“Sudden Infant Death Syndrome and the time of death: factors associated with night-time and day-time deaths”

The article “Syndrome and the time of death: factors correlated with night-time and day-time deaths” reflects on the causes of Sudden Infant Death as well as an overview of the risk factors of children's sleeping environments. According to studies, the disorder usually happens during an infant's sleep cycle and has catastrophic consequences. This paper provides additional material on the article as well as an assessment of the appropriateness of the methodologies used. It also considers whether the study's conclusion and advice are warranted, as well as the research's reputation.
Background information
The Sudden Infant Death Syndrome is a common condition that occurs during the sleeping periods of an infant. It sometimes referred to as crib death since most of the infants die in their cribs. Most of the common infant care practices are usually associated with the SID or may end up hurting the baby (Berkowitz 2012, p.65). Sleeping environments for an infant during the day vary from that at night and parents are advised to ensure that they focus on embracing suitable practices. In the U.S., more than 4500 infants between 4 and six months die as a result of SID (Blair, Platt, Smith and Fleming 2006, p.23). In as much as the main cause of the condition remains a mystery, most scientists argue that it might be associated with defects in infant’s brain that have significant control on the breathing and its arousal from sleep.

Researchers have also identified that there are various factors that are associated with Sudden Infant Death Syndromes and are categorized into physical and environmental. Physical factors include brain defect that may impair an infant’s sleep arousal and breathing, an infant’s low birth weight and respiratory infections that negatively affects inhalation and exhalation. Sleeping environmental factor also plays a huge role in the acceleration of the condition, and they include a baby sleeping on his or her stomach which affects normal breathing (Katz, Shore, Bandle, Niermeyer, Bol and Khanna 2015, p.17). Laying a baby on a soft surface such as a fluffy comforter and a soft mattress can also block airways, thus leading to the occurrence of sudden death. Other factors include sharing a bed with parents that may result in instances of suffocation or overheat.

Reviews from countries such as New Zealand and the Nordic imply that diurnal variations in the Sudden Infant Death Syndrome show that there are various causal mechanism and risk factors for the condition. The studies further reveal that sleeping position has a strong relationship with the condition during the daytime hours while nighttime infant deaths were associated with risk factors such as infant illness, maternal smoking and drug abuse (Blair, Platt, Smith and Fleming 2006, pp.37-43). Other factors that increase the infant’s risks to SID include family history, the sex of the baby, with boys prone to the condition, race and being premature. During pregnancy, mothers may also play a role in affecting the baby’s risk of SID by inadequate prenatal care, alcohol consumption and cigarette smoking or she is younger than 20 years.

Occasionally, SID deaths occur in the unobserved sleeping periods of the infants either during the day or at night. Usually, the exact time when the deaths occur is never known, and estimations can hardly be proven using post-mortem. Most researchers, through observations, have found it hard to understand the reason why some risk factors are significantly associated with the condition during the daytime while others in the nighttime hours (Katz, Shore, Bandle, Niermeyer, Bol and Khanna 2015, pp.56-59). However, from a bigger picture, poor parental practices play a significant role in the infant deaths. Parents are advised to practice several preventative measures that can help in the reduction in the chances of the occurrence of the condition. First and foremost, a baby is supposed to be placed in a back sleep position to facilitate breathing (Blair, Platt, Smith and Fleming 2006, pp.37-43). The mattress in the infant’s crib has to be firm and fluffy materials such as pillows that can interfere with the baby’s breathing have to be removed. Mothers have to ensure that they regularly breastfeed their children since it lowers the risks of SID. Other preventive measures include immunization of the baby and having a baby sleep in the parent’s room so that they can regularly monitor him or her to avoid any instances of impaired airways.

Objective and significance of the research article

The primary objective of the research article was to conduct an investigation on the diurnal occurrence of the SID as well as the existing interactions with the various risks factors including sleeping environment and physical factors. The research article also tries to identify the daytime and nighttime risk factors associated with the condition and measures that can be embraced in its prevention (Blair, Platt, Smith and Fleming 2006, pp.103-116). The study of the SID was purposely designed to provide the readers and the audience in-depth information on the epidemiology as well as the current risk factors associated with the condition after the 1991 “Back to Sleep” campaign that led to the subsequent declining rates. Results from the research were essential to the parents in that it provided then with a clear picture of some of the suitable practices that they can embrace with the aim of avoiding the occurrence of SID.





Appropriateness of the author’s methodologies and their application in the study

The methodology that is applicable by the authors in the research study was a case study based on a large population. The research was conducted in a three-year time frame from 1993-1996 and is aimed at including all the SID cases aged 7 to 364 days with regions such as Wessex, Yorkshire, Trend and Northern and southwestern states among the five former health regions of England that were selected. The study used a large population sample, and this was vital in the promotion of the accuracies of the findings. A total of 17.7 million parental data was collected from the parents in the mapped out regions. Parents were supposed to provide the interviewers with medical records and reports on their babies’ health.

The data was collected on standard questionnaires, and interviews and those families that had lost their infants were visited a few hours after the death of their children for detailed information with another visit done in two weeks with the aim of completing the questionnaire. Control infant (four-age) was set-up, and the interviewer visited the families two weeks after the death of the infants to collect data for the index case. Time frames of day time and night time sleep were identified 24 hours before a controlled interview was conducted and termed as reference periods (Blair, Platt, Smith and Fleming 2006, pp.119-127). Parents were supposed to inform the researcher whether their infant’s deaths occurred at night or during the day. Interviewers preferred to conduct most of the control interviews during weekdays, and this made it easier for them to match the control infants with the month, day and time of their death. After a full pediatric autopsy done based on a standard protocol, the cause of death was identified and ascertained by a multi-disciplinary committee.

The use of questionnaires and interviews in the collection of data was appropriate techniques for the research study in various ways. First and foremost, both methods are simple and allow the researcher to collect extra information from the respondents. The techniques are also less costly compared to survey and reduce instances of bias (Berkowitz 2012, p.14). Results and research findings that are obtained from both techniques can efficiently be analyzed, and this made them appropriate for the study. Finally, the scalability and the reliability of both research methods were suitable in the derivation of appropriate findings that were to meet the study’s objectives (Katz, Shore, Bandle, Niermeyer, Bol and Khanna 2015, p.45). As a part of the interviewing, parents were supposed to inform the researcher about the last time that they saw their baby alive and this was used as the last observation. Precise point in time, on the other hand, was termed as the last time the infant woke up.

During the research methodology, the researcher was also interested in the sleeping positions of the babies before their death as well as whether they were sharing a room or not and some of the practices that parents were applying. In the quest for ensuring that data collection was efficient, statistical methodology was also embraced. Data that was hardly normally distributed was described using median and mean, and Whitney test was used in the testing of the differences between the existing distributions. Statistical data was then arranged in such a way that it made it easier for the researcher to analyze the various factors that played a significant role in the promotion of the condition (Blair, Platt, Smith and Fleming 2006, pp.171-177). The baby’s health before sleeping was recorded and this was determined using a previously validated system termed to as the Cambridge “Baby Check.” The system is designed in such a way that it can easily determine the degree of an infant’s illness.

From a bigger picture, the methodology that is used in the research article is appropriate due to its ability to derive results that are of significant importance especially in the determination of risk factors that escalate the Sudden Infant Death Syndrome in the infants. The use of interviews and questionnaires in the collection of data provide the researchers with an opportunity to collect detailed information from the respondents that is vital for the study. Introduction of the statistical methodology plays a key role in the strengthening of the research and at the same time enhancing the accuracy of the collected information. By classifying all the deaths based on an Avon clinicopathological system, the interviewer simplified the analysis of the data and ensuring that no information was lost in the process (Blair, Platt, Smith and Fleming 2006, pp.151-155). The authors of the article further confirm the appropriateness of the applicable methodologies by stating that they have been recommended nationally especially in the event of occurrence of sudden unexpected infant deaths.

Application of methodologies in the study

The various methodologies such as interviews, questionnaires and statistical data that are evident in the article are reflection of the research objectives. The interview, for instance, uses standardized questionnaires in the collection of parental data from the home region of England. Some of those critical components that are focused on as a part of data collection include the health of the infant before the occurrence of unexpected death, whether the baby shared a room with the parents or not, the sleeping position of the baby before his or her death and the last time the parent observed the baby before the occurrence of death (Blair, Platt, Smith and Fleming 2006, pp.132-146). The factors are critical because, during the assessment of the collected information, they will help the researcher identify the risk factors that led to the infant’s death either during daytime or at night.

The inclusion of the statistical methodology was essential in that it helped in the assessment of some of the data that was collected using interviews and questionnaires. Application of the methodology in the research study was in such a way that it allowed for the use of the Whitney test in differentiating normally distributed data from the rest. Covariant factors that were essential under the methodology included family factors such as family size, unemployment, and the maternal age. Infant factors including gestational age, age and birth centile were also assessed (Blair, Platt, Smith and Fleming 2006, pp.132-146). Finally, the previously identified risk factors such as the taking of illegal drugs, excessive consumption of alcohol, infant illness, and parental smoking were also assessed as a part of the statistical review. Time lags affected the control statistical procedure, and this and this implied that the control infants that were selected were ten days older than the index infants. The variation in the infant ages was included in both the multivariate and univariate analyses.

Credibility of the research

The research is credible, and this is proven by different types of information provided by the author. First and foremost, the researchers provide a list of those organizations that were involved in the funding of the research including The Foundation for the Study of Infant Deaths, Babies in Arms organization and The Confidential Enquiry into Stillbirths and Deaths in Infancy. It further claims that none of its authors have at any point in time been involved in a conflict of interest and that all the references were checked for high levels of accuracy and completeness.

The authenticity and credibility of the research article can also be deduced from the data collected and the sampled population. Incorporation of the “Back to Sleep” campaign paints a picture of the accurate information that is used in the study. The period from 1993 to 1996 is a representation of the data collection timeframe, and this reveals to the audience that the article is genuine (Blair, Platt, Smith and Fleming 2006, p. 124). The sample population for the research was from the five former health regions in the UK. Apparently, it is evident that with sample population, the accuracy of the references used and the reference to 1991 SDI campaign that led to the declining rates, the research article is credible and authentic.

Justification of the study’s conclusion and recommendation

The research study appropriately justifies its conclusion and recommendation. According to the article, most of the parents observed that their children were at least alive before midnight but died shortly implying that it occurred rapidly. Poor parental practices were cited as the reason behind the death of the infants during the observational intervals. It was recommended that parents be actively involved in ensuring that their babies were out of dangers of suffocation or head their health checked on regular occasions.

Most of the risk factors associated with SDI played a major role in infant deaths that occurred both during the daytime hours and at night. There was a significant relationship between the sleeping position and the time in which they died. The prevalence of infants losing their lives as a result of inappropriate positioning was higher during the day as compared to night time (Katz, Shore, Bandle, Niermeyer, Bol and Khanna 2015, p.33). It was advisable for the parents to place their infants in a supine position both daytime and at night so that they would find it easy to breathe and avoid instances of suffocation.

Factors such as co-sleeping, maternal substance abuse, and excessive alcohol consumption led to more nighttime deaths as compared to daytime. Pre-maternal smoking exposed the baby to a high risk of SID, and this was the same case with alcohol consumption. The co-sleeping dead infants were earlier discovered unlike the solitary sleeping SIDS infants, and this was a confirmation that bed sharing was risky and it would easily impair the babies’ breathing. There was a lower risk factor associated with room sharing compared to bed sharing, and this implied that parents were supposed to ensure that they had a close watch on their infants. Both daytime and nighttime supervision of the infants was necessary to ensure that they were not exposed to those factors that would have contributed to SID (Blair, Platt, Smith and Fleming 2006, pp.167-172). According to the researchers, it was also necessary for the parents to be made aware of those risks associated with inappropriate and poor sleeping environments for the infants during daytime naps.

On average, SID deaths were discovered 90 minutes later than the waking up of the control infants. However, it is evident that there was bias since most of the SID mothers were interviewed an hour after the death of their babies. It also finds that some of the deaths primarily occurred as a result of lack of observation and poor parental practices. As a justification of the conclusion and recommendations of the study, it is evident that in as much as SIDs mostly occur during the nighttime when there is no observation or watch, the onset of the events occur rapidly and may take place at any time of the day (Blair, Platt, Smith and Fleming 2006, pp.511-551). Differences between sleeping during daytime and at night may be pivotal in the highlighting of the variations in the diurnal pathogenesis for the unexpected infant deaths. Parents are recommended to ensure that they place their infants supine for sleep and keep them under intense supervision at day and nighttime.

Information on the authors, motivation, source of funding and users of the study

All the authors including, Blair, Ward Platt, Smith, Fleming, and the CESDI SUDI Research Group were responsible for the research, including design, data interpretation, and analysis. Their motivation was the 1991 Black Sleep campaign that led to the significant reduction in the reported SDI cases. The authors were hardly faced with financial pressures since they received funding from grants from organizations such as The Foundation for the Study of Infant Deaths, Babies in Arms organization and The Confidential Enquiry into Stillbirths and Deaths in Infancy. The study will be vital to both the pre-maternal and post-maternal mothers in helping them prevent their babies from Sudden Infant Death Syndrome.

Conclusion

From the above article review, it is apparent that Sudden Infant Death Syndrome is a condition that is preventable. Risk factors such as sleeping environment, health of the baby and the pre-maternal practices of the mother that contributes to the condition are assessed. It calls for parents to embrace suitable practices that can protect their babies from SDI.

































Bibliography

Berkowitz, C. (2012). Sudden Infant Death Syndrome, Sudden Unexpected Infant Death, and Apparent Life-Threatening Events. Advances in Pediatrics, 59(1), pp.183-208.

Blair, P., Platt, M., Smith, I. and Fleming, P. (2006). Sudden Infant Death Syndrome and the time of death: factors associated with night-time and day-time deaths. International Journal of Epidemiology, 35(6), pp.1563-1569.

Katz, D., Shore, S., Bandle, B., Niermeyer, S., Bol, K. and Khanna, A. (2015). Sudden Infant Death Syndrome and Residential Altitude. PEDIATRICS, 135(6), pp.e1442-e1449.