It was before dawn when the pediatrician was called in to the hospital maternity floor to support the delivery of slightly premature twins. Pediatricians on call always come in for these deliveries, no matter the time of day or night. Fortunately, the infants did well, and the family went home in just a week. Everyone was happy and healthy.
Two months later another late night call brought this doctor to the emergency department to resuscitate an infant. It was one of the twins. He was unresponsive to all efforts to revive him. It was a sudden and unexpected death and a devastating tragedy for his family.
Maine’s infant mortality rate has increased as the national rate has declined. In 2010, the infant mortality rate in Maine was 5.4 deaths per 1,000 infants, which translates to 70 deaths per year. In 2013, this rate rose to 7.1 deaths per 1,000 babies born in Maine: 90 babies.
People who provide care for babies wonder what could cause an infant to die in our state. We know the risk for Sudden Unexpected Infant Death Syndrome, or SUIDS, goes up when a baby sleeps with an adult on a bed. Sleeping with a baby on a couch dramatically increases this risk, as babies can suffocate between the cushions. If parents who share a bed with their baby have had alcoholic drinks, smoked marijuana or taken medications that cause drowsiness, such as methadone, the risk of SUID is 50 times greater.
We know the risk is higher for baby boys, when babies are born premature, when parents smoke tobacco, when babies sleep on soft surfaces or waterbeds and especially when babies sleep face down or on their side.
In early 2015, five healthy infants — younger than 4 months old — died within a two-month period in Maine because of accidental suffocation while bed sharing. The Maine attorney general’s office and the chief medical examiner were so concerned that they issued a news release to raise public awareness.
Finland has successfully decreased its rate of SUID using a different approach. Every expectant mother who attends her four-month prenatal appointment is provided what’s called a baby box. The box contains clothes, blankets, a warm coat, diapers and other essential items for the first year of life. The box also is lined with a mattress, serving as a safe sleeping environment for the infant.
This simple solution allows for close proximity for mother and child to promote breastfeeding and discourage bed sharing. The baby box is recognized as a contributing factor in Finland’s decrease in infant deaths, from 65 deaths per 1,000 births in 1938 to 2.52 deaths per 1,000 births in 2016. Similar pilot programs exist in Delaware, Pennsylvania and Minnesota.
In Maine, a similar program is promoting safer sleep habits. Dr. Jennifer Hayman and perinatal Nurse Kelley Bowden, colleagues at the Barbara Bush Children’s Hospital in Portland, reviewed all cases of babies dying from SUID in Maine over a five-year period, 2001-2006, and found that most (61 percent) of the deaths were related to bed sharing. She also found that most (71 percent) of these babies were sleeping face down at the time of death and that most (81 percent) had blankets, stuffed animals and other things in their sleeping area at the time of death.
You can imagine that the risk of a baby dying suddenly and unexpectedly increases dramatically when there are multiple risk factors for SUID. What can you do to save these babies lives, lower the infant mortality rate and eliminate the risk that your baby will die suddenly?
It’s easy to say, “To lower your risk, don’t smoke, don’t sleep with your baby on a bed or a couch, always place your baby to sleep on his or her back.” Pediatricians have been saying this for years and years.
But these days parents say it feels nice to snuggle with a baby in bed, that dad likes to lay on the couch with the baby while he watches a game, and it’s nice to have stuffed animals and soft bedding in the crib. Many babies sleep better when they lay on their side or tummy. And it’s so hard to quit smoking. Parents may say their friends and family members slept with their babies, and they didn’t die.
Some people have said they can’t afford a crib. So Hayman and others at the Barbara Bush Children’s Hospital worked with a program called “Cribs for Kids.” This program makes cribs available at a low cost. It doesn’t make a profit. Hayman reports it has distributed more than 650 cribs since the program started in 2010.
We need to expand the “Cribs for Kids” program throughout Maine. And based on current knowledge and encouraging results with the baby box program in Finland, we propose adopting a similar approach, so every newborn in Maine has the best chance for survival.
SUID is tragic for families and providers. We can and should do more to reduce Maine’s infant mortality rate. The Alfond Family offers $500 per child born in the state to start an education fund, but implementing a baby box program is a lot less expensive and can make a difference immediately for newborns and their families.
The Maine chapter of the American Academy of Pediatrics is ready to collaborate with Maine companies, insurance companies, the Maine Children’s Trust and other philanthropic stakeholders to offer a baby box or crib to the family of each newborn to promote healthy and safe sleep habits, and reduce the rate of SUID in Maine.
Dr. Stephen Meister is medical director at the Edmund N. Ervin Pediatric Center at MaineGeneral Medical Center in Augusta, president elect of the Maine chapter of the American Academy of Pediatrics and a member of the Child Death and Serious Injury Review panel. Celeste Murtha is a senior biology student at Colby College in Waterville and a student intern at the pediatric center.