"The project is a great public health example
of merging of basic and clinical science."
At 10 a.m. on March 7, 1989 the phone rang in Mary Ann Kjemhus’ Grand Forks office. It was her husband. One of their 8-month-old triplets had stopped breathing and an ambulance was taking her to the hospital. Kjemhus rushed to the hospital, but Heather was already gone. The doctors blamed the sudden death of a seemingly healthy baby on crib death.
“We were all in such shock,” she said. “That night when I put the other two into their cribs, Tyler, the youngest one, kept looking over at Heather’s crib. He still is the one who talks about her the most, even today.”
Also known as crib death, Sudden Infant Death Syndrome (SIDS) is a sudden and unexpected death of an apparently healthy infant. It typically occurs during sleep and in infants aged two weeks to a year old, with the highest prevalence at the age of three months. The cause is still under debate, but great strides have been made in preventing it.
Through the North Dakota Fetal Alcohol Syndrome Center at the UND School of Medicine and Health Sciences, center director Larry Burd, Ph.D., has been studying SIDS for several years and his work has shown tremendous results.
The rate of SIDS has declined rapidly for several decades. In the early ‘80s there were about 25 SIDS deaths a year in North Dakota, now it is down to about five a year. This 80 percent decline has been due to the recognition of risk factors and the public education of those risk factors.
“SIDS risk factor awareness is a public health success story,” said Burd.
Safe sleep & sweet dreams guidelines:
- Avoid alcohol
- Avoid smoking
- Do not use pillows, bumper pads or mattress pads in cribs
- Put babies to sleep on their backs
- Position babies at the bottom of the crib with feet at foot
- Give babies their own beds — no co-sleeping
- Keep babies’ room at 65-70 degrees
- Use three layers only:
- Diaper, sleeper and blanket
- Do not sleep with babies on a couch
However, one population that continues to see high rates of SIDS is Native Americans. According to the U.S. Department of Health and Human Services, the SIDS rate at the Aberdeen Area of the Indian Health Service (including North Dakota, South Dakota, Nebraska, and Iowa) is 158 percent higher than that of all races in the U.S.
Seeing this very troubling epidemic, Burd joined forces with several partners including the Indian Health Service, the Aberdeen Area Tribal Chairmen’s Health Board and the North Dakota Department of Health to further investigate these deaths.
“We use a systematic perinatal and infant mortality review to improve the classification of the cause and manner of death for each infant,” Burd explained. “We try to identify preventable factors contributing to the death of Indian infants.”
By looking at the clinical data, the group determined there were several risk factors that were connected to SIDS deaths among Native Americans including: pre- and post-natal smoking, inappropriate positioning of infants
in cribs, cosleeping (parents sharing a bed with their infant), overdressing, wearing a cap or hat during sleep, and inappropriate bedding. There also seemed to be an increased risk of infant deaths on the weekends and in rooms that were too cold or too warm.
“As part of our effort to improve risk factor awareness,” explained Burd, “we looked at a variety of strategies to improve parental knowledge of the risk factors.”
With the knowledge gained from this research, Burd and his team developed a brief and simple intervention program performed in Native American communities through home visit programs and obstetrics departments in community hospitals.
It was determined that the intervention must be brief and needed a mechanism to get the information into the home, especially where the infants sleep and would not easily be discarded.
“The project is a great merging of basic and clinical science,” said Burd. “We decided to use a baby blanket with the risk factors printed on it.”
Through the study, 341 women were tested on their knowledge of SIDS risk factors before and after a brief, 20-minute education session by hospital nurses or home health staff and given a blanket and a handout summarizing the risk factors in easy-to-understand terms.
Before the session, only 5 percent of the women knew the nine risk factors for SIDS, but after the session, that knowledge grew to 74 percent.
According to Burd, the program was so successful because the program is brief, the diagrams make it easy for most parents to understand, providing the education right after the baby is born make it an optimal learning time for the parents and the teaching precedes the period of risk for SIDS.
“Through this and other outreach programs, the prevalence has gone down enormously,” said Burd. “I would not be surprised if soon we have a year with no cases of SIDS in North Dakota.”
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