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Feature

Cot Death Conundrum

Cot deaths in Canterbury are among the highest in the Western world. Researchers are hoping that an education campaign will change that.

By Cathryn Crane, NZSM

The charts paint a stark picture -- more babies die of unexplained causes in Canterbury than anywhere else in the country. To make matters worse, the rate is one of the highest in the world. Add that to a sudden rise in inexplicable deaths at the beginning of the 80s, and you have a situation that demands action.

Dr Rodney Ford, Community Paediatrician at Christchurch Hospital, and his colleague, Cot Death Research Fellow Jeff Brown, are hoping that the work they do will make a difference.

Early indications suggest that it has already -- the number of cot deaths dropped in Canterbury last year. The doctors are wary of attaching any significance to the result, as they are aware that it could be just a statistical glitch.

"It's very important not to be lulled into a sense of we must be doing something right," says Brown. "We don't know if it'll be sustained. We don't know why it occurred."

All the same, the apparent drop has heartened Canterbury researchers.

Bad Infant Mortality

Infant deaths are much the same across all countries, notes Ford. They occur when babies are born prematurely, through accidents and infections. These deaths are explicable. There is an identifiable reason for them. The deaths which can't be explained are tagged as cot deaths, or sudden infant death syndrome (SIDS). For some reason, the infant stops breathing and dies.

"Our very bad infant mortality ratings can be attributed solely to cot deaths," Ford says. A survey of child deaths in Canterbury showed that one-third of all deaths from the time of birth to age 15 were cot deaths. It was a surprising statistic, says Ford, and one which demanded attention.

The problem was in identifying causative factors so that something could be done. A historical analysis of child deaths showed a surge in cot deaths during the early 80s. Between 1950 and 1975, two to three deaths per year were unexplained. In the 80s, this jumped to around seven. No-one knows why, although many theories have been suggested. Possible causes ranged from mould on plastic cot liners to trace element deficiencies.

Ford acknowledges that the apparent trebling in cot death rate may have come about from greater awareness of cot death. The suggestion was that more deaths were being labelled as cot death.

"I thought it was that, first of all," he observes. "But if it was labelling, we shouldn't have this huge infant mortality rate that is unexplained."

National Survey

Whatever the reason for the apparent rise, it prompted a number of projects aimed at finding out more about what made infants die in this fashion. A major epidemiological study was launched nationally. from November 1987 to November 1990, some 500 cot deaths were studied intensively. For every family experiencing a cot death, four "normal" control families were also interviewed.

The survey involved a massive number of questions covering all aspects potentially related to cot death. Feeding practices, washing powders, nappy use, family dynamics, sleeping conditions -- all the "flavour of the month" possibilities were covered.

Preliminary analysis identified three main factors that appear to be linked with cot death: the baby's sleeping position, the value of breastfeeding, and smoking in the pregnant mother. These factors are definitely linked in some fashion, although the researchers are still unsure in what way.

Ford also notes that there are deaths where those factors are not involved. Information about these, and possible further preventative measures, may be locked up in the survey data.

Analysis Lacking

It may take some time for that to be assessed. While the researchers were able to gain funding to collect the information, they are short of critical funds necessary to analyse that information.

"Funding bodies are not interested in funding analysis," says Ford. This puts the researchers in an awkward Catch 22 situation. If they include the cost of analysis in their original proposal, the amount requested becomes too high. Yet analysis does not qualify as original research for the purposes of funding. The work is being done, albeit by volunteers and at a very slow rate. Nevertheless, the original quick scan through the data showed that they had something to go on.

"We felt the case for going for a preventative programme was so strong, we couldn't ethically wait for three years of data analysis," Ford says.

The programme has covered a large number of groups, including community health services, La Leche, Plunket and the Maori Women's Welfare League. A television campaign has also brought the message home to New Zealand.

80% Reduction Possible

"Cot death could be reduced by as much as 80% if those factors were followed by parents in New Zealand," Ford maintains. He's been involved with the recent launch of a campaign to make pregnant women aware of the dangers of smoking. According to Ford, some 30% of mothers smoke during pregnancy. In the last three years, 25% of cot deaths have been associated with mothers who smoke 20 or more cigarettes a day.

As well as studying cot deaths, researchers are studying at-risk babies. Brown is running a sophisticated computer monitoring programme, measuring breathing patterns, body temperature and a host of other factors. Parents keep records of sleeping position, clothing and any potentially related changes.

At present, Brown has only two of the "Baby Log" systems running, and hopes to get funding for more. As it is, analysing the data from three to four weeks of continuous monitoring is going to take some time. He sees the study as particularly valuable in that it measures the real things that happen in the real world. Over the monitoring period, babies grow and develop, they are immunised, the weather changes.

"We want to learn what makes babies tick and what makes them tick not quite so well," Brown muses. He's hopeful that the study will provide some information on causes of cot death and what can be done to prevent it.

"There are hundreds of theories about causes. There are tens of factors that are statistically linked," he says. The difficulty is in finding factors that can be used to reduce the deaths. It is known, for example, that boys are more likely to die of cot death than girls. Does this mean we should give boy babies sex changes?

Brown doesn't think that that's an option, but he does believe that parents can make a difference by being aware of the three main factors already identified.

"We've established a link -- we don't know why -- but it's something that can be changed. It's worth putting the effort into."

Cathryn Crane is a freelance journalist with an interest in environmental issues.