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Cradle of Knowledge
Researcher seeks evidence-based interventions to save babies.
By Debra Sorvig Pedraza
This story is all about the children—in particular, two especially worrisome and tough-to-fight medical challenges that hit children hard: sudden infant death syndrome (SIDS) and fetal alcohol spectrum disorder (FASD).
SIDS and FASD are familiar diagnoses to Larry Burd, professor of pediatrics, and director of the Fetal Alcohol Syndrome Center at the University of North Dakota
School of Medicine and Health Sciences.
Burd has worked with children for much of his 36-year career. As his clients’ needs have changed, so has his research, leading to new ways of identifying, diagnosing, and treating those problems. He’s driven by the certain knowledge that recommending interventions that are not backed by good
research can have serious consequences.
As an epidemiologist, he looks at diseases at a community level, tracking possible causes and finding effective treatments on a large scale.
According to Burd, today’s families face a wider range of problems than those he saw early in his career. Drug abuse was rare until the 1980s. Since then, prenatal drug and alcohol abuse are much more common; there’s been a rise in behavioral problems associated with physical, sexual, and substance abuse; and family disintegration has become a big problem.
What is SIDS?
A parental nightmare.
Sudden infant death syndrome is the unexplained death of an infant younger than one year.
Often referred to as crib death, cribs do not cause SIDS. But even though the cause of SIDS remains unknown, scientific efforts have eliminated various misleading theories, according to the North Dakota
Department of Health.
Burd and his associates have determined that certain interventions can reduce the risk of SIDS. Informing new parents of the risk factors in a reliable and consistent manner is crucial.
“One needs to be very thoughtful about implementing interventions, especially when dealing with babies,” Burd said.
One proven recommendation is infant sleeping position—babies need to sleep on their backs.
An early and successful intervention was the development of a baby blanket with the risk factors for SIDS printed on it. This was sent home from the hospital with the baby, so every time the baby was put to bed, wrapped in the blanket, there was a visual reminder of the risk factors. By the time the blanket wore out, the baby was past four months of age—the peak risk period of SIDS incidence.
SIDS rates declined considerably from 130.3 deaths per 100,000 live births in 1990 to 38.7 deaths per 100,000 live births in 2014, according to the U.S. Centers for Disease Control and Prevention.
As Burd says, when supported by good data, “a little intervention goes a long way.”
His research looks at many variables, including drug or alcohol use, co-sleeping, and even the mother’s sleeping position, as well as looking more carefully at unexplained deaths. Also, there are some ethnic groups that are still at higher risk. As happens with much research, some questions get answered; however, new questions arise.
Fetal Alcohol Spectrum Disorder—as goes the mother so goes the baby
According to the CDC, FASDs are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. These conditions can affect each person in different ways, and can range from mild to severe. They can include physical problems and problems with behavior and learning—FASDs last a lifetime. There is no cure for FASDs, but research shows that early intervention treatment services can improve a child’s development.
Part of Burd’s initial research led to the development of the Fetal Alcohol Syndrome Center for the state of North Dakota, which is noted in the North Dakota Century Code (15-11-35).
This led to further funding by the state to develop a program for women at risk during pregnancy, a one-question standardized screening to be given to all prenatal patients: When was your last drink?
The answer opens the door for the practitioner to begin a conversation related to alcohol or drug abuse during pregnancy. Almost 100 percent of N.Dak. women get this screening. Providers are now requesting more training for office-based interventions.
Being able to show the cost and benefit of early intervention is critical, Burd notes.
A study done in Canada—Burd was directly involved with it—estimated that the cost of care for a child with FASD averages $500,000, including costs of speech therapy, residential care, lost productivity, cost of corrections system, early mortality, and substance abuse treatment for FASD.
The actual costs are probably much higher, as this condition is likely underreported.
Few estimates for the prevalence of FASDs are available. Based on community studies using physical examinations, experts estimate that the full range of FASDs in the United States and some Western European countries might number as high as 2 to 5 per 100 school children (or 2 percent to 5 percent of the population).
“We are looking at FASD across the world and have had a site in the Congo for over eight years to examine prenatal alcohol exposure, which is very common in this society,” Burd said.
Moreover, prenatal exposure to alcohol may be far-reaching, affecting not only the specific fetus but that fetus’s future offspring.
“Many people thinking about this issue would recognize the link between maternal drug use and developmental problems, which is a major public health issue in the United States and across the
world,” Burd said.
PASS Network—Prenatal Alcohol Stillbirth and SIDS
Burd’s current research project involves the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network.
The PASS Network was established in 2003 as a partnership between the National Institute of Child Health and Human Development’s Pregnancy and Perinatology Branch and the National Institute on
Alcohol Abuse and Alcoholism.
The National Institute on Deafness and Other Communication Disorders joined the partnership in 2009.
The network conducts community linked studies to investigate the role of prenatal exposure to alcohol in SIDS and adverse pregnancy outcomes, such as stillbirth and FASDs, and how SIDS and these other outcomes may be interrelated.
Teaching and learning
As an active researcher and professor, Burd not only teaches students but continues to learn from them. He said he enjoys and appreciates their unique way of looking at specific problems and considers their possible solutions.
Burd is from Vona, Colorado, and received his PhD in Epidemiology from the University of Manitoba.