Cot Deaths (Hansard, 20 March 1989)

§ Miss Joan Lestor (Eccles)

Each year in Britain more than 2,000 babies between the ages of one week and two years die suddenly and unexpectedly. Ninety per cent. of those deaths occur before those babies reach the age of eight months. In about 1,500 of those cases, no adequate cause of death is ever found. As the House is aware, such cases are described as the sudden infant death syndrome. There are between four and five such deaths a day.

When it was publicised that my Adjournment debate tonight would deal especially with cot deaths, I received a great amount of literature from many organisations working in the area, and some heart-breaking letters from parents who have been thus bereaved. The plea from all of them is for more research into the subject. As I am sure we are all aware, there can be nothing worse than losing a child except, perhaps, losing a child and never knowing why that child died. Few parents do not fear this appalling tragedy and it is the responsibility of us all to ensure that no reasonably researched pilot scheme goes unfunded or is dismissed because it appears far-fetched. As long as we do not know the reason for such deaths, we must explore every possibility.

I have never been a scaremonger or prone to react favourably to every claim in medicine—or any other area —that a cure has been found for some particular ill. But having been interested and concerned for years about the infant mortality rate and cot deaths in particular, I was startled when I read of the research into the possible connection between those sad, unexplained deaths of babies and the possibility that they are caused—or partly caused—by the growth in our environment of electromag-netic fields.

The Minister will no doubt be aware of the recent publicity given to the work of Roger Coghill of Coghill Research Associates and I assume that it was that research to which he was referring on 20 February when, in a written answer to the hon. Member for Rutland and Melton (Mr. Latham) about whether his Department had investigated the studies into the electromagnetic wave theory and the possible relationship to cot deaths, he replied that neither his Department nor the National Radiological Protection Board, which has a responsibility to advise on hazards from electromagnetic fields, was aware of any authoritative, peer-reviewed studies that had demonstrated an association between sudden infant deaths and exposure to those fields at any frequency. In the list of areas under study given in the written answer, that area was not included. Of course, much depends on what is meant by "authoritative study", which was the phrase used in the written answer.

I have come across other work on the same subject and, as I understand it, research has been going on since as far back as 1976. In that year a German doctor, Dr. Eckert, published research into cot deaths and the proximity of electromagnetic waves from tube trains, electric railways and similar things. It was widely discussed by the medical profession at the time and as recently as 1988 a Swedish researcher, Mr. Hansson, carried out experiments with small mammals exposed to such rays, using a method of high-powered cables of high voltage. The results seemed to 886 demonstrate at least the necessity to research further, as the reaction of the mammals was similar to those of babies dying unexplained deaths for which there appeared to be no medical cause. The work was edited by Connor and Lovely and published by Alan R. Liss.

If the Department is not aware of those works, that should be rectified at once, as they add a little weight to the research that I mentioned earlier. If it is aware of them, perhaps the Minister will tell me why, apparently, that circumstantial evidence and research appears to have been dismissed. We all know that, although the research into cot deaths has produced various explanations, which could be termed individual explanations, it is far from conclusive and we are already looking at a variety of substances, areas and causes.

I am sure that the Minister is aware of the research that has been carried out by Roger Coghill in a pilot study in this area. I am asking that those results should be researched further by the Department when it researches this whole subject. There is not enough evidence, in my view—I am no doctor—to be dogmatic, but on the other hand there is enough evidence to warrant further investigation and not simply dismiss that other research.

The main argument is based on the massive rise in the use of artificially created electromagnetic energy. At the beginning of the century, few houses were centrally heated or lit by electricity. There were no commercial radio stations until 1920, no radar surveillance until 1939 and no widespread television until 1951, but all our homes are now electrified to an enormous degree. In the past 30 years the use of electricity in Britain has trebled. There has been a massive rise in the use of electrical appliances, from electric blankets to satellite dishes and car telephones.

As the research points out, so filled is the air with radiated electromagnetic transmissions that only with the greatest difficulty can space be found for new radio stations. As the research states: We have, in the space of one lifetime, bathed ourselves in an ocean of electromagnetic energy waves. As we are all aware, it took more than a quarter of a century before the regulations curtailing the use of X-rays were introduced, despite research of many years standing showing how organic tissue could be damaged by too much exposure. How many people died as a result of that ignorance of X-rays and how many were damaged we shall never know, but I have always been impressed by the fact that that knowledge was around for many years and was discussed long before the regulations were introduced. Many people, eminent in many areas, dismissed the evidence and argued that that connection was not possible and that much of the damage to tissue was caused by other things.

One could enlarge that view into other areas, considering X-rays alone and the safeguards that we now have, the nervousness with which we approach them, and the fact that, the moment that a young woman enters a hospital to be X-rayed, the first question asked is. "Are you pregnant?" We must remember that those rays are dangerous, and then question some of the research, which has not been confined to one individual but has already been highlighted in other parts of the world and has not been investigated enough.

In November last year, the Select Committee on Social Services published its report on infant mortality. The report is awaiting a response. I do not in any way criticise the Department for that. These things take time, and it is 887 important that, when we get a response, it is the correct one. Since that report was published, the electromagnetic theory has achieved some prominence in this country. I hope that, when they respond to the report, the Government will take on board the recommendation about cot deaths and the stated concern in the report that little progress has been made, particularly since a report in 1980 asked that there should be a general introduction of confidential inquiries into all health districts. I understand that special attention is being placed on one or two areas —Wolverhampton is one—because of certain incidents.

Bearing in mind the criticisms of the report, that not enough work has been done on cot deaths and that more research generally needs to be done and notice taken of a report that was published nine years ago, the electromagnetic waves theory should be given more serious consideration in any future research and work than it is at present.

I cannot refer to all the experiments that have led me to stand here tonight and make this plea. It would take too long, and none of us is expert in the matter and able to give a proper analysis. But I make this plea on behalf of all parents who have seen their children inexplicably die. On behalf of the people, many of whom work on the subject in various ways, it is in our interests that no research is left unlooked at and that proper credence is given to people who may have come up with at least something that bears a causal relationship to cot deaths, if it is not entirely the cause.

§ The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)

I congratulate the hon. Member for Eccles (Miss Lestor) on being successful in the ballot for the Adjournment debate. This is a very important issue and one about which the Government are deeply concerned. In addition to the number of deaths attributed to sudden infant death syndrome, we are concerned about the devastating effect that such tragic losses have on the families involved. My hon. Friend the Member for Rutland and Melton (Mr. Latham) also is interested in the subject.

It might be helpful if I commence by explaining that the terms "cot death" and "sudden infant death syndrome" are not synonymous. The term "cot death" was first introduced by Dr. A. M. Barrett in 1954 to describe the unexpected death during sleep of an apparently healthy infant. The term "sudden death syndrome" has been defined as "the sudden and unexpected death of any infant or young child which is unexpected by history and in which a thorough postmortem examination fails to demonstrate an adequate cause of death". Thus, whereas the term "cot death" might include an unexpected death for which an explanation is subsequently discovered—for example, an unsuspected congenital anomaly or a respiratory or gastro-intestinal infection—the term "sudden infant death syndrome" should be used only after a thorough postmortem has been unable to identify a cause. It is a diagnosis of exclusion.

Both terms, and other similar phrases, are used in practice to record unexpected infant deaths on death certificates. The Office of Population Censuses and Surveys has indentified separately since 1971 deaths 888 registered where such terms have been mentioned on death certificates. Of the 4,108 post-neonatal deaths—that is deaths after 28 days but within one year of birth—in England and Wales in the past three years of available statistics, 1985–87, with mention of cot death or a similar term on the death certificate, sudden infant death syndrome was given as the underlying cause in 91 per cent. of cases, a respiratory condition in 5 per cent. and a non-respiratory condition in 4 per cent.

In the 10 years to 1987, the latest year for which figures are available, there has been a significant increase in the number of deaths attributed to sudden infant death syndrome and a similar decrease in deaths attributed to respiratory conditions. The provisional figures for the first nine months of 1988 continue to bear this out. An expert group which prepared a report in 1988 on infant mortality in England for the chief medical officer drew attention to the belief that there is a trend in the pattern of certification towards certifying as sudden infant death syndrome deaths which, hitherto, would probably have been assigned to respiratory disease. The combined post-neonatal mortality rate has remained essentially unchanged over the same period at 2.3–2.4 deaths per 1,000 live births. I should add that the infant mortality rate as a whole in England has fallen from 12.8 per 1,000 live births in 1979 to 9.1 in 1987, the latest year for which figures are available. There have been significant decreases in the perinatal—the first week of life—and neonatal—the first month of life—mortality rates. That is encouraging. The worry is with the post-neonatal period.

Few cases of sudden infant death syndrome occur after one year of age. The peak is between one and four months. I now turn to possible causes. The syndrome is much more common among boys than girls. About 60 per cent. of sudden infant deaths are among boys. There is a clear seasonal pattern to the syndrome. Most deaths occur in winter months. We must not jump to conclusions, however. There is evidence that unintentional overheating may be a factor in some babies, and accidental chilling is likely to be a factor in some others. Similar seasonal patterns occur with deaths due to recognisable respiratory disease.

It would be unwise to believe that we are looking for one common factor among these unexplained deaths. It seems more likely that there is a variety of contributory clinical factors. Numerous theories have been mooted, and they can be classified into four kinds: first, that a previously normal infant succumbs to overwhelming stress —for example, chilling or infection—secondly, that there is a defect in function or anatomy that has been present from birth; thirdly, that infants are especially vulnerable to such events as minor infections, changes in temperature and even domestic upheaval during critical phases of development; fourthly, that there is some failure in the processes of maturation of one or more organ systems.

The hon. Lady has mentioned in particular the theory linking sudden infant death to electromagnetic fields. The advice which I have received from the experts in this subject, the National Radiological Protection Board, is that it is not aware at present—I stress "at present"—of any authoritative study which has demonstrated an association between sudden infant death syndrome and exposure to these fields at any frequency. I shall respond to the hon. Lady's suggestion that research should take place.

889 The main Government agency for supporting biomedical and clinical research is the Medical Research Council. In the year 1987–88, about £400,000 was spent on projects directly or indirectly related to sudden infant death syndrome and respiratory distress in the new born. We recognise, however, that there is a need to continue such efforts, and in April the Department will be discussing with the Medical Research Council what further avenues of research, including, if necessary, the influence of electromagnetic fields, might next most fruitfully be explored. I can give the hon. Lady an undertaking that I shall draw specifically to the attention of the Medical Research Council this debate and the research that has been cited. Following the discussions, I shall write to the hon. Lady and my hon. Friend the Member for Rutland and Melton. I am sure that the hon. Lady will agree that this is essentially a matter for clinical judgment and research judgment. I shall discharge my duty to the House by drawing the attention of the council specifically to the debate.

Sudden infant deaths have been shown to be associated with a number of social, biological and demographic factors, including social class, parents' marital status, mother's age, past pregnancies and low birth weight. Smoking during pregnancy and passive smoking have also been linked with sudden infant death syndrome. There are also regional variations but no common themes. I answered a recent question from my hon. Friend the hon. Member for Rutland and Melton on the regional pattern and he will have noted from my reply today, if he has had a chance to study it, that no clear themes seem to emerge from the statistics that I have provided.

While none of those factors has been unequivocally identified as the cause of sudden infant death syndrome, it is important to increase public awareness of the factors that may be influenced by individual actions. We need to continue to encourage good professional practice and sound parenting to ensure that those families whose circumstances are associated with risk to their infant, or whose babies are unwell, have ready access to the advice, support and care that they may need. For example, all new mothers already receive, on their first visit to antenatal clinics, a free copy of the "Health Education Authority's Pregnancy Book" which gives advice on giving up smoking. That is backed up by advice at antenatal clinics and from general practitioners. A new teenage antismoking campaign costing £2.2 million a year starts in April and will take special account of the worrying trends in smoking among girls approaching child-bearing age.

The hon. Lady may have seen the reports of the article in last week's British Medical Journal which discussed the relationship between the sleeping position of the infant and sudden infant death. However, I do not believe that clinicians can yet give parents unequivocal advice about the best sleeping position for their baby. I am sure that clinicians and paediatricians will be considering that.

In the voluntary sector the Foundation for the Study of Infant Deaths plays a significant role in funding and promoting research. At present it is spending about half a 890 million pounds a year. The foundation also provides an extremely valuable support and counselling service for bereaved families. I pay tribute to its work.

Both the Department and the Foundation for the Study of Infant Deaths are concerned that parents who have already lost a child—the risk for subsequent children is statistically only very slightly higher—or whose child is considered to be at risk of sudden infant death should not be misled by recent media coverage about the use of apnoea monitors. Unfortunately, there is no guarantee that these alarms, which are attached to the chest of an infant, will prevent sudden infant deaths occurring. We support the advice recently issued by the foundation that such monitors should be used only with the knowledge, advice and support of the paediatrician, the general practitioner and health visitor.

As I have said, the Government are concerned about the incidence of sudden infant death syndrome—a concern shared by the Select Committee on Social Services, which, as the hon. Lady is well aware, published its report on perinatal, neonatal and infant mortality in December. The Government welcomed the Select Committee's interest in this area. However, as I am sure the hon. Lady will understand, and as she has already acknowledged, I cannot comment in any detail on our response to the Committee's report, which is currently being prepared and will, I hope, be published shortly after Easter. In our response to the Committee we plan to demonstrate by our proposals the importance which we attach not only to identifying the factors associated with sudden infant death syndrome, but to reducing further the infant mortality rate as a whole.

We believe that the way forward could be to build on the approach of one of the most commonly referred to research studies on sudden infant death syndrome—the multi-centre study of post-neonatal mortality coordinated by Professor Knowelden and funded by the Department. This study investigated 988 infant deaths over a three-year period, 1976 to 1979, in eight parts of England and Wales. The aim in each case was to perform a full postmortem, carried out by a paediatric pathologist, to determine how far the death could be explained and, separately, to hold a confidential case conference to determine whether or not signs of the infant's terminal condition had been exhibited before death and whether appropriate action had been taken. The study showed that a number of deaths were partly or wholly explicable. The line of approach pursued by the professor in this study possibly shows the way forward, concentrating as it does on proper pathology and the importance of confidential case conferences to establish exactly the circumstances and factors surrounding each particular tragedy. As I have said, we shall be publishing our conclusions and our response to the Select Committee's report shortly, and I hope that that response will be constructive and will be studied by the whole House.