Maternal substance abuse tied to risk of sudden neonatal death

Of 32 neonates who died suddenly at a hospital in the United Kingdom and whose deaths remained unexplained after a thorough postmortem, 12 (37.5%) were born to mothers with a history of methadone use or use of drugs of addiction during pregnancy. A retrospective review of postmortem examinations in 138 babies who died at the hospital before the age of 28 days during an 8-year period revealed this unexpectedly large proportion of sudden deaths associated with maternal drug use.

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In addition, all 12 of the infants with a maternal drug history who died at a mean age of 11 days were exposed to multiple risk factors for sudden infant death syndrome. Specifically, 10 mothers of these neonates smoked, some of them heavily; 8 of the infants were placed in an unsafe sleeping environment, such as a shared sleep surface with the mother or on a bed, sofa, or mattress on the floor; and 10 infants were born prematurely. (Cohen MC, et al. Acta Paediatr. 2015;104[9]:883-887).

Commentary: Deaths described here are earlier than most sudden infant death syndrome (SIDS) deaths, suggesting that something different is going on in the brains, hearts, lungs, or homes of these children. Perhaps it is the direct or indirect effect of maternal drugs either in utero or after birth. Or perhaps drug use in the home decreases maternal and family member recall and implementation of recommended behaviors to prevent SIDS. If mothers in the nationally representative survey described in the preceding abstract often reported not hearing advice from doctors, nurses, and family members, imagine how much less likely an addicted parent would be to remember advice, even if it was delivered. We may not be able to address the innate differences that might be causing early and frequent SIDS in these children, but we can focus on minimizing their risk by vigorously addressing modifiable factors. Perhaps a series of home visits to check conditions and practices in the home and to reinforce parents’ understanding would be a justifiable use of health care resources.

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.