Mp Ward-Platt

Randomised trial of infant sleep location on the postnatal ward

Objective: To determine whether postnatal mother–infant sleep proximity affects breastfeeding initiation and infant safety. Design: Randomised non-blinded trial analysed by intention to treat. Setting: Postnatal wards of the Royal Victoria Hospital (RVI), Newcastle upon Tyne, UK. Participants: 64 newly delivered mother–infant dyads with a prenatal intention to breastfeed (vaginal deliveries, no intramuscular or intravenous opiate analgesics taken in the preceding 24 h). Intervention: Infants were randomly allocated to one of three sleep conditions: baby in mother’s bed with cot-side; baby in side-car crib attached to mother’s bed; and baby in stand-alone cot adjacent to mother’s bed. Main outcome measures: Breastfeeding frequency and infant safety observed via night-time video recordings. Results: During standardised 4-h observation periods, bed and side-car crib infants breastfed more frequently than stand-alone cot infants (mean difference (95% confidence interval (CI)): bed v stand-alone cot = 2.56 (0.72 to 4.41); side-car crib v stand-alone cot = 2.52 (0.87 to 4.17); bed v side-car crib = 0.04 (−2.10 to 2.18)). No infant experienced adverse events; however, bed infants were more frequently considered to be in potentially adverse situations (mean difference (95% CI): bed v stand-alone cot = 0.13 (0.03 to 0.23); side-car crib v stand-alone cot = 0.04 (−0.03 to 0.12); bed v side-car crib = 0.09 (−0.03–0.21)). No differences were observed in duration of maternal or infant sleep, frequency or duration of assistance provided by staff, or maternal rating of postnatal satisfaction. Conclusion: Suckling frequency in the early postpartum period is a well-known predictor of successful breastfeeding initiation. Newborn babies sleeping in close proximity to their mothers (bedding-in) facilitates frequent feeding in comparison with rooming-in. None of the three sleep conditions was associated with adverse events, although infrequent, potential risks may have occurred in the bed group. Side-car cribs are effective in enhancing breastfeeding initiation and preserving infant safety in the postnatal ward.

Patterns of child death in England and Wales

In the past century, child mortality has fallen to very low rates in all developed countries. However, rates between and within countries vary widely, and factors can be identified that could be modified to reduce the risk of future deaths. An understanding of the nature and patterns of child death and of the factors contributing to child deaths is essential to drive preventive initiatives. We discuss the epidemiology of child deaths in England and Wales. We use available data, particularly that of death registration and other available datasets, and published literature to emphasise issues relevant to reduction of child deaths in developed countries. We examine the different patterns of mortality at different ages in five broad categories of death: perinatal causes, congenital abnormalities, acquired natural causes, external causes, and unexplained deaths. For each category, we explore what is known about the main causes of death and some of the contributory factors. We then explain how this knowledge might be used to help to drive prevention initiatives.

Bed‐sharing by breastfeeding mothers: who bed‐shares and what is the relationship with breastfeeding duration?

To explore the link between breastfeeding duration and bed‐sharing frequency among women reporting a prenatal intention to breastfeed.

How Low Can I Go? The Impact of Hypoglycemia on the Immature Brain

To the Editor .— In a recent commentary in Pediatrics ,1 Inder discussed neonatal hypoglycemia and commented on an article by Burns et al2 that presented a diverse picture of hypoglycemia-related cerebral abnormalities found on neuroimaging in neonates. Dr Inders review and cautions in extrapolation were sensible, but she concluded with a statement with which we strongly disagree: “… the experimental and human clinical data are clear that hypoglycemia (blood glucose level < 45 mg/dL), isolated or combined with …

Use of interactive telephone technology for longitudinal data collection in a large trial

We report here on the use of interactive telephone technology for collecting longitudinal data in a large randomized non-blinded parallel trial. Data were primarily collected via an automated interactive telephone system which enabled data to be downloaded by researchers periodically via a secure website. Alternative methods were used by some participants to provide data; here we analyze the demographic profiles of groups by preferred data provision, and consider the cost-effectiveness and efficiency of such a system. The automated telephone system was used to provide the majority of data obtained (75.7%), however the group preferring to use this system to provide the majority of their data was on the whole older, more likely to be married, university educated, higher income and white compared to participants preferring to submit their data via personal phone call or post. We conclude that interactive telephone technology provides a means by which large quantities of longitudinal data may be collected efficiently. Depending on the target population, however, considerable staff time may be required to manage attrition and consequent data loss, and alternative strategies should be considered to minimize this.

Bi-ethnic infant thermal care beliefs in Bradford, UK

Purpose – Overheating is considered a modifiable risk factor for sudden infant death syndrome (SIDS). The purpose of this paper is to explore differences in infant thermal care beliefs between mothers of South Asian and white British origin in Bradford, UK. Design/methodology/approach – This study employed face-to-face interviews with semi-structured and structured questions with 51 white British and 51 South-Asian mothers in the Bradford District, UK. Findings – White British mothers were more concerned about overheating causing SIDS whereas South-Asian mothers were more concerned about cold causing respiratory infections. However concerns around hypothermia and chills causing colds were expressed in both groups. White British mothers were significantly more likely to be concerned about their infant getting too hot than too cold and South-Asian mothers about both heat and cold (p0.001), but white British mothers on lower incomes and with poorer education expressed concern about cold more so than their b...