Cribs Linked To Injuries And Deaths In Babies And Young Children, US Report

Cribs Linked To Injuries And Deaths In Babies And Young Children, US Report

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Main Category: Pediatrics / Children's Health
Also Included In: Pregnancy / Obstetrics;  Public Health;  Nursing / Midwifery
Article Date: 18 Feb 2011 - 2:00 PST

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In view of the unacceptable rates of injury, including deaths, in babies and young children that are linked to cribs, playpens
and bassinets, US researchers are calling for greater efforts to increase awareness of their dangers, for products to be
better designed for safety and for standards to be enforced more rigorously. 

The first study to use a nationally representative sample to analyze injuries associated with cribs, playpens, and bassinets in
the US appeared online on 17 February in the journalPediatrics.

In December 2010, the United States Consumer Product Safety Commission (CPSC), after issuing recalls for more than 11
million cribs and receiving reports of more than 30 infant and toddler deaths in the past decade, voted unanimously to ban
drop-sided cribs, the sort where a side rail can be lowered to allow a child to be lifted in and out more easily.

From June 2011 it will be against the law in the US to manufacture, sell or lease drop-sided cribs.

In a first study of its kind, researchers from the Center for Injury Research and Policy of The Research Institute at
Nationwide Children's Hospital in Columbus, Ohio, analyzed data covering 1990 to 2009 on children under 2 years old who
received treatment in emergency rooms in the US for injuries related to cribs, playpens, and bassinets. The data came from
the National Electronic Injury Surveillance System which is operated by the CSPC.

Dr Gary Smith, who is director of the Center for Injury Research and Policy and senior author of the study, told the media
that:

"Despite the attention given to crib safety over the past two decades, the number of injuries and deaths associated with
these products remains unacceptably high."

For the 19-year period they reviewed, he and his colleagues found that:

 Each year, an average of 9,500 injuries and more than 100 deaths occuring in US emergency departments among
children under 2 years old were linked to cribs, playpens, and bassinets.

 Most of the injuries involved cribs (83%).

 The most common injury was soft-tissue injury (34%), followed by concussionor head injury (21%).
 The most frequently injured part of the body was the head or neck (40%), followed by the face (28%).

 Two thirds of injuries were due to falls, and the percentage attributed to falls went up with age.

 Babies under 6 months old were nearly 3 times more likely to be hospitalized than older children.

The researchers concluded that:

"Given the consistently high number of observed injuries, greater efforts are needed to ensure safety in the design and
manufacture of these products, ensure their proper usage in the home, and increase awareness of their potential dangers to
young children."

However, although there are risks, a crib is still considered the safest place in which to place a baby to sleep. Given this,
there are several things parents, childminders and caregivers should bear in mind when choosing a crib and placing a child
to sleep in one, says the Research Institute at Nationwide Children's Hospital:

 Look up www.recalls.gov to make sure the crib has not been recalled.

 Make sure the crib is not old, broken or modified, meets all current safety standards and does not have a drop
side.

 Avoid cribs with cutouts, decorative knobs or corner posts that stick up more than 1.6 mm (1/16th in).

 Make sure the slats are no more than 6 cm (2 and 3/8 ins) apart.

 Ensure the mattress fits tightly in the crib: if you can fit two fingers between the crib and the mattress it is too small
- get a bigger mattress.

 Examine the crib frequently and make sure nothing is broken or loose and it is in good condition.

 Read and follow the assembly instructions closely.

 Always place babies on their backs to sleep.

 Don't add pillows, blankets, sleep positioners, cuddly toys or bumpers in the crib. The safest crib is a bare crib.

 Don't put tents and mesh canopies over the crib: children can become tangled up in them and strangle themselves
trying to get out.

 Don't put the crib near a window, especially if it has sashes, cords and drawstrings for blinds, shades or curtains.

 Children often develop faster than we think so keep checking what they can do: once a child can push up onto
hands and knees, and definitely by the age of 5 months, you should remove all mobiles and nearby hanging toys.

 Once they can pull up to standing, move the mattress to the lowest position and make sure the sides of the crib are
at least 66 cm (26 in) above the mattress to stop them falling out.

 Your child will most likely be too big for his or her crib when they near 90 cm (about 35 in) in height. Check the
manufacturers' information about their advice on when the crib will be too small for your child.

 If you put your child in a bassinet or playpen, make sure it has a wide and sturdy base and it is within the safety
limits for your child's height and weight.
 Breaking The Amniotic Membrane Shortens Delivery Time When First-Time
Mothers Are Induced
 Editor's Choice
Main Category: Pregnancy / Obstetrics
Article Date: 12 Feb 2011 - 0:00 PST
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In a study presented at the Society for Maternal-Fetal Medicine's (SMFM) annual meeting, The Pregnancy Meeting
™, in San Francisco, researchers will present findings that show that by performing an amniotomy on first time
mothers in situations when labor has to be induced, that delivery time can be shortened by more than 10 percent. 

There are many reasons that labor may need to be induced after a woman's due date. Today's study looked at
whether or not performing an amniotomy early on in the labor process would shorten delivery time and whether it
would cause any adverse affects. 
The researchers performed a randomized clinical trial. Nulliparous patients with singleton, viable pregnancies
undergoing labor induction at or beyond 37 weeks were eligible for inclusion. They excluded subjects with PROM,
cervical dilation > 4cm at admission, or significant vaginal bleeding. 

Eligible subjects were randomized to early amniotomy (AROM at ≤ 4cm) or standard management (AROM at >
4cm). Outcomes for this study included duration of labor, % delivered within 24 hours, cesarean rate, maternal
infectious complications, and measures of neonatal outcome. A priori sample size was based on the proportion of
subjects delivered within 24 hours of randomization. 

The study randomized 585 subjects into the clinical trial, 292 into early amniotomy group and 293 into the standard
management group. Baseline demographics at randomization, cervical dilation at admission, and methods of
induction were similar between the groups. Early amniotomy shortened the time from randomization to delivery by
over 2 hours (p=0.04) and increased the proportion of subjects delivered within 24 hours of randomization. 

The study found that by doing an early amniotomy, you can shorten the time to delivery by over 10 percent, and
increase the likelihood of delivery within 24 hours without adversely impacting maternal or neonatal well-being. 

"I think this offers the first bit of evidence that shows that by performing an amniotomy early in labor, you can
shorten labor time by a significant amount with no ill effects to the mother or baby," said George Macones, M.D.,
one of the study's authors. "This greatly increases the comfort of the mother." 

Source: Society for Maternal-Fetal Medicine