[More cot deaths in child care settings than during the same hours at home: 10-year statistics]. / Meer wiegendood tijdens kinderopvang dan in dezelfde uren thuis: 10-jaarscijfers.

OBJECTIVE: To determine whether the incidence of sudden infant death syndrome (SIDS) in child care settings (child care centres or child minders) is different from that in the home setting, and to search for any differences in the prevalence of SIDS risk factors in both settings. DESIGN: Descriptive and comparative. METHOD: All SIDS cases (< 2 years), that occurred between September 1996-August 2006 and known to the 'Landelijke Werkgroep Wiegendood' (the National Cot Death Study Group) of the Dutch Paediatric Association were analysed. The percentage of children involved in child care and the mean duration of their participation in child care, was calculated from national surveys carried out in well-baby clinics. RESULTS: In the 10 years of the study, 216 cases of SIDS became known to the Cot Death Study Group. In the first year of life, the number was 75% of the number registered by Statistics Netherlands. 28 of these infants died from SIDS between the ages of 3-6 months and on Monday-Friday between 8:00 am-5:00 pm: the usual hours of opening of child care facilities. Based on the uptake of child care during this period, 15% of this mortality was expected to have occurred in a child care setting and 85% at home. In reality, 61% (17/28) of the deaths occurred at a child care facility and 39% (11/28) at home. The relative risk was 8.8 (95% CI: 4.1-19.0). This high incidence of SIDS in a child care setting did not appear to be due to a higher prevalence of known risk factors for SIDS at child care facilities i.e. sleeping position (prone or side), passive smoking, heat congestion, or use of a quilt or pillow. CONCLUSION: For infants aged 3-6 months, the relative risk ofSIDS during child care appeared to be increased 8.8 times (95% CI: 4.1-19.0) when compared with home settings in The Netherlands in September 1996-August 2006.

Epidemiology of neonatal group B streptococcal disease in the Netherlands before and after introduction of guidelines for prevention.

OBJECTIVES: (1) To describe the epidemiology of neonatal group B streptococcal (GBS) disease over five years (1997-2001) in the Netherlands, stratified for proven and probable sepsis and for very early (<12 h), late early (12 h - <7 days) and late (7-90 days) onset sepsis. (2) To evaluate the effect of the introduction in January 1999 of guidelines for prevention of early onset GBS disease based on risk factors. METHODS: Data on cases were collected in collaboration with the Dutch Paediatric Surveillance Unit and corrected for under-reporting by the capture-recapture technique. RESULTS: Total incidence of proven very early onset, late early onset and late onset GBS sepsis was 0.32, 0.11 and 0.14 per 1000 live births, respectively, and of probable very early onset, late early onset and late onset GBS sepsis was 1.10, 0.18 and 0.02 per 1000 live births, respectively. Maternal risk factors were absent in 46% of the proven early onset cases. Considerably more infants with proven GBS sepsis were boys. 64% of the infants with proven very early onset GBS sepsis were first born compared with 47% in the general population. After the introduction of guidelines the incidence of proven early onset sepsis decreased considerably from 0.54 per 1000 live births in 1997-8 to 0.36 per 1000 live births in 1999-2001. However, there was no decrease in the incidence of meningitis and the case fatality rate in the first week of life. The incidence of late onset sepsis also remained unchanged. CONCLUSION: After the introduction prevention guidelines based on risk factors there has been a limited decrease in the incidence of proven early onset GBS sepsis in the Netherlands. This study therefore recommends changing the Dutch GBS prevention guidelines.

[Epidemiology of 25 years of crib death (sudden infant death syndrome) in the Netherlands; incidence of crib death and prevalence of risk factors in 1980-2004]. / Epidemiologie van 25 jaar wiegendood in Nederland; incidentie van wiegendood en prevalentie van risicofactoren in 1980-2004.

OBJECTIVE: To describe the prevalence of risk factors and the incidence of cot death (sudden infant death syndrome; SIDS) in the Netherlands during the last 25 years. DESIGN: Descriptive. METHOD: The incidence of cot death/SIDS in infants aged 7-365 days in 1980-2004 was derived from Statistics Netherlands, the Dutch Central Bureau of Statistics. The prevalence of risk factors for cot death/SIDS in the general population was derived from national surveys of baby clinics (0-9 months; 1985-2004) and studies of cot death/SIDS victims (0-23 months; 1984-1991 and 1996/'04). RESULTS: The prevalence of the following risk factors for cot death/SIDS has decreased: primary prone sleeping position (from 60% to 8%), the use of a duvet (from 85% to 18%), maternal smoking (from 34% to 20%), paternal smoking (from 48% to 32%). The prevalence of routine bed-sharing with a parent increased from nearly 0% to 5%. The registered incidence of cot death/SIDS per 100,000 live births decreased from 103 in 1986 to < 15 in 2003 and 2004. The incidence of cot deaths/SIDS that occurred during habitual bed-sharing with a parent, in a playpen, in child-care settings, or in a secondary prone sleeping position increased. CONCLUSION: The incidence of cot death/SIDS and the prevalence of known risk factors for cot death/SIDS has decreased. New risk factors have emerged in recent years. Considering the evolving conditions of infant care, an ongoing study on the special features of child care and the factors involved in cases of cot death/SIDS is warranted. This knowledge is essential for periodic adaptation of the national prevention programme.

[Sudden infant death syndrome in playpens]. / Wiegendood in een box.

OBJECTIVE: To explain the increase in the number of deaths due to sudden infant death syndrome (SIDS) that occurred while the infant was in a playpen or on a playpen mat placed outside of the pen. 13 deaths were reported in the period 1 September 1996-31 August 2004, in contrast to 0 deaths in the years 1984/'96. DESIGN: Descriptive. METHOD: Data on the 13 infants that were reported to the National Study Group on SIDS were analysed and the presence of risk factors for SIDS was assessed. RESULTS: Of the 13 infants, 9 were male and 4 were female. 12 were aged less than 12 months and 1 was aged 13 months. Known risk factors for SIDS were often present and frequently occurred in combinations: male sex (n = 9), higher birth order (n = 9), age 1-8 months (n = 12), parental smoking (n = 6), primary prone sleeping position (n = 4), secondary prone (n = 6, often the first time), face down (n = 9), no adult present (n = 13). CONCLUSION: There was no clear explanation for the observed increase in SIDS that occurred in a playpen or on a playpen mat placed outside of the pen.

Sudden infant death syndrome in child care settings in the Netherlands.

BACKGROUND: In the Netherlands, there is a very low incidence of sudden infant death syndrome (SIDS) due to effective preventive campaigns. METHODS: During the period September 1996 to August 2002, nationwide 161 deaths from SIDS (about 85% of all cases of SIDS during that time) were investigated by the Cot Death Committee of the Dutch Paediatric Association. RESULTS AND DISCUSSION: Over 10% of cases of SIDS took place during some type of child care. From a national survey carried out in 2000/01 information was available on the child care attendance of 2000 Dutch infants aged 3-6 months. Based on the hours usually spent in child care by these infants, the number of similarly aged infants that died from SIDS while attending child care was 4.2 times higher than expected. Remarkably, the prevalence of known risk factors for SIDS, such as sleeping position and parental smoking, was favourable in the SIDS cases in child care settings. The adherence of child care facilities to the safe sleeping recommendations is high in the Netherlands, and no explanation as to why child care settings may be associated with an increased risk of SIDS is apparent. The possibility of other explanations, such as stress and change in routine care, is hypothesised.

[Increased percentages of breastfed infants in Amsterdam]. / Toegenomen percentages borstgevoede zuigelingen in Amsterdam.

OBJECTIVE: To investigate the prevalence of breastfeeding amongst infants in Amsterdam prior to and following an active breastfeeding policy that has been operating in Amsterdam since 1993; investigate the link between ethnic origin and breastfeeding and the reasons mothers give for stopping breastfeeding. DESIGN: Retrospective, descriptive study. METHOD: During the period 1998 to 2000, 1274 mothers in six child health centres in Amsterdam, the Netherlands, were asked about how they had fed their infant, aged 6 to 8 months, from the first week onwards, and their reasons for starting formula feeding. The breastfeeding percentages were compared with a study for the period 1992 to 1993. RESULTS: During the first week of the infant's life, 87% of the mothers gave breastfeeding, and at 25 weeks this figure was 30%. For the period 1998 to 2000, the breastfeeding rate at 15 weeks was higher compared with the period 1992 to 1993, 45.1% as opposed to 36.4%. An increased percentage of breastfed infants were found in each ethnic group studied. More Turkish and Moroccan mothers than Dutch mothers started to breastfeed, and they breastfed for a similar period. Surinam mothers started breastfeeding as often as Dutch mothers, but breastfed for a shorter period. Concern about inadequate milk supply was stated as the most important reason for starting formula feeding (44%). This was also the most important reason stated by each of the ethnic groups, Dutch (139/411; 34%), Surinam (63/129; 49%), Moroccan (70/130; 54%) and Turkish women (42/67; 63%). CONCLUSION: An active breastfeeding policy in Amsterdam that has been operating since 1993 has been accompanied by an increase in the number of breastfed infants. This has also been the case in non-Dutch groups. Health programmes should devote greater attention to mothers' concerns about a shortage of milk.

[Ethnic origin and care giving styles relevant to cot death]. / Etnische afkomst en voor wiegendood relevante verzorgingsfactoren.

OBJECTIVE: To examine whether ethnic origin is related to care giving styles relevant to sudden infant death. DESIGN: Prospective/retrospective, descriptive. METHOD: In six child health care centres in Amsterdam, the Netherlands, data about sleep position, bedclothes and passive smoking of infants aged 1-5 months were collected by face-to-face interviews of mothers visiting these centres between February 1997 and October 1998. RESULTS: Eligible for the study were 1815 infants, 919 boys and 896 girls, mean age 2 months. In Amsterdam 12.5% of infants were usually or sometimes put to sleep in a prone position, 31.0% usually or now and then in a side position (but not in a prone position) and 56.5% usually in a supine position. Prone sleeping position was more frequent among Surinamese infants and less frequent among Moroccan infants compared with Dutch infants. Overall use of a duvet among infants was 22.7%. Use of duvets was higher among allochtonous infants; after controlling for demographic factors this difference was not significant, however. 6.3% of the infants had slept in the previous night with a pillow. Use of a pillow was much more frequent among allochtonous than among autochtonous infants: 13% versus 1.2%. Maternal daily smoking during pregnancy and daily smoking by mothers or others at home at time of interview was found in 15.1% and 25.8% of the infants respectively. Almost no Moroccan mothers smoked during pregnancy (0.4%), while Turkish mothers smoked as much as Dutch mothers (18.5% and 21.6% respectively). No differences in daily smoking at home were found between Surinamese, Moroccan and Dutch families (circa 26%). However, daily smoking at home was much more frequent in Turkish families (43.8%). CONCLUSION: Health education about a safe sleeping position, about safe bedclothes and about the dangers of passive smoking is still needed. Education programmes to prevent sudden infant death must take into account ethnic differences in care giving styles. Special attention must be paid to the use of a pillow among allochtonous infants.

Ethnic origin and care giving styles relevant to cot death

OBJECTIVE: To examine whether ethnic origin is related to care giving styles relevant to sudden infant death. DESIGN: Prospective/Retrospective, descriptive METHOD: In six child health care centres in Amsterdam, the Netherlands, data about sleep position, bedclothes and passive smoking of infants aged 1-5 months were collected by face-to-face interviews of mothers visiting these centres between February 1997 and October 1998. RESULTS: Eligible for study were 1815 infants, 919 boys and 896 girls, mean age 2 months. In Amsterdam 12.5 percent of infants were usually or sometimes put to sleep in a prone position, 31.0 percent usually or now and then in a side position (but not in a prone position) and 56.5 percent usually in a supine position. Prone sleeping position was more frequent among Surinamese infants and less frequent among Moroccan infants compared with Dutch infants. Overall use of a duvet among infants was 22.7 percent. Use of duvets was higher among allochtonous infants; after controlling for demographic factors this difference was not significant, however. 6.3 percent of the infants had slept in the previous night with a pillow. Use of a pillow was much more frequent among allochtonous than among autochtonous infants: 13 percent versus 1.2 percent. Maternal daily smoking during pregnancy and smoking by mothers or others at home at time of interview was found in 15.1 percent and 25.8 percent of the infants respectively. Almost no Moroccan mothers smoked during preganancy (0.4 percent), while Turkish mothers smoked as much as Dutch mothers (18.5 percent and 21.6 percent respectively). No differences in daily smoking at home were found between Surinamese, Moroccan and Dutch families (circa 26 percent). However, daily smoking at home was much more frequent in Turkish families (43.8 percent). CONCLUSION: Health education about a safe sleeping position, about safe bedclothes and about the dangers of passive smoking is needed. Education programmes to prevent sudden infant death must take into account ethnic differences in care giving styles. Special attention must be paid to the use of a pillow among allochtonous infants. (AU)

[Hypertonic dehydration in "silent" malnutrition of breast-fed infants]. / Hypertone dehydratie bij 'stille' ondervoeding aan de borst.

Two firstborn, breast-fed infants (delivery at home) were admitted to the hospital in a critical state of hypernatraemic dehydration. Case 1, a boy aged 13 days, had suffered 1220 g loss of weight since birth (31%), his serum sodium concentration was 180 mmol/l. Case 2, a girl aged 7 days, had lost 610 g since birth (18%); her serum sodium level was 159 mmol/l. In both cases poor professional support of lactation and lack of weight control had resulted in unnoticed severe malnutrition. After slow rehydration recovery was uneventful. Closer monitoring of babies' weight, e.g. twice a week, is advocated especially for breast-fed firstborns in the early weeks of life.

Mothers' reports of infant crying and soothing in a multicultural population.

OBJECTIVES: To investigate the prevalence of infant crying and maternal soothing techniques in relation to ethnic origin and other sociodemographic variables. DESIGN: A questionnaire survey among mothers of 2-3 month old infants registered at six child health clinics in Amsterdam, the Netherlands. SUBJECTS: A questionnaire on sociodemographic characteristics and crying behaviour was completed for 1826 of 2180 (84%) infants invited with their parents to visit the child health clinics. A questionnaire on soothing techniques was also filled out at home for 1142 (63%) of these infants. RESULTS: Overall prevalences of "crying for three or more hours/24 hour day" "crying a lot", and "difficult to comfort" were 7.6%, 14.0%, and 10.3%, respectively. Problematic infant crying was reported by 20.3% of the mothers. Of these infants, only 14% met all three inclusion criteria. Problematic crying occurred less frequently among girls, second and later born children, Surinamese infants, and breast fed infants. Many mothers used soothing techniques that could affect their infant's health negatively. Shaking, slapping, and putting the baby to sleep in a prone position were more common among non-Dutch (especially Turkish) mothers than among Dutch mothers. Poorly educated mothers slapped their baby more often than highly educated mothers. CONCLUSIONS: Mothers' reports of infant crying and soothing varied sociodemographically. Much harm may be prevented by counselling parents (especially immigrants) on how and how not to respond to infant crying. Health education should start before the child's birth, because certain soothing techniques could be fatal, even when practised for the first time.

[Sleeping position and covering of infants in the fall of 1994]. / Slaaphouding en toedekken van zuigelingen in het najaar van 1994.

OBJECTIVE: To determine whether the sleeping position and the use of duvets in infants in 1994 had changed in comparison with earlier years. DESIGN: Questionnaire survey. SETTING: Nationwide investigation in infant welfare centres. METHOD: 194 infant welfare centres participated in the investigation. In November a questionnaire was completed regarding 25 preferably consecutive infants younger than 10 months, featuring: age in completed months, sex, parity of the mother, birth weight and subsequently: the position in which the infant was laid to sleep, and its cover during the last night. RESULTS: The prone sleeping position decreased roughly from more than 55% in 1985-1987 to 24% in 1988 and 9% in 1994. In these surveys prone sleeping was significantly associated with masculine gender, low birthweight and higher parity of the mother. These associations explain at least partly the increased risk of cot death in each of these three conditions. In the Netherlands in November 1994 duvets were still used (77%). CONCLUSION: A further reduction of the cot death incidence (in 1993 0.30 per 1000 live births) may be expected from further implementation of preventive measures.