Sudden infant death syndrome: bed sharing with mothers who smoke.

AIM: To examine the sleeping arrangements of sudden infant death syndrome (SIDS) cases on the Wirral. In particular to determine the prevalence of bed sharing with mothers who smoke, a known risk factor for SIDS. METHODS: Retrospective study of postmortem determined cases of SIDS from 1995 to 2000 on the Wirral peninsula (population 350 000, 3500 annual births). Ambulance crew reports, case notes, health visitor reports, postmortem reports, and case discussion records were studied for each case. RESULTS: There were 25 cases of SIDS in the postneonatal age group over the six year period. In nine cases the baby was bed sharing with the mother, of whom seven were smokers. Five of these mothers reported using alcohol or illicit drugs on the night of their infant's death. In two further cases the baby slept on a sofa with a parent. CONCLUSIONS: Bed sharing and smoking remain important risk factors for SIDS. Mothers should be advised ante- and postnatally of this combination of risk factors. Such advice should also include a recommendation not to sleep with their baby if under the influence of alcohol or illicit drugs, and never to sleep on a sofa with their baby. All "Child Health Record" books given to parents on the Wirral now include this advice. "Reduce the Risk" advice leaflets given to parents pre- and postnatally also now carry the recommendation, and health visitors and midwives have been educated with respect to these additions.

A randomized controlled trial of early physiotherapy for high-risk infants.

The aim of this study was to investigate the hypothesis that infants at high risk of cerebral palsy would benefit from early physiotherapy. In total, 105 infants with abnormal cranial ultrasound scans were randomized at around term to early physiotherapy or standard treatment (delaying physiotherapy until abnormal physical signs became apparent). At 12 and 30 months there were clinical and objective assessments. Nine infants died and nine were lost to follow-up by 12 months when 87 infants were assessed. One other child had died and three others were lost to follow-up by 30 months when 83 children were assessed. Cerebral palsy was only accurately predicted in 45 (54%) infants. There was no difference in outcome. The difficulty of predicting cerebral palsy reliably and the heterogeneity of the condition should be borne in mind when planning treatment and assessing its efficacy.

A comparison of three procedures to assess the motor ability of 12-month-old infants with cerebral palsy.

This study compared three methods of assessing motor impairment during infancy. The 77 infants studied were considered to be at high risk of motor impairment because of abnormal neonatal cranial ultrasound scans or abnormal somatosensory responses. The children were assessed at eight and 12 months post-term by the Movement Assessment of Infants, the Griffiths locomotor development quotient and the limb-by-limb approach, and the results were compared with clinical assessment at 12 months post-term. The sensitivity of the limb-by-limb approach was highest, although its specificity was slightly lower than the other tests. It was also the easiest to perform. While giving information about the quality of movement, none of these methods is a quantitative test of movement.

Babies born in a district general hospital to mothers taking heroin.

The effect of maternal abuse of heroin on newborn babies was studied in 25 babies born during 1982-6 to 23 heroin users, most of whom smoked the drug. Nineteen of the babies developed withdrawal symptoms, which in 12 were severe enough to require treatment. Five babies were born prematurely; 17 were adequately grown for their gestational age. Four mothers successfully established breast feeding. Twenty two infants were discharged from the hospital into their mother's care with support from the family and community services; at the end of the study only six were living in families in which the parents were married or had a stable relationship. Withdrawal symptoms were short lasting and often self limiting, and no evidence of adverse effect on postnatal growth and development was found. Unstable social circumstances with changes in family dynamics made follow up difficult. Further assessment needs to be carried out to investigate the long term effect of maternal heroin abuse on children.