The American Academy of Pediatrics (AAP) published, “SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment“ which recommends that monitoring should not be used to prevent SIDS and SUID.
https://pediatrics.
In the 2016 article, it references 4 studies from the 1980’s to justify their position to not monitor (100-103). To my knowledge, these were not based rigorous scientific studies, and based on studies performed with equipment obsolete by today’s standards.
One was just a survey on apnea programs and apnea monitors, and was not performed in the controlled test environment (101). Two evaluated whether or not a future SIDS risk could be determined, but did not actually evaluate whether monitoring could prevent SIDS. (100, 102)
The 4th reference was to the reference to the CHIME study, which did not test whether monitoring could prevent SIDS. (103) https://jamanetwork.com/
The CHIME study, probably the largest and most expensive study on infant monitoring, did not conclude that monitoring was not effective, but gave evidence that it was. In the study, 1079 infants were monitored with 6 deaths occurring during the study. However, none of the deaths occurred while the infants were being monitored. It was also stated in the CHIME report, “Since many conventional and extreme events caused a monitor alarm, it is possible that the duration of some events in the risk groups was shortened by either an alarm-induced auditory arousal or by caretaker intervention.”
Here are the last 2 paragraphs of the CHIME study report. Note the highlighted text:
“The CHIME study was also not designed to determine whether use of a monitor decreases the rate of SIDS. The finding that preterm infants 43 weeks’ PCA exhibited more extreme events than healthy term infants does not resolve the debate whether such infants would benefit from monitoring. The observation that 20% of asymptomatic preterm infants experienced 1 extreme event highlights the need to determine clinical relevance of extreme events. Until then, however, it is not possible to refute or support the recommendations of the NIH Consensus Development Conference that monitoring or an alternative therapy is medically indicated for symptomatic but not asymptomatic preterm infants.
Controversies regarding who should be monitored notwithstanding, the CHIME data are responsive to an identified gap in our knowledge by defining risk of occurrence and timing of extreme events during early postnatal development.1 These data also document a high frequency of obstructed breathing within events. Our choice of RIP for breath detection does limit direct comparison to all prior (transthoracic impedance–based) data, but it is important to note that commercially available monitors would likely have missed many CHIME events due to the high frequency of obstructed breaths. These results should be important for designing future monitors and determining if an infant is likely to be at risk for a cardiorespiratory event.“
This last point made in the CHIME report was that commercially available monitors at that time, 2001, were not adequate for monitoring for ALTE’s. The others 3 studies sited in the AAP recommendation to “not monitor” were all performed in the 1980’s. This means that the CHIME study report invalidates those previous studies in determining whether monitoring can prevent SIDS/SUID because those monitors were not adequate for the job.
The AAP recommendation has no valid studies on which to base their conclusion that infant monitoring is ineffective in preventing these deaths!
There may be no study that proves infant monitoring prevents SIDS and SUID, but there is also no scientific study that proves they don’t. Also, there has been no physiological explanation given as to why monitoring would not be effective in preventing these deaths.
In taking a scientific approach on this topic, there is a valid hypothesis that monitoring can prevent many of these deaths, backed with some supporting evidence and theory. There needs to be a rigorous scientific study to determine whether or not the hypothesis is correct. That is the scientific approach. In the meantime, other less expensive studies can be performed to provide additional evidence to support the hypothesis and justify a more rigorous and expensive study. The Snuza study could be one such study.
In the balance, we have about 3500 SIDS/SUID deaths per year in the US alone, which accounts for more deaths than all other causes of death combined for infants between the ages of 1 and 12 months. From the CDC data, an infant is 20 times more likely of dying from SIDS/SUID than dying in an auto accident, and yet infant car seats are mandated by law.
The “Safe to Sleep” program, as recommended by AAP, was put into place more than 20 years ago and was successful in reducing the number of deaths. However, SIDS/SUID continues to be a major health crisis, and there has been little progress in the last 20 years in reducing the death rate or in finding a solution. In spite of this improvement, during the last 20 years, more than 70,000 infants have died in the US of SIDS/SUID. At this point, the most likely solution is monitoring of all infants with a high quality monitor, just like all infants are required to be placed in a high quality infant car seat when in an automobile.