February 22, 2008
NIH Podcast Episode #0052
Balintfy: Welcome to the 52nd episode of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health-the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this episode: Sudden Infant Death Syndrome, tips to prevent it, especially in winter months; also, a report on predicting the spread and survival of liver cancer. But first a tropical virus may be headed to the United States. That's next on NIH Research Radio.
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Possible Spread of Dengue in the U.S.
Balintfy: A virus, most Americans have never heard of, could become a potential health threat in the continental United States. Wally Akinso reports:
Akinso: Previously confined to tropical and subtropical climates, dengue, a mosquito-borne virus, is becoming a much more serious problem along the U.S.-Mexico border in the commonwealth of Puerto Rico. Dr. David Morens, senior scientific advisor at the National Institute of Allergy and Infectious Diseases, said the widespread of dengue in the continental United States is a real possibility.
Morens: There is a theoretical risk of transmission and cases and even epidemic, hopefully small ones, in a number of states that we don’t think of as being tropical.
Akinso: Those who get the illness sometimes experience minor bleeding, such as from the nose or gums, high fever, serve headache, pain behind the eyes and in joints and muscles, a rash and dropping of blood pressure. Early diagnosis and treatment of dengue is critical to preventing shock and death. Dr. Morens is optimistic that scientist will develop a vaccine. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Sudden Infant Death Syndrome
Balintfy: There are about 2,500 babies who die each year from Sudden Infant Death Syndrome, or SIDS.
Willinger: It turns out that there appears to be a rise in the incidence of SIDS in the winter months, compared to the rest of the year.
Balintfy: Dr. Marion Willinger is the special assistant for SIDS at the National Institute of Child Health and Human Development.
Willinger: We know that back sleeping significantly reduces the risk of SIDS.
Balintfy: Dr. Willinger explains that SIDS is defined as the sudden death of an infant less than one year of age that is unexplained after a full death investigation.
Willinger: The most well-established risk factor for SIDS is a baby sleeping on their stomach or a baby sleeping on their side because side is a very unstable position and they're at greater risk of rolling to their stomach. So one of the best preventive strategies and best documented strategy we have is for babies to be placed sleep on their back, during all sleep periods. That includes night and nap time, and by all care providers, daycare providers, babysitters, grandparents, parents. So we recommend that strongly and since back sleeping has become the norm in the United States, the SIDS rates have been dropped by half. So it's a very powerful intervention. It's an intervention that's been successful all around the world.
Balintfy: Dr. Willinger says other risk factors include soft bedding, and overheating, especially in winter months.
Willinger: The other thing in the winter months that happens is people take their kids outside and they put on the snowsuit and everything else. When you come back inside and it's not cold, as cold inside as it outside, and the baby is asleep, you've just taken the baby for a walk, you want to make sure that you remove the warm clothing. Take the hat off the head because the head is where babies exchanges heat. And if you keep that head covered then they're not able to exchange their heat and release the heat. So you want to take hat off, unzip the snowsuit, ideally take them out of the warm clothing while they're sleeping.
Balintfy: Up next, more from Dr. Marion Willinger about the risk factors for SIDS.
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Dr. Marion Willinger Interview
Balintfy: We’re talking with Dr. Marion Willinger, the special assistant for SIDS at the National Institute of Child Health and Human Development and we’re talking about SIDS and the increased risk in winter months. Can you explain more about what happens this time of year?
Willinger: Well, one of the things that happens in the winter months is that babies tend to get more blankets on, or heavier clothing on. The parents feel they should keep the room warm, the baby warm. And overheating a risk factor for SIDS. It increases the possibility that a baby will die of SIDS. So it’s important that you don’t over-bundle the baby either with clothes or with blankets, that you don’t overheat the room, that the baby feels cool to the touch. The baby should not feel hot to the touch. And this is particularly the case, it’s very often when children are sick, and they’re running a fever, parents feel they need to cover them and make sure that they take the best care they can. Well, it turns out that when a baby has a fever and they’re sweating, they want to exchange heat. You want them to lose heat. So when a baby has an infection, you don’t want to over-bundle them either. Again, and studies have shown that the combination of a fever with heavy bedding even increases the risk more. So those are some of the things.
Balintfy: We’ve heard about the importance of placing babies to sleep on their backs. What are some other tips to reduce the risk of SIDS?
Willinger: You want to make sure that their head doesn’t have any possibility of being covered. So you don’t want to use any heavy quilts or comforters in the crib. If you are going to use a blanket, make sure the blanket is tucked under the armpits and under the mattress so the baby can’t squiggle underneath, because you know how babies love to move in their sleep, even the very little ones. Ideally, you’d like, in the winter months, if you keep the room cool, you want the baby to be in a blanket sleeper, then you don’t even have to worry about the use of blankets and the possibility that their face gets covered. There shouldn’t be any pillows in the crib, soft stuffed animals that they can get their face buried in. All these -- having their face buried or covered is a significant risk for SIDS whether or not the baby is on their stomach or on their back. So even though we know back sleeping reduces the risk, to keep the risk minimal, you want to make sure the head does not stay covered.
 The next thing is to keep your baby in a smoke free zone. And that’s before birth, that is while you’re pregnant. Smoking during pregnancy is another major factor for Sudden Infant Death Syndrome. And as well as a baby living in an environment where other people smoke, so we recommend keeping the baby in a smoke free zone.
For a mattress, you want the baby, a baby -- soft bedding is a risk factor for SIDS as well, because it is compressible and their face can mold into the bedding. So we recommend the baby be placed to sleep on a firm mattress. We also say that it’s very important that the baby be kept in a separate sleep environment, on a firm mattress. Now, there have been studies that have shown that the risk of SIDS is reduced if the baby is sleeping in the same room as the parents. But what -- there are also studies that have shown that sleeping in the same bed as the parents increases the risk. So we say, if you want to bring your baby into bed to cuddle, comfort, breastfeed, bond, we’re all for that, but when you’re ready to go to sleep, place the baby in their own sleep environment. You should not be in bed with the baby if you’re the least bit sleepy or the least bit drowsy. And the baby should have their own place to sleep and it could be a crib in your room, a cradle, whatever.
The other thing that a recent piece of information that we have that has come out in the most recent recommendations from the American Academy of Pediatrics is to try using a pacifier with the baby. There have been many studies around the world that have shown that babies who use pacifiers are at much reduced risk of Sudden Infant Death Syndrome. Now we say that establish the breastfeeding in those early months and days. Once breastfeeding is established, if the baby is willing to take the pacifier, then use it. Some babies won’t, and it’s not worth trying to force it on them, but it’s certainly something to consider using.
Balintfy: For more information about SIDS visit www.nichd.nih.gov/sids or call toll free 1-800-370-2943.
Predicting Liver Cancer Spread and Survival
Balintfy: In this final report, we learn that researchers at the National Cancer Institute have discovered new biomarkers for predicting how liver cancer spreads and whether liver cancer patients will have shorter or longer survival. Here again is Wally Akinso:
AKINSO: The biomarkers, known as microRNAs, have been implicated in various aspects of human disease, including liver cancer. Since microRNAs can effectively regulate the activity of multiple cancer-related genes and pathways they are prime candidates for spotting out the events that lead to the spread of cancer which is known as metastasis. Dr. Anuradha Budhu, lead author of the study, discusses the findings.
BUDHU: A lot of these microRNAs are associated with patient survival and so patients who have this particular profile of microRNAs that are associated with metastasis do have a worse survival than patients without that particular expression of those genes and they have about a two fold higher risk of death than patients who don't have that signature.
AKINSO: Dr. Budhu said the findings are important because it shows that microRNAs play a significant role in liver metastasis. She added that since microRNAs can affect multiple genes, including those related to cancer, they are also promising new targets for therapeutic approaches to liver cancer treatment. This is Wally Akinso at the National Institutes of Health, Bethesda Maryland.
Balintfy: And that’s it for this episode of NIH Research Radio. Please join us again on Friday, March 7th when the next edition of NIH Research Radio will be available for download. I'm your host, Joe Balintfy. Thanks for listening.
NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.