SIOUX CITY | Each year in the state of Iowa, 35 to 40 seemingly healthy infants die on average in their sleep.

Patty Keeley, executive director of the Iowa SIDS Foundation said parents and caregivers are "very aware" that placing a baby on his or her stomach to sleep is a risk factor for Sudden Infant Death Syndrome or SIDS, which is defined as the sudden death of an apparently healthy infant less than one year of age that remains unexplained after a thorough investigation.

Keeley, who will speak about SIDS and SUID facts and myths at the 43rd Annual Perinatal Conference at UnityPoint Health-St. Luke's on May 24, said most people aren't as knowledgeable about the other risk factors for SIDS, which include placing soft bedding in the crib, exposing the child to nicotine from cigarette smoking and co-sleeping or sharing a sleep surface with the child -- a trend popular with attachment parenting advocates.

"We've actually seen fewer SIDS deaths both in our state and in the nation, but we've seen an increase in SUID deaths," said Keeley, whose nonprofit organization offers support to grieving families and safe sleep education to child and health care providers in Iowa.

Sudden unexplained infant death (SUID) is the death of an infant less than one year of age that occurs suddenly and unexpectedly, and whose cause of death is not immediately obvious prior to investigation. About half of sudden unexplained infant deaths are due to SIDS, according to the Centers for Disease Control and Prevention.

Keeley said more sleep-related deaths where an environmental risk factor is present are being classified as SUID rather than SIDS.

"From our foundation's perspective, it's the same scenario -- that parent, that caregiver laid baby down with every expectation (the baby was) going to wake up," she said.

As a health care provider, Cindy Running, a clinical practice expert for St. Luke's, said she's doing everything she can to spread the word about what a safe sleep environment looks like. She said some Siouxland parents are placing their babies in car seats and bouncy chairs at bedtime and naptime.

"These really are not a safe sleep environment for infants. I think part of it is convenience, part of it is cost, part of it is lack of education," she said. "(These babies) are at risk for positional issues from bending their neck down. They're at risk for delayed motor development because they don't have the ability to move around. They can't turn their head as well, which can result in head flattening and torticollis (crick in the neck)."

When a baby in the neonatal intensive care unit is stable enough to be lying in a crib, Running said she puts a fitted sheet on the mattress. The crib is clear of pillows, blankets and bumper pads. She dresses the baby in only a sleep sack, a wearable blanket, and places the child on his or her back.

Breastfeeding, sharing a room with the child until they are a year old, offering a pacifier at bedtime and naptime, and eliminating smoking, Running said are all recommended to reduce the risk of SIDS.

"Babies that are exposed to cigarette smoke, even if it's secondhand or thirdhand, just exponentially increases their risk," she said. "If you're going to come here into the NICU, take a shower, don't smoke after you take a shower and put on clean clothes, because that is such a risk to the smallest babies. We start that education really early."

Unfortunately, Keeley said, there is no surefire way to prevent SIDS. She said babies who sleep flat on their backs and have no risk factors associated with SIDS still die of SIDS.

She said researchers believe SIDS deaths could be connected to a serotonin deficiency. Serotonin is a chemical in the brain that conveys messages between cells and plays an important role in regulating breathing, heart rate and sleep.

"Most commonly what we see in babies who are dying of SIDS is that they get into a situation where they re-breathe," Keeley said. "Instead of having a whole room of oxygen-rich air if they were flat on their back with nothing blocking their airway, they have a pocket of air either off that bumper pad, off that blanket or the mattress. They start re-breathing the air that they just exhaled, which is high in carbon dioxide." 

As the carbon dioxide is inhaled, Keeley said the baby is unable to respond appropriately or quickly enough because of a serotonin deficiency.

A study conducted by Dr. Hannah C. Kinney and her colleagues, which was published in 2009 in the New England Journal of Medicine, found that infants who died of SIDS had 26 percent less serotonin and 22 percent less tryptophan hydroxylase, an enzyme involved in the synthesis of serotonin.

If the research is correct, Keeley said the next step is figuring out how to determine which infants have these deficiencies before it claims their lives and then finding out how to treat them.

"Is it pharmaceutical, or is it some type of monitor?" she said. "What can we do to identify those babies, and once they're identified, help them so we eliminate that unexpected sudden death?"

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