[Changes in infant sleeping position after an educational intervention in a University General Hospital during a ten year follow up]. / Cambios en la posición al dormir para la prevención de la muerte súbita del lactante: diez años de seguimiento.

INTRODUCTION: The prone sleeping position has been identified as the main risk factor for the sudden infant death syndrome (SIDS). OBJECTIVES: The aim was to assess the prevalence of the different sleeping positions of infants, between 1 and 6 months, who attended the immunizations office of the "Hospital Italiano de Buenos Aires" during a ten year period. During this time an important educational intervention, called "Project Link" was developed. MATERIAL AND METHODS: An analytical, prospective study was developed. The recommended position (RP) was the supine position,as well as the side position, to place infants to sleep. Mothers were advised to avoid the prone position or a non-recommended position (NRP). RESULTS: A hundred completed questionnaires were obtained each year in 1996, 1998-2001, 2004 and 2006. The percentage of mothers who placed their infants in sleep supine was 49 % in 1996 vs. 90 % in 2006 (p = 0.0001). The accomplishment of the RP was divided in two periods: 1996-1998 (59 %) and 1999-2006 (88 %), p = 0.0002. CONCLUSIONS: The prevalence of the infant prone sleeping position reduced gradually in the studied population. Nevertheless, it is imperative to emphasize the benefits of the RP, because only during 1999 and 2004 was the percentage of prone position less than 10 %, as in developed countries.

Cambios en la posición al dormir para la prevención de la muerte súbita del lactante: diez años de seguimiento / Changes in infant sleeping position after an educational intervention in a University General Hospital during a ten year follow up

Introducción: La posición en decúbito prono al dormir se ha identificado como el principal factor de riesgo para el síndrome de muerte súbita del lactante (SMSL). Objetivo: Conocer los cambios en la prevalencia de la posición al dormir en lactantes de hasta 6 meses en un período de 10 años, durante los cuales se realizó una intervención educativa para modificar los factores de riesgo del SMSL en un hospital general universitario. Material y métodos: Estudio prospectivo y analítico. Se definió como posición recomendada (PR) el decúbito supino y/o lateral y como posición no recomendada (PNR) el decúbito prono y/o indiferente. Las pruebas de chi al cuadrado de tendencia y chi al cuadrado se consideraron significativas con un valor de p menor de 0,05. Resultados: Se obtuvieron 100 encuestas en los años 1996, 1998-2001, 2004 y 2006. El porcentaje de madres que colocaron a sus hijos en la PR a dormir fue del 49 % en el año 1996 frente al 90 % en el año 2006 (p 5 0,0001). Se dividió en dos intervalos de tiempo el cumplimiento de la PR: 1996-1998 (59 %) y 1999-2006 (88 %), p 5 0,0002. Conclusiones: La prevalencia de lactantes acostados en decúbito prono fue disminuyendo sustancialmente en la población estudiada. Sin embargo, a partir de 1999 no hubo una mejoría significativa en el cumplimiento de la PR y sólo en los años 1999 y 2004 la prevalencia de la posición en decúbito prono durante el sueño incluyó a menos del 10 % de los lactantes, que es el objetivo propuesto en los países desarrollados (AU)

Introduction: The prone sleeping position has been identified as the main risk factor for the sudden infant death syndrome (SIDS). Objectives: The aim was to asses the prevalence of the different sleeping positions of infants, between 1 and 6 months, who attended the immunizations office of the "Hospital Italiano de Buenos Aires" during a ten year period. During this time an important educational intervention, called "Project Link" was developed. Material and methods: An analytical, prospective study was developed. The recommended position (RP) was the supine position,as well as the side position, to place infants to sleep. Mothers were advised to avoid the prone position or a non-recommended position (NRP). Results: A hundred completed questionnaires were obtained each year in 1996, 1998-2001, 2004 and 2006. The percentage of mothers who placed their infants in sleep supine was 49 % in 1996 vs. 90 % in 2006 (p 5 0.0001). The accomplishment of the RP was divided in two periods: 1996-1998 (59 %) and 1999-2006 (88 %), p 5 0.0002. Conclusions: The prevalence of the infant prone sleeping position reduced gradually in the studied population. Nevertheless, it is imperative to emphasize the benefits of the RP, because only during 1999 and 2004 was the percentage of prone position less than 10 %, as in developed countries (AU)

International Child Care Practices Study: infant sleeping environment.

BACKGROUND: The International Child Care Practices Study (ICCPS) has collected descriptive data from 21 centres in 17 countries. In this report, data are presented on the infant sleeping environment with the main focus being sudden infant death syndrome (SIDS) risk factors (bedsharing and infant using a pillow) and protective factors (infant sharing a room with adult) that are not yet well established in the literature. METHODS: Using a standardised protocol, parents of infants were surveyed at birth by interview and at 3 months of age mainly by postal questionnaire. Centres were grouped according to geographic location. Also indicated was the level of SIDS awareness in the community, i.e. whether any campaigns or messages to "reduce the risks of SIDS" were available at the time of the survey. RESULTS: Birth interview data were available for 5488 individual families and 4656 (85%) returned questionnaires at 3 months. Rates of bedsharing varied considerably (2-88%) and it appeared to be more common in the samples with a lower awareness of SIDS, but not necessarily a high SIDS rate. Countries with higher rates of bedsharing appeared to have a greater proportion of infants bedsharing for a longer duration (>5 h). Rates of room sharing varied (58-100%) with some of the lowest rates noted in centres with a higher awareness of SIDS. Rates of pillow use ranged from 4% to 95%. CONCLUSIONS: It is likely that methods of bedsharing differ cross-culturally, and although further details were sought on different bedsharing practices, it was not possible to build up a composite picture of "typical" bedsharing practices in these different communities. These data highlight interesting patterns in child care in these diverse populations. Although these results should not be used to imply that any particular child care practice either increases or decreases the risk of SIDS, these findings should help to inject caution into the process of developing SIDS prevention campaigns for non-Western cultures.

A randomized, double-blind, placebo-controlled trial of the effects of prophylactic theophylline on renal function in term neonates with perinatal asphyxia.

BACKGROUND: The kidney is the most damaged organ in asphyxiated full-term infants. Experiments in rabbits and rats have shown that renal adenosine acts as a vasoconstrictive metabolite in the kidney after hypoxemia and/or ischemia, contributing to the fall in glomerular filtration rate (GFR) and filtration fraction. Vasoconstriction produced by adenosine can be inhibited by the nonspecific adenosine receptor antagonist, theophylline. Gouyon and Guignard performed studies in newborn and adult rabbits subjected to normocapnic hypoxemia. Their results clearly showed that the hypoxemia-induced drop in GFR could be avoided by the administration of low doses of theophylline. OBJECTIVE: This study was designed to determine whether theophylline could prevent and/or ameliorate renal dysfunction in term neonates with perinatal asphyxia. SETTING: Buenos Aires, Argentina. STUDY DESIGN: We randomized 51 severe asphyxiated term infants to receive intravenously a single dose of either theophylline (8 mg/kg; study group: n = 24) or placebo (control group: n = 27) during the first 60 minutes of life. The 24-hour fluid intake and the urine volumes formed were recorded during the first 5 days of life. Daily volume balances (water output/input ratio and weights) were determined. Severe renal dysfunction was defined as serum creatinine elevated above 1.50 mg/dL, for at least 2 consecutive days after a fluid challenge, or rising levels of serum creatinine (.3 mg/dL/day). The GFR was estimated during the second to third days of life by endogenous creatinine clearance (mL/minute/1.73 m2) and using Schwartz's formula: GFR (mL/minute/1.73 m2) =.45 x length (cm)/plasma creatinine (mg/100 mL) during the first 5 days of life. Tubular performance was assessed as the concentration of beta2-microglobulin (beta2M) determined by enzyme immunoassay, on the first voided urine 12 hours after theophylline administration. The statistical analysis for the evaluation of the differences between the groups was performed with Student's t and chi(2) tests as appropriate. RESULTS: During the first day of life, the 24-hour fluid balance was significantly more positive in the infants receiving placebo compared with the infants receiving theophyline. Over the next few days, the change in fluid balance favored the theophyline group. Significantly higher mean plasma values were recorded in the placebo group from the second to the fifth days of life. Severe renal dysfunction was present in 4 of 24 (17%) infants of the theophylline group and in 15 of 27 (55%) infants of the control group (relative risk:.30; 95% confidence interval:.12-.78). Mean endogenous creatinine clearance of the theophylline group was significantly increased compared with the creatinine clearance in infants receiving placebo (21.84 +/- 7.96 vs 6.42 +/- 4.16). The GFR (estimated by Schwartz's formula) was markedly decreased in the placebo group. Urinary beta2M concentrations were significantly reduced in the theophylline group (5.01 +/- 2.3 mg/L vs 11.5 +/- 7.1 mg/L). Moreover, 9 (33%) patients of the theophylline group versus 20 (63%) infants of the control group had urinary beta2M above the normal limit (<.018). There was no difference in the severity of the asphyxia between infants belonging to the theophylline and control groups in regards of Portman's score. Except for renal involvement, a similar frequency of multiorganic dysfunction, including neurologic impairment, was observed in both groups. The theophylline group achieved an average serum level of 12.7 microg/mL (range: 7.5-18.9 microg/mL) at 36 to 48 hours of live versus traces (an average serum level of .87 microg/mg) in the placebo group. CONCLUSIONS: Our data suggest that prophylactic theophylline, given early after birth, has beneficial effects on reducing the renal dysfunction in asphyxiated full-term infants. (ABSTRACT TRUNCATED)