By Dr Tom Turner, Chairman, Scottish Cot Death Trust
THIS week 500 delegates will attend the biannual conference of the International Stillbirth Alliance (ISA) and the International Society for the Study and Prevention of Perinatal and Infant Death (ISPID), hosted at the University of Strathclyde Technology and Innovation Centre by the Scottish Cot Death Trust. At the heart of this gathering will be a substantial number of bereaved families with whom participants will share both their knowledge and experiences of bereavement.
Sudden unexpected death in infancy (Sudi), the modern term for cot death, and stillbirth are conditions that occur in every country in the world. Unlike most medical conditions they cannot be treated. The only way to significantly reduce these tragic events is to prevent them from happening. Worldwide, only a small proportion of health care budgets, about three per cent, are spent on prevention. This conference brings together experts from around the world who will present and discuss interventions to prevent stillbirth and Sudi.
Stillbirth(where a foetus dies beyond 24 weeks gestation) has been a major focus of healthcare improvement worldwide. The UK has been recognised as a country with a higher than average stillbirth rate in developed countries and this has led to many initiatives aimed at reducing this, including the Each Baby Counts project from the Royal College of Obstetricians and Gynaecologists and the work of the Maternity and Children Quality Improvement Collaborative in Scotland. All these initiatives are focusing on achieving a reduction in stillbirth through public health messaging around smoking cessation, improved perception of fetal movements, better identification of poorly growing babies in the womb and better methods to assess baby heart rate monitoring in labour. There are many organisations such as MBRRACE, and charities(Sands) involved in these projects. ISA aims to bring such organisations together by providing a high quality comprehensive source of information from across the world for parents, health professionals and the community.
Sudi was responsible for 180 infant deaths per year, most in the first six months of life, in the mid-1980s in Scotland. This has now been reduced to 20-40 deaths each year. Preventing these deaths has largely been achieved by educating parents, through health professionals, to place their baby to sleep on their backs. Other “causes” of Sudi such as not breastfeeding and smoking during pregnancy seem more resistant to current education policies. Both breastfeeding and stopping smoking will also help mothers to live long and healthy lives and we need to learn from others attending this conference, from countries where they have been more successful in affecting lifestyle choices, how they have successfully negotiated this thorny problem. Other areas of common interest amongst delegates include the significant issue of unsafe sleep practices such as sofa sleeping with small infants, co-sleeping whilst under the influence of alcohol or drugs and unintentional unsafe co-sleeping.
Not all causes of stillbirth and Sudi can be placed at the feet of public health issues however and the pathologists, microbiologists , geneticists, biochemists and cellular biologists attending this conference will be hard at work telling the rest of us how their research is steadily allowing us to understand how else we can influence the incidence of both conditions. We need to ensure that legacy of this conference is a steady reduction in both Sudi and stillbirth and families shattered by their effects worldwide.
* Additional input from Alan Cameron, Professor of Fetal Medicine, and David Tappin, Professor of Clinical Trials for Children, both University of Glasgow.
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