HIV, SIDS, and Breastfeeding in the Pediatric Spectrum of HIV Disease Cohort Open Access

Little, Kristen Marie (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/7w62f8480?locale=en%255D
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Abstract

Abstract

HIV, SIDS, and Breastfeeding in the Pediatric Spectrum of HIV Disease Cohort
By Kristen M. Little


Objective: Though the rate has declined significantly in the past two decades,
Sudden Infant Death Syndrome (SIDS) remains the leading cause of death for infants
in the post-neonatal period in the U.S. A number of studies have noted an elevated
rate of SIDS among HIV-exposed infants. The objective of this analysis was to
identify risk factors and trends in SIDS rates in HIV-exposed infants.
Methods: We analyzed data from the medical records of 13,084 HIV-exposed
infants followed from birth from 1988-2004. Data was obtained from eight geographic sites in
the United States involved in the Pediatric Spectrum of HIV Disease Project, which
was conducted by the Centers for Disease Control and Prevention.
Results: Seventeen cases of SIDS were diagnosed during the study period, for a
crude SIDS rate of 1.3 per 1,000 infants. Rates of SIDS were not statistically
different among white, black, and infants of other races. Rates of SIDS were
highest among HIV-status-indeterminate infants (6.2 per 1,000 infants), compared
to HIV-infected infants (1.3 per 1,000 infants) and HIV-uninfected infants (0.4 per
1,000 infants).
Significant risk factors for SIDS included a lack of prenatal care (OR: 5.26; 95% CI:
1.493, 18.797), maternal drug use during pregnancy (OR: 4.2; 95% CI: 1.35, 12.93),
low birth weight (OR: 2.60; 95% CI: 1.004, 6.753) and infant birth in 1994 or earlier
(OR: 6.3; 95% CI: 2.0515, 19.3185). Breastfeeding, premature delivery, male
gender, and black race were not significantly associated with SIDS. Among infants
dying of all causes during the first year of life HIV-infected infants had a
significantly higher risk of SIDS than HIV-uninfected infants, after controlling for age
at death (aOR: 11.04; 95% CI: 1.660, 73.475).
Conclusions: The rate of SIDS in this cohort declined steadily from 1988-2004, a
trend also observed in the general population during this period. Significant risk
factors for SIDS for infants in this study included maternal drug use during
pregnancy, no prenatal care, and low birth weight. Race, gender, and
breastfeeding were not significantly associated with SIDS. HIV-infection was only a
significant risk factor for SIDS among infants dying during the first year of life.

Table of Contents

vii

Table of Contents
Acknowledgements..................................................................................................................... vi
CHAPTER 1: INTRODUCTION ............................................................................................................ 1
Rationale: ..................................................................................................................................... 1
Perinatal HIV ............................................................................................................................ 1
Sudden Infant Death Syndrome (SIDS) .................................................................................... 2
The Issue: ..................................................................................................................................... 4
Study Aims: .................................................................................................................................. 4
Study setting: ............................................................................................................................... 5
CHAPTER 2: EXPLANATION OF STUDENT INVOLVEMENT ................................................................ 7
CHAPTER 3: REVIEW OF THE LITERATURE ....................................................................................... 9
Sudden Infant Death Syndrome:.................................................................................................. 9
Causative Theories of SIDS ....................................................................................................... 9
SIDS Risk Factors .................................................................................................................... 10
Protective Factors against SIDS .............................................................................................. 18
HIV and SIDS: .............................................................................................................................. 22
HIV and Breastfeeding: .............................................................................................................. 25
SIDS and Breastfeeding in the Context of Perinatal HIV Transmission and HAART: ................. 28
CHAPTER 4: MANUSCRIPT.............................................................................................................. 29
ABSTRACT ................................................................................................................................... 30
Objective: ............................................................................................................................... 30
Methods: ................................................................................................................................ 30
Results: ................................................................................................................................... 30
Conclusions: ........................................................................................................................... 31
INTRODUCTION: ......................................................................................................................... 33
SIDS: ....................................................................................................................................... 33
Perinatal HIV: ......................................................................................................................... 36
METHODS: .................................................................................................................................. 38
The Pediatric Spectrum of HIV Disease Cohort: .................................................................... 38
Definitions: ............................................................................................................................. 38
Inclusion Criteria: ................................................................................................................... 39
Statistical Analysis: ................................................................................................................. 39

viii

RESULTS: .................................................................................................................................... 40
Characteristics of Infants and Mothers: ................................................................................ 40
Infant and Maternal Factors Associated with SIDS Deaths: .................................................. 41
Changes in the Rate of SIDS: .................................................................................................. 43
Risk Factors for SIDS among Infants Dying during the First Year of Life: ............................... 44
DISCUSSION: .............................................................................................................................. 45
Limitations: ............................................................................................................................ 49
CONCLUSIONS: ........................................................................................................................... 50
Table 1: Demographic Maternal and Infant Characteristics, PSD Cohort 1988-2004 ........... 52
Table 2: Risk Factors for SIDS among 13,084 HIV-Exposed Infants Followed from Birth: PSD,
1988-2004 .............................................................................................................................. 53
Figure 1: ................................................................................................................................. 54
Figure 2: ................................................................................................................................. 55
Figure 3: SIDS Rate among HIV-Exposed Infants in the PSD Cohort and the U.S. General
Population*, 1988-2004 ......................................................................................................... 56
Table 3: Characteristics of Infants Dying during the First Year of Life, by SIDS Status .......... 57
Figure 2: SIDS and Non-SIDS Deaths by Season, PSD Cohort 1988-2004 .............................. 58
Figure 4: Maternal Drugs Use and SIDS Rate, PSD Cohort 1988-2004 .................................. 59
RESOURCES ................................................................................................................................ 60
CHAPTER 5: PUBLIC HEALTH IMPLICATIONS .................................................................................. 63
Explanation of Results: ............................................................................................................... 63
Effects of Recommending Breastfeeding:.................................................................................. 65
Conclusions: ............................................................................................................................... 67
CHAPTER 6: RESOURCES ................................................................................................................ 68
CHAPTER 7: APPENDIX ................................................................................................................... 73
Table 1: Studies of Infant Risk Factors for Sudden Infant Death Syndrome .............................. 73
Figure 1: Predicted Additional HIV-Infections Caused by Breastfeeding in the PSD Cohort,
1988-2004* ................................................................................................................................ 77
Attachment 1: Signature Form for Non-Research Projects ....................................................... 78

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