffocation Incidents Related to Co-Sleeping or Breastfeeding in the Side-Lying Position in Japan.

Co-sleeping and breastfeeding in the side-lying position have recently been pointed out as risk factors for suffocation in sleeping infants; however, there is no actual report on an "incident." "Incident" is defined as a tense or sobering experience without a consequential fatal suffocation accident. It is important to understand infant suffocation incidents to prevent accidents during co-sleeping and breastfeeding in the side-lying position. We investigated factors and frequency of infant suffocation incidents associated with co-sleeping and breastfeeding in the side-lying position using a self-administered questionnaire survey of 895 mothers during their infant's 1-, 4-, or 10-month health checkups. Co-sleeping and breastfeeding in the side-lying position were practiced by 28.3% and 56.0% of mothers, respectively; thus, 84.3% of the mothers surveyed were practicing either co-sleeping or breastfeeding in the side-lying position. Of those who received guidance from a medical professional, 36.1% practiced only co-sleeping while 60.1% practiced only side-lying breastfeeding. In the co-sleeping group, 10.6% had faced infant suffocation incidents, while 13.2% in the breastfeeding in the side-lying position group had faced similar incidents. Regarding factors associated with suffocation incidents while co-sleeping, the frequency of occurrence was significantly more in mothers of 1-month and 4-month-old infants compared with those of 10-month-old infants. Of mothers who faced suffocation incidents while breastfeeding in the side-lying position, 45% also had faced similar incidents while co-sleeping. These results demonstrate the importance of thoroughly educating mothers about the risks associated with co-sleeping and breastfeeding in the side-lying position for preventing infant suffocation.

Right-to-left shunting in the ductus arteriosus is induced readily by intense crying and rapid postural change in neonates with meconium-stained amniotic fluid.

OBJECTIVE: To investigate postnatal changes in the direction of blood flow through the ductus arteriosus in neonates with meconium-stained amniotic fluid, we measured preductal and postductal oxygen saturation in normal neonates, neonates with meconium-stained amniotic fluid, and a neonate with persistent pulmonary hypertension of the newborn. DESIGN: Prospective, observational case series report. SETTING: A single, tertiary neonatal intensive care unit. PATIENTS: Twelve normal neonates, seven neonates with meconium-stained amniotic fluid, and a neonate with persistent pulmonary hypertension of the newborn. INTERVENTIONS: SpO2 is simultaneously monitored in the right upper and lower limbs after birth. MEASUREMENTS AND MAIN RESULTS: Compared with normal neonates, three neonates with meconium-stained amniotic fluid required longer than +2 SD of the mean time for the postductal SpO2 to reach 90% and/or 95%. In a neonate with meconium-stained amniotic fluid, intense crying triggered frequent decreases to <70% in the postductal SpO2 from 25 mins after birth, while the preductal SpO2 remained at 95% or above. When the other newborn with meconium-stained amniotic fluid was held in the father's arms after 98 mins, the postductal SpO2 decreased rapidly to <80%, while the preductal SpO2 remained at 95%. Thus, 5% or greater difference between the preductal and postductal SpO2 was observed from 25 mins after birth until 120 mins in all neonates with meconium-stained amniotic fluid, whereas the difference disappeared after 25 mins in 12 normal neonates. In a neonate with persistent pulmonary hypertension of the newborn who required vigorous resuscitation, 5% or greater difference between the preductal and postductal SpO2 levels was observed until 6 hrs after birth. CONCLUSIONS: Right-to-left shunting in the ductus arteriosus may be induced readily by intense crying and rapid postural change in infants with meconium-stained amniotic fluid. It is important to monitor SpO2 at both pre- and postductal regions until 120 mins after birth in neonates with meconium-stained amniotic fluid and to subject these infants to minimal manipulations.

Characteristics of metabolic and lifestyle risk factors in young Japanese patients with coronary heart disease: a comparison with older patients.

Coronary heart disease (CHD) is recognized as a lifestyle-related disease and is the second leading cause of death in Japan. However, the cardiac risk factor profile of young patients with CHD has not been clarified in suburban areas of Japan. Our study aimed to determine metabolic and lifestyle risk factors in young patients and compare them with older patients living in suburban areas of Nagano Prefecture. A multicenter study was conducted in 86 young (aged less than 40 years) and 91 older (aged 50 years and over) patients diagnosed with CHD from 1992 to 2002. There was a strong association between obesity and the occurrence of CHD events in young patients (odds ratio = 3.61, P = 0.006). Lifestyle in the young patients was characterized by a lack of physical activity and regular physical activity was found to decrease the risk of the CHD events in these patients (odds ratio = 0.31, P = 0.030). In older patients, hypertension was identified as an independent risk factor for CHD events. The results of the present study have demonstrated that obesity and a lack of regular physical exercise are independent risk factors for CHD events in younger patients. Thus, the data may be useful for the effective screening of high-risk individuals and the development of educational programs for the prevention of CHD, especially in younger Japanese.