American Indians and Sudden Infant Death Syndrome:
A Selected Annotated Bibliography

Burd L, Peterson M, Face GC, Face FC, Shervold D, Klug MG.
Efficacy of a SIDS risk factor education methodology at a Native American and Caucasian Site.
Matern Child Health J. 2007 Feb 13; [E-pub ahead of print]

Objective: To complete a community based efficacy study of a SIDS risk reduction methodology. Methods: We utilized two community sites for this study: 1) a Native American home visiting program for pregnant and young mothers; and 2) an obstetrics department in a community hospital. Pre and posttests were used to measure learning. The risk reduction intervention was delivered by hospital nurses or the home visiting staff and required about 20 minutes. Each of the nine risk factors was discussed. Results: We completed paired pre and post testing with 341 women. The pre tests found substantial knowledge deficits about SIDS risk factors in both groups. The pre and posttest changes for the nine risk factors ranged from 5% to 74%. Participants from both groups demonstrated nearly equivalent rates of learning for all nine of the risk concepts. Conclusion: This study demonstrated the efficacy of this brief intervention program. The program was effective in increasing parental knowledge of the risk factors targeted by this study in both settings. The magnitude of change supports additional research with this program in other settings and with additional populations.

Full-text available at: http://www.springerlink.com

Tomashek KM, Qin C, Hsia J, Iyasu S, Barfield WD, Flowers LM.
Infant mortality trends and differences between American Indian/Alaska Native infants and white infants in the United States, 1989-1991 and 1998-2000.
Am J Public Health. 2006 Dec; 96(12):2222-7. E-pub 2006 Oct 31.

Objectives: To describe changes in infant mortality rates, including birth weight-specific rates and rates by age at death and cause. Methods: We analyzed US linked birth/infant-death data for 1989-1991 and 1998-2000 for American Indians/Alaska Native (AIAN) and White singleton infants at > or =20 weeks' gestation born to US residents. We calculated birth weight-specific infant mortality rates (deaths in each birth weight category per 1000 live births in that category), and overall and cause-specific infant mortality rates (deaths per 100000 live births) in infancy (0-364 days) and in the neonatal (0-27 days) and postneonatal (28-364 days) periods. Results: Birth weight-specific infant mortality rates declined among AIAN and White infants across all birth weight categories, but AIAN infants generally had higher birth weight-specific infant mortality rates. Infant mortality rates declined for both groups, yet in 1998-2000, AIAN infants were still 1.7 times more likely to die than White infants. Most of the disparity was because of elevated post-neonatal mortality, especially from sudden infant death syndrome, accidents, and pneumonia and influenza. Conclusions: Although birth weight-specific infant mortality rates and infant mortality rates declined among both AIAN and White infants, disparities in infant mortality persist. Preventable causes of infant mortality identified in this analysis should be targeted to reduce excess deaths among AIAN communities.

Full-text available at: http://www.apha.org

Castor ML, Smyser MS, Taualii MM, Park AN, Lawson SA, Forquera RA.
A Nationwide Population-Based Study Identifying Health Disparities Between American Indians/Alaska Natives and the General Populations Living in Select Urban Counties.
Am J Public Health. 2006 Mar 29; [Epub ahead of print]

Objectives: Despite their increasing numbers, little is known about the health of American Indians/Alaska Natives living in urban areas. We examined the health status of American Indian/Alaska Native populations served by 34 federally funded urban Indian health organizations. Methods: We analyzed US census data and vital statistics data for the period 1990 to 2000. Results: Disparities were revealed in socioeconomic, maternal and child health, and mortality indicators between American Indians/Alaska Natives and the general populations in urban Indian health organization service areas and nation wide. American Indians/Alaska Natives were approximately twice as likely as these general populations to be poor, to be unemployed, and not to have a college degree. Similar differences were observed in births among mothers who received late or no prenatal care or consumed alcohol and in mortality attributed to sudden infant death syndrome, chronic liver disease, and alcohol consumption. Conclusions: We found health disparities between American Indians/Alaska Natives and the general populations living in selected urban areas and nationwide. Such disparities can be addressed through improvements in health care access, high quality data collection, and policy initiatives designed to provide sufficient resources and a more unified vision of the health of urban American Indians/Alaska Natives.

For Full-text: http://www.ajph.org

Kinney HC, Myers MM, Belliveau RA, Randall LL, Trachtenberg FL, Fingers ST, Youngman M, Habbe D, Fifer WP.
Subtle autonomic and respiratory dysfunction in sudden infant death syndrome associated with serotonergic brainstem abnormalities: A case report.

Sudden infant death syndrome (SIDS) is characterized by a sleep-related death in a seemingly healthy infant. Previously, we reported abnormalities in the serotonergic (5-HT) system of the medulla in SIDS cases in 2 independent datasets, including in the Northern Plains American Indians. The medullary 5-HT system is composed of 5-HT neurons in the raphe, extra-raphe, and arcuate nucleus at the ventral surface. This system is thought to modulate respiratory and autonomic function, and thus abnormalities within it could potentially lead to imbalances in sympathetic and parasympathetic tone. We report the case of a full-term American Indian boy who died of SIDS at 2 postnatal weeks, and who had subtle respiratory and autonomic dysfunction measured prospectively on the second postnatal day. Cardiorespiratory assessment of heart rate variability suggested that the ratio of parasympathetic to sympathetic tone was higher than normal in active sleep and lower than normal in quiet sleep in this case. At autopsy, arcuate nucleus hypoplasia and 5-HT receptor-binding abnormalities in the arcuate nucleus and other components of the medullary 5-HT system were found. This case suggests that medullary 5-HT system abnormalities may be able to be identified by such physiological tests before death. Replication of these findings in a large population may lead to the development of predictive cardiorespiratory assessment tools for future screening to identify infants with medullary 5-HT abnormalities and SIDS risk.

For Full-text: http://www.jneuropath.com

CJ Foundation for SIDS
Face up SIDS risk reduction resource kit. 2004.

This culturally appropriate kit is intended to support the reduction of racial and ethnic disparities in Sudden Infant Death Syndrome (SIDS) among American Indians. The Kit includes a manual designed not only to assist the educator in both one-on-one and classroom instruction but also to enhance the instructor’s current level of understanding regarding SIDS. Two videos in both VHS and CD-ROM format and Resource CD that contains posters, brochures and other educational materials are included.

Available from:
CJ Foundation for SIDS
The Don Imus-WFAN Pediatric Center
30 Prospect Ave.
Hackensack, NJ 07601.
(888) 825-7437
info@cjsids.com (e-mail)
http://www.cjsids.com

Luo ZC, Wilkins R, Platt RW, Kramer MS; For the Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System
Risks of adverse pregnancy outcomes among Inuit and North American Indian women in Quebec, 1985-97.
Paediatr Perinat Epidemiol. 2004 Jan; 18(1): 40-50.

Authors used Statistics Canada's linked stillbirth, live birth and infant death files to assess the risks of adverse pregnancy outcomes among Inuit and North American Indian vs. other ethnic women in Quebec, 1985-97 (1 125 462 singleton births). Mother tongue was used to define ethnicity, with the largest French language group as the reference. Main outcome measures are adjusted odds ratios (AOR) for preterm birth, small-for-gestational-age (SGA), stillbirth, neonatal and postneonatal death controlled for maternal age, education, marital status, parity, infant sex, community size, and community-level random effects using multilevel logit models. Inuit women had higher risks of preterm birth (AOR = 1.49, 95% CI [1.25: 1.78]) and immaturity-related infant mortality (AOR = 3.03 [1.36: 6.74]), while Indian women did not. Infants of Inuit (AOR = 0.39 [0.31: 0.49]) and Indian (AOR = 0.27 [0.24: 0.31]) women had substantially lower risks of SGA. Elevated risks of stillbirth were observed among Indian women [AOR = 1.53 (1.09: 2.15)], and of postneonatal death among both Inuit (AOR = 4.45 [2.74: 7.22]) and Indian (AOR = 1.86 [1.28: 2.70]) infants. Both Inuit and Indian infants had much higher risks of sudden infant death syndrome (SIDS) and infection-related mortality. Although the absolute risks of adverse outcomes declined from 1985-87 to 1995-97, the relative disparities between aboriginal and non-aboriginal women changed little over this period. We conclude that Inuit and Indian women have different risk profiles for adverse pregnancy outcomes, and that prevention of preterm birth among Inuit women, and of SIDS and infection-related infant mortality in both aboriginal groups, are important targets for future research and intervention.

For Full-text: http://www.blackwell-synergy.com

Muhuri PK, MacDorman MF, Ezzati-Rice TM.
Racial differences in leading causes of infant death in the United States.
Paediatr Perinat Epidemiol. 2004 Jan; 18(1):51-60.

We used linked birth/infant death records of over 23 million singletons belonging to six birth cohorts (1989-91 and 1995-97) and examined changes in race differentials in the overall and cause-specific infant mortality risks across time in the United States. Results show that infant mortality declined for all races during the time period, with disproportionately greater declines among non-Hispanic American Indians (AIs). Among the leading causes of infant death, declines in mortality from sudden infant death syndrome (SIDS), respiratory distress syndrome (RDS) and congenital anomalies contributed the most to the overall decline in infant mortality in the 1995-97 cohorts, compared with the 1989-91 cohorts. Disproportionately greater reductions in mortality resulting from SIDS and congenital anomalies led to more rapid mortality declines among non-Hispanic AIs than for other races. There are disturbing findings that infants of almost every race experienced increases in mortality from newborn affected by maternal complications of pregnancy (maternal complications) and that none of the race groups experienced a significant decline in mortality from disorders resulting from short gestation/low birthweight.

For Full-text: http://www.blackwell-synergy.com

Eaglestaff ML, McClain, M.; Fernbach, K.
American Indian Infant Mortality meeting: Community driven strategies
Rapid City, SD: National Institute of Child Health and Human Development, 81 p. 2003.

The purpose of the meeting was to design strategies to promote SIDS risk reduction messages in American Indian Communities of the Northwest, Northern Plains, and Alaska Natives while preserving cultural traditions. This report summarizes the identified community action driven plans and/or recommendations discussed by participants at the invitational meeting held in Rapid City, SD. It overviews background of SIDS, meetings purpose, goals and objectives; meeting preparation and participant selection; agenda; summary of presentations; summary of discussion groups; combined recommendations from discussion groups; risk factors for infant mortality; risk reduction strategies; action plans; what each Indian Health Service (IHS) area can do to reduce infant mortality; suggested areas for research; what the next steps were to be. Includes appendices 1-4 covering minutes from the American Indian Infant Mortality Meeting held at (Minneapolis, MN, June 28, 2002), list of participants of the 2003 meeting, full presentations of the participants and full report from each discussion group.

Serotonergic brainstem abnormalities in Northern Plains Indians with Sudden Infant Death Syndrome.
J Neuropathol Exp Neurol, 2003 Nov; 62(11): 1178-91.

The rate of the sudden infant death syndrome (SIDS) among American Indian infants in the Northern Plains is almost 6 times higher than in U.S. white infants. In a study of infant mortality among Northern Plains Indians, we tested the hypothesis that receptor binding abnormalities to the neurotransmitter serotonin (5-HT) in SIDS cases, compared with autopsied controls, occur in regions of the medulla oblongata that contain 5-HT neurons and that are critical for the regulation of cardiorespiration and central chemosensitivity during sleep, i.e. the medullary 5-HT system. Tritiated-lysergic acid diethylamide binding to 5-HT1A-D and 5-HT2 receptors was measured in 19 brainstem nuclei in 23 SIDS and 6 control infants using tissue receptor autoradiography. Binding in the arcuate nucleus, a part of the medullary 5-HT system along the ventral surface, in the SIDS infants (mean age-adjusted binding 7.1 ± 0.8 fmol/mg tissue, n = 23) was significantly lower than in controls (mean age-adjusted binding 13.1 ± 1.6 fmol/mg tissue, n = 5) (p = 0.003). Binding also demonstrated significant diagnosis × age interactions (p < 0.04) in 4 other nuclei that are components of the 5-HT system. These data suggest that medullary 5-HT dysfunction can lead to sleep-related, sudden death in affected SIDS infants, and confirm the same binding abnormalities reported by us in a larger dataset of non-American Indian SIDS and control infants. This study also links 5-HT abnormalities in the arcuate nucleus with exposure to adverse prenatal exposures, i.e. cigarette smoking (p = 0.011) and alcohol (p = 0.075), during the periconceptional period or throughout pregnancy. Prenatal exposure to cigarette smoke and/or alcohol may contribute to abnormal fetal medullary 5-HT development in SIDS infants.

For Full-text: http://www.jneuropath.com

Iyasu S, Randall LL, Welty TK, et al.
Risk factors for sudden infant death syndrome among northern plains Indians.
JAMA, 2002 Dec 4. 288(21): 2717-23.

Context: Sudden infant death syndrome (SIDS) is a leading cause of postneonatal mortality among American Indians, a group whose infant death rate is consistently above the US national average. Objective: To determine prenatal and postnatal risk factors for SIDS among American Indians. Design, Setting, and Participants: Population-based case-control study of 33 SIDS infants and 66 matched living controls among American Indians in South Dakota, North Dakota, Nebraska, and Iowa enrolled from December 1992 to November 1996 and investigated using standardized parental interview, medical record abstraction, autopsy protocol, and infant death review. Main Outcome Measures: Association of SIDS with maternal socioeconomic and behavioral factors, health care utilization, and infant care practices. Results: The proportions of case and control infants who were usually placed prone to sleep (15.2% and 13.6%, respectively), who shared a bed with parents (59.4% and 55.4%), or whose mothers smoked during pregnancy (69.7% and 54.6%) were similar. However, mothers of 72.7% of case infants and 45.5% of control infants engaged in binge drinking during pregnancy. Conditional logistic regression revealed significant associations between SIDS and 2 or more layers of clothing on the infant (adjusted odds ratio [aOR], 6.2; 95% confidence interval [CI], 1.4-26.5), any visits by a public health nurse (aOR, 0.2; 95% CI, 0.1-0.8), periconceptional maternal alcohol use (aOR, 6.2; 95% CI, 1.6-23.3), and maternal first-trimester binge drinking (aOR, 8.2; 95% CI, 1.9-35.3). Conclusions: Public health nurse visits, maternal alcohol use during the periconceptional period and first trimester, and layers of clothing are important risk factors for SIDS among Northern Plains Indians. Strengthening public health nurse visiting programs and programs to reduce alcohol consumption among women of childbearing age could potentially reduce the high rate of SIDS.

For Full-text: jama.ama-assn.org/

Wilson A, Talley RC.
State of South Dakota's child: 2001.
S D J Med 2002 Jan; 55(1): 23-30.

In the year 2000, there was a reversal of the previous year's increase in births in South Dakota, with the total number of births decreasing by 170. There also was an increase in the percentage of low birth weight newborns (< 2500 grams), but a slight decrease in the percent of babies born weighing less than 1500 grams. Most dramatic, was the drop noted in the year 2000 in the state's infant mortality, achieving its lowest ever rate of 5.5 per thousand live births. This drop was observed in both the neonatal (< 29 days of age) and post neonatal (28-364 days of age) rates of death, and for both the White and American Indian populations. An analysis of the causes of infant death showed that during the year 2000 there was an approximate 50% decrease in previous years' rate of death attributable to congenital anomalies and Sudden Infant Death Syndrome. As its special topic, this year's report discusses the epidemic of overweight and obesity that affects approximately one-third of school age youth in South Dakota and is associated with risks for their current and future health.

Grossman, D.C.; Baldwin, L-M; Casey, S.; Nixon, B.; Hollow, et al.
Disparities in infant health among American Indians and Alaska Natives in US metropolitan areas.
Pediatrics 2002 Apr; 109(4): 627-633.

The objective of this study was to determine geographic variation in urban American Indian and Alaska Native (AI/AN) rates of infant mortality, low birth weight, prenatal care use, and maternal-child health care service availability. This was a retrospective cohort study using data from the 1989 to 1991 birth-death linked database from the National Center for Health Statistics. The authors examined births from metropolitan areas with a minimum of 300 AI/AN births during the study period. Key outcomes of interest included rates of low birth weight, neonatal mortality, postneonatal mortality, and women receiving inadequate prenatal care using the modified Kessner index. To determine the type of health services tailored to AI/AN mothers residing in these urban areas, we conducted a telephone survey of the 36 urban Indian health programs operating in 1997 using a semistructed survey. Items in the survey included questions about the availability of prenatal and infant health care. Results showed that during the 1989 to 1991 study period, there were 72,730 singleton births to AI/AN mothers and/or fathers residing in urban areas, representing 49 percent of all AI/AN births in the United States. Overall 14.4 percent of urban AI/AN births were to women who received inadequate care during pregnancy, 5.7 percent of pregnancies resulted in low birth weight infants, and 11.0 infants died per 1000 live births. Death rates for the neonatal period (5.5 per 1000 births) and postneonatal period (5.4 per 1000 births) were similar. Marked disparity in these indicators exist between pregnancies to AI/AN and white women. Among the 54 metropolitan areas, 46 had a rate ratio (AI/AN: white) for inadequate care of greater than or equal to 1.5 (range: 0.9-8.5). The mean rate ratios for neonatal and postneonatal mortality were 1.6 (range 0.3-4.0) and 2.0 (range: 0.5-5.5). There was also considerable geographic variation of AI/AN mortality rates between metropolitan areas in all of the outcomes studied. All of the 20 metropolitan areas with the highest birth counts had some type of direct medical care or outreach service available from an urban clinic targeted toward AI/AN patients. It was concluded that considerable variation also exists among rates of AI/ANs between metropolitan areas. Disparity exists in rates of perinatal outcomes between AI/ANs and whites living in the same metropolitan areas. Although AI/AN urban health programs exist in most cities with large birthcounts, it seems that many have inadequate resources to meet existing needs to improve perinatal outcomes and infant health.

For Full-text: http://www.pediatrics.org

Randall LL, Krogh C, Welty TK, et al.
The Aberdeen Indian Health Service infant mortality study: design, methodology, and implementation.
Am Indian Alsk Native Ment Health Res 10(1): 1-20, 2001.

Of all Indian Health Service areas, the Aberdeen Area has consistently had the highest infant mortality rate. Among some tribes in this area the rate has exceeded 30/ 1000 live birth and half the infant deaths have been attributed to Sudden Infant Death Syndrome, a rate four to five times higher than the national average. The Indian Health Service, Centers for Disease Control and Prevention, National Institute of Child Health and Human Development, and the Aberdeen Area Tribal Chairmen's Health Board collaborated to investigate these high rates with the goals of refining the ascertainment of the causes of death, improving cause-specific infant mortality rates and identifying factors contributing to the high rates. Ten of the 19 tribes or tribal communities, representing 66%of the area population, participated in a 4-year prospective case-control study of infants who died after discharge from the hospital. Infant care practices and socio-demographic, economic, medical, health care, and environmental factors were examined. The study included parental interviews, death scene investigations, autopsies, neuropathology studies, medical chart abstractions, blood cotinine assays, and a surveillance system for infant deaths. Controls were the previous and subsequent infants born on the case mother's reservation. From December 1,1992 until November 30,1996,72 infant deaths were investigated. This report describes the study methods and the model employed for involving the community and multiple agencies to study the problem of infant mortality among Northern Plains Indians. Data gathered during the investigations are being analyzed and will be published at a later date.

For Full-text: http://www2.uchsc.edu/ai/ncaianmhr/journal_home.asp

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