Abstract
Background:
Preterm infants are at increased risk of sudden infant death syndrome (SIDS). Use of a dummy/pacifier is thought to be protective against SIDS; accordingly, we assessed the effects of dummy/pacifier use on blood pressure, cerebral oxygenation, and heart rate control over the first 6 mo of life after term corrected age (CA) when SIDS risk is greatest.
Methods:
Thirty-five preterm infants were studied longitudinally at 2–4 wk, 2–3 mo, and 5–6 mo CA. Cardiac control was assessed from spectral indices of heart rate variability (HRV) in the low frequency (LF) and the high frequency (HF) range, and the ratio of HF/LF indicating sympathovagal balance was calculated.
Results:
Overall, at 2–3 mo, mean arterial pressure was significantly higher in the supine position in dummy/pacifier users in both quiet sleep (70 ± 2 vs. 60 ± 2 mm Hg; P < 0.05) and active sleep (74 ± 3 vs. 69 ± 2 mm Hg; P < 0.05). Dummy/pacifier users had higher LF HRV and LF/HF ratio and lower HF HRV.
Conclusion:
Dummy/pacifier use increased blood pressure during sleep, at the age of greatest SIDS risk. Overall, LF HRV was elevated and HF HRV reduced in dummy/pacifier users, suggesting that dummy use alters cardiac control in preterm infants.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Blencowe H, Cousens S, Oestergaard MZ, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012;379:2162–72.
Blair PS, Platt MW, Smith IJ, Fleming PJ ; CESDI SUDI Research Group. Sudden infant death syndrome and sleeping position in pre-term and low birth weight infants: an opportunity for targeted intervention. Arch Dis Child 2006;91:101–6.
Blair PS, Sidebotham P, Berry PJ, Evans M, Fleming PJ. Major epidemiological changes in sudden infant death syndrome: a 20-year population-based study in the UK. Lancet 2006;367:314–9.
Trachtenberg FL, Haas EA, Kinney HC, Stanley C, Krous HF. Risk factor changes for sudden infant death syndrome after initiation of Back-to-Sleep campaign. Pediatrics 2012;129:630–8.
Moon RY, Horne RS, Hauck FR. Sudden infant death syndrome. Lancet 2007;370:1578–87.
Kinney HC, Thach BT. The sudden infant death syndrome. N Engl J Med 2009;361:795–805.
Witcombe NB, Yiallourou SR, Walker AM, Horne RS. Blood pressure and heart rate patterns during sleep are altered in preterm-born infants: implications for sudden infant death syndrome. Pediatrics 2008;122:e1242–8.
Yiallourou SR, Witcombe NB, Sands SA, Walker AM, Horne RS. The development of autonomic cardiovascular control is altered by preterm birth. Early Hum Dev 2013;89:145–52.
Horne RS. Effects of prematurity on heart rate control: implications for sudden infant death syndrome. Expert Rev Cardiovasc Ther 2006;4:335–43.
Fyfe KL, Yiallourou SR, Wong FY, Odoi A, Walker AM, Horne RS. Cerebral oxygenation in preterm infants. Pediatrics 2014;134:435–45.
Horne RS, Hauck FR, Moon RY, L’hoir MP, Blair PS ; Physiology and Epidemiology Working Groups of the International Society for the Study and Prevention of Perinatal and Infant Death. Dummy (pacifier) use and sudden infant death syndrome: potential advantages and disadvantages. J Paediatr Child Health 2014;50:170–4.
Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Sauerland C, Mitchell EA ; GeSID Study Group. Sleep environment risk factors for sudden infant death syndrome: the German Sudden Infant Death Syndrome Study. Pediatrics 2009;123:1162–70.
American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, Moon RY. Policy statement - SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 2011;128:1030–9.
Franco P, Scaillet S, Wermenbol V, Valente F, Groswasser J, Kahn A. The influence of a pacifier on infants’ arousals from sleep. J Pediatr 2000;136:775–9.
Hanzer M, Zotter H, Sauseng W, Pfurtscheller K, Müller W, Kerbl R. Pacifier use does not alter the frequency or duration of spontaneous arousals in sleeping infants. Sleep Med 2009;10:464–70.
Howard CR, Howard FM, Lanphear B, et al. Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their effect on breastfeeding. Pediatrics 2003;111:511–8.
Franco P, Chabanski S, Scaillet S, Groswasser J, Kahn A. Pacifier use modifies infant’s cardiac autonomic controls during sleep. Early Hum Dev 2004;77:99–108.
Yiallourou SR, Poole H, Prathivadi P, Odoi A, Wong FY, Horne RS. The effects of dummy/pacifier use on infant blood pressure and autonomic activity during sleep. Sleep Med 2014;15:1508–16.
Australian Bureau of Statistics. Socio-economic Indexes for Areas (SEIFA). Technical paper. 2011. (http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/22CEDA8038AF7A0DCA257B3B00116E34/$File/2033.0.55.001%20seifa%202011%20technical%20paper.pdf).
Yiallourou SR, Sands SA, Walker AM, Horne RS. Maturation of heart rate and blood pressure variability during sleep in term-born infants. Sleep 2012;35:177–86.
Niemelä M, Pihakari O, Pokka T, Uhari M. Pacifier as a risk factor for acute otitis media: a randomized, controlled trial of parental counseling. Pediatrics 2000;106:483–8.
Mauch CE, Scott JA, Magarey AM, Daniels LA. Predictors of and reasons for pacifier use in first-time mothers: an observational study. BMC Pediatr 2012;12:7.
Odoi A, Andrew S, Wong FY, Yiallourou SR, Horne RS. Pacifier use does not alter sleep and spontaneous arousal patterns in healthy term-born infants. Acta Paediatr 2014;103:1244–50.
Jaafar SH, Jahanfar S, Angolkar M, Ho JJ. Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding. Cochrane Database Syst Rev 2011;CD007202.
Malloy MH. Prematurity and sudden infant death syndrome: United States 2005-2007. J Perinatol 2013;33:470–5.
Yiallourou SR, Walker AM, Horne RS. Validation of a new noninvasive method to measure blood pressure and assess baroreflex sensitivity in preterm infants during sleep. Sleep 2006;29:1083–8.
Suzuki S, Takasaki S, Ozaki T, Kobayashi Y. Tissue oxygenation monitor using nir spatially resolved spectroscopy. Proc SPIE 1999;582–92.
Anders T, Emde RN, Parmelee AH ; University of California LABIS 1971. A Manual of Standardized Terminology, Techniques and Criteria for Scoring of States of Sleep and Wakefulness in Newborn Infants. Los Angeles, CA: UCLA Brain Information Service/BRI, 1971.
Brase CH, Brase CP. Understandable Statistics: Concepts and Methods. Melbourne, Australia: Cengage Learning, 2011.
Rosenstock EG, Cassuto Y, Zmora E. Heart rate variability in the neonate and infant: analytical methods, physiological and clinical observations. Acta Paediatr 1999;88:477–82.
Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: Standards of measurement, physiological interpretation and clinical use. Circulation 1996;93:1043–65.
deBoer RW, Karemaker JM, Strackee J. Hemodynamic fluctuations and baroreflex sensitivity in humans: a beat-to-beat model. Am J Physiol 1987;253:H680–9.
Acknowledgements
The authors would like to thank all the parents and their infants who participated in this study and the staff of the Melbourne Children’s Sleep Centre where the studies were carried out.
Author information
Authors and Affiliations
Corresponding author
PowerPoint slides
Rights and permissions
About this article
Cite this article
Horne, R., Fyfe, K., Odoi, A. et al. Dummy/pacifier use in preterm infants increases blood pressure and improves heart rate control. Pediatr Res 79, 325–332 (2016). https://doi.org/10.1038/pr.2015.212
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/pr.2015.212
This article is cited by
-
Autonomic development in preterm infants is associated with morbidity of prematurity
Pediatric Research (2022)
-
Cerebral cortical autonomic connectivity in low-risk term newborns
Clinical Autonomic Research (2021)
-
Autonomic nervous system development and its impact on neuropsychiatric outcome
Pediatric Research (2019)
