This annual report - Taranaki District Health Board

Vennemann M, et al. 2007. Do immunisations reduce the risk for SIDS? A meta-analysis. Vaccine, 25(26), 4875-79.This meta-analysis, aimed at examining the relationship between immunisation and SIDS, identified nine case-controlstudies, four of which were adjusted for potential confounders. The summary OR was 0.58 (95% CI 0.46 to 0.73) in theunivariate analysis, suggesting that immunisations were protective, but the presence of heterogeneity made it difficult tocombine these studies. The summary OR for the four studies that reported multivariate ORs was 0.54 (95% CI 0.39 to0.76) with no evidence of heterogeneity. The authors conclude that immunisations are associated reduced risk of SIDS.A number of explanations are offered, including infection as a risk factor for SIDS, and the healthy vaccinee effect(vaccination may be avoided during illness), making the reduction in SIDS with immunisations a marker of the wellbeingof the infant, and not causally linked. It is recommended that immunisations be part of SIDS prevention campaigns.Mitchell EA, et al. 2006. Should Pacifiers Be Recommended to Prevent Sudden Infant Death Syndrome? Pediatrics,117(5), 1755-58.This report aimed to review the evidence for a reduction in the risk of SIDS with pacifier use, discuss possiblemechanisms for the reduction in SIDS risk, and assess other possible effects of pacifiers on infants and children. It isreported that in New Zealand pacifier use is low overall (approximately 10%) but there is wide variation within the countryfrom three per cent in the far south to 30 per cent in the northern North Island. The pooled the results of 7 case-controlstudies and one prospective study revealed a pooled OR of 0.83 (95% CI 0.75 to 0.93) for routine pacifier use. Eightcase-control studies also examined pacifier use for the last sleep, with a pooled OR of 0.48 (95% CI 0.43 to 0.54),supporting consistent evidence of a reduction in SIDS with pacifier use. Possible mechanisms for this effect arediscussed. Potential negative effects were reviewed, including: a possible reduction in the duration of breastfeeding (3RCTs, conflicting results): and an increased risk of infection, particularly otitis media, although this may result fromreverse causality. The authors conclude that the evidence supports an association between pacifier use and a reducedrisk of SIDS and their use should therefore not be discouraged, although they do not support active recommendation. Itis suggested that discussion of pacifier use should include advice to offer a pacifier only when breastfeeding isestablished, after the neonatal period and that they should only be used for sleeping periods in the first year of life.Hauck FR, et al. 2005. Do Pacifiers Reduce the Risk of Sudden Infant Death Syndrome? A Meta-analysis.Pediatrics, 116(5), e716-e23.This meta-analysis measured the association between pacifier use and sudden infant death syndrome (SIDS), with theaim of identifying whether pacifier use lowers the risk of SIDS. Seven case-control studies were included. The calculatedsummary odds ratios (SORs) identified a reduction in SIDS risk associated with pacifier use, suggesting that pacifier useis protective for SIDS. For usual pacifier use the univariate SOR was 0.90 (95% CI 0.59–0.85) and the multivariate SORwas 0.71 (95% CI 0.59–0.85). For pacifier use during the last sleep the univariate SOR was 0.47 (95% CI 0.40-0.55) andmultivariate SOR was 0.39 (95% CI 0.31-0.50). The authors recommend pacifier use for infants up to 1 year of age(introduced after breastfeeding has been well established in breastfed infants). Concerns about possible adverse effects,including on breastfeeding, and otitis media, led to a further review in 2006 (see above).Other Relevant Publications and ResourcesHauck F & Tanabe K. 2010. International Trends in Sudden Infant Death Syndrome and Other Sudden UnexpectedDeaths in Infancy: Need for Better Diagnostic Standardization. Current Pediatric Reviews, 6(1), 95-101.This study compared international trends in SIDS and post neonatal mortality (PNM) since the introduction of SIDS riskreduction and safe sleep campaigns for 15 countries (including New Zealand) from 1990 to the year for which most therecent data were available (2005 to 2008). SIDS rates had declined in all countries, with reductions of over 50% for mostcountries. These declines are attributed to SIDS risk reduction campaigns, which achieved success primarily in reducingrates of prone sleeping among infants. The largest declines generally occurred in the first few years after initiation ofnational campaigns. The authors highlight the need for diagnostic accuracy in comparing trends and recommend thatnational and local campaigns are re-energised to continue the early successes made in reducing SIDS incidence.McManus V, et al. 2010. Narratives of deprivation: Women's life stories around Māori sudden infant deathsyndrome. Social Science & Medicine, 71(3), 643-9.This qualitative study provides a thematic analysis of life story interviews conducted between 2002 and 2004 withnineteen Māori mothers whose infants died of SIDS. Common themes of alienation, marginalisation and exclusion andlives lived with serious deprivation within an affluent society were identified. The authors argue that constructing the riskfactors as non-modifiable is unhelpful and new approaches that build on the WHO Social Determinants of Healthframework are needed to address the high SIDS mortality rate among Māori babies.Child and Youth Mortality Review Committee, Te Rōpū Arotake Auau Mate o te Hunga Tamariki, Taiohi. 2009. Chapter1: Sudden Unexpected Death in Infancy (SUDI) in Fifth Report to the Minister of Health: Reporting mortality2002–2008. Wellington: Child and Youth Mortality Review Committee.http://www.hqsc.govt.nz/assets/CYMRC/Publications/cymrc-5th-report-chp1-sudi.pdfThis report includes an analysis of SUDI mortality data from 2003-2007, including an assessment of risk factors for SUDI,recommendations from local mortality review groups, and observations and recommendations from the Child and YouthMortality Review Committee on how to reduce incidents of SUDI in New Zealand.Hymel K. 2006. Distinguishing sudden infant death syndrome from child abuse fatalities. Pediatrics 118(1) 421-7.This clinical report from the American Academy of Pediatrics provides guidance for professionals regarding proceduresto help avoid stigmatizing families of sudden infant death syndrome victims while allowing accumulation of appropriateevidence in potential cases of infanticide.Infant Mortality and SUDI - 274