Can the fall in Avon's sudden infant death rate be explained by changes in sleeping position?

Wigfield, R; Fleming, Peter; Berry, P J; Rudd, P T; Golding, Jean

doi:10.1136/bmj.304.6822.282

Cited by 138 publications

(60 citation statements)

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“…17,18,24 Most SIDS studies were conducted in developed countries and reported higher risk in lower socioeconomic populations. 22,25 Since most Brazilians have lower socioeconomic conditions, it was hypothesized that SIDS risk factors would be related to poverty and thus would not be specifi cally related to SIDS but rather to overall infant mortality. To test it, it was chosen to study a control group of children deaths.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for sudden infant death syndrome in a developing country

2008

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OBJECTIVE:To analyze whether previously identifi ed risk factors for sudden death syndrome have a signifi cant impact in a developing country. METHODS:Retrospective longitudinal case-control study carried out in Porto Alegre, Southern Brazil. Cases (N=39) were infants born between 1996 and 2000 who died suddenly and unexpectedly at home during sleep and were diagnosed with sudden death syndrome. Controls (N=117) were infants matched by age and sex who died in hospitals due to other conditions. Data were collected from postmortem examination records and questionnaires answers. A conditional logistic model was used to identify factors associated with the outcome. RESULTS:Mean age at death of cases was 3.2 months. The frequencies of infants regarding gestational age, breastfeeding and regular medical visits were similar in both groups. Sleeping position for most cases and controls was the lateral one. Supine sleeping position was found for few infants in both groups. Maternal variables, age below 20 years (OR=2, 95% CI: 1.1; 5.1) and smoking of more than 10 cigarettes per day during pregnancy (OR=3, 95% CI: 1.3; 6.4), signifi cantly increased the risk for the syndrome. Socioeconomic characteristics were similar in both groups and did not affect risk. CONCLUSIONS:Infant-maternal and socioeconomic profi les of cases in a developing country closely resembled the profi le described in the literature, and risk factors were similar as well. However, individual characteristics were identifi ed as risks in the population studied, such as smoking during pregnancy and maternal age below 20 years. Sudden infant death syndrome (SIDS) is defi ned as "the sudden death of any infant under one year of age which remains unexplained after a thorough case investigation, including complete postmortem examination, review of clinical history and examination of death scene." 23 The pathology of SIDS has not been established, but many hypotheses have been raised in the last years. 19 Advances in the knowledge about SIDS are associated with the identifi cation of environmental risk factors, the so-called "triggers," that may favor this lethal outcome in an organically predisposed child. 7 Currently, many risk factors are associated with SIDS, some of which are definitely correlated with this syndrome. The implications of other factors, however, still need to be further explored. Prone sleeping position and maternal smoking are wellestablished risk factors for SIDS in developed countries. A 50% reduction in SIDS incidence in countries that have adopted the recommendation of supine sleeping position is well documented in the literature. 2,4 Pediatricians and health providers in developing countries, such as Brazil, have little knowledge on risk RESUMO OBJETIVO: Analisar se fatores de risco previamente identifi cados para a síndrome da morte súbita do lactente têm impacto signifi cativo em um país em desenvolvimento. DESCRIPTORS MÉTODOS:Estudo retrospectivo, longitudinal, de caso-controle pareado realizado em Porto Alegre, RS. Os cas...

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Section: Discussionmentioning

confidence: 99%

Risk factors for sudden infant death syndrome in a developing country

2008

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“…E pidemiologic studies identifying risk factors and public health campaigns to reduce these risks have been followed by large reductions in the rates of sudden infant death syndrome (SIDS) in many countries. [1][2][3][4][5][6][7][8][9][10] In Reduce the Risk public health campaigns, priority has been given to risk factors that may be causally related to SIDS. 11,12 In addition, priority has been given to risk factors that are readily correctable and at the same time acceptable to care providers and parents.…”

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confidence: 99%

Unsafe Sleep Practices and an Analysis of Bedsharing Among Infants Dying Suddenly and Unexpectedly: Results of a Four-Year, Population-Based, Death-Scene Investigation Study of Sudden Infant Death Syndrome and Related Deaths

et al. 2000

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ABSTRACT. Background. Prone sleep and unsafe sleep surfaces increase the risk of sudden infant death. Recent epidemiologic studies also suggest that when an infant's head or face is covered by bedding, or when a sleep surface is shared with others, the risk of dying increases. The inference of a causal role for these risk factors is supported by physiologic studies and by the consistent finding that fewer infants die when risk factors are reduced. The prevalence of most of these risk factors in infant deaths in the United States is uncertain.Objective. To describe the prevalence of several important risk factors related to sleep practices among a defined population of infants dying suddenly and unexpectedly.Methods. In this population-based study, we retrospectively reviewed death-scene information and medical examiners' investigations of deaths in the city of St Louis and St Louis County between January 1, 1994 and December 31, 1997. Because of the potential for diagnostic overlap, all deaths involving infants <2 years old with the diagnoses of sudden infant death syndrome (SIDS), accidental suffocation, or cause undetermined were included.Results. The deaths of 119 infants were studied. Their mean age was 109.3 days (range: 6 -350). The diagnoses were SIDS in 88 deaths, accidental suffocation in 16, and undetermined in 15. Infants were found prone in 61.1% of cases and were found on a sleep surface not designed for infants in 75.9%. The head or face was covered by bedding in 29.4%. A shared sleep surface was the site of death in 47.1%. Only 8.4% of deaths involved infants found nonprone and alone, with head and face uncovered.Conclusions. Using detailed death-scene descriptions, we found that similar unsafe sleeping practices occurred in the large majority of cases diagnosed as SIDS, accidental suffocation, and cause undetermined. Considering these diagnoses together may be useful in public health campaigns during a time when there may be diagnostic overlap. Regardless of the diagnosis, recommendations that infants sleep supine on firm sleep surfaces that lessen the risk of entrapment or head covering have the potential to save many lives. Campaigns are needed to heighten awareness of these messages and of the risks of dangerous bedsharing. Pediatrics 2000; 106(3). URL: http://www.pediatrics.org/cgi/content/full/ 106/3/e41; sudden infant death syndrome, sleep, child, consumer product safety, suffocation.ABBREVIATIONS. SIDS, sudden infant death syndrome; ME, medical examiner. E pidemiologic studies identifying risk factors and public health campaigns to reduce these risks have been followed by large reductions in the rates of sudden infant death syndrome (SIDS) in many countries. [1][2][3][4][5][6][7][8][9][10] In Reduce the Risk public health campaigns, priority has been given to risk factors that may be causally related to SIDS. 11,12 In addition, priority has been given to risk factors that are readily correctable and at the same time acceptable to care providers and parents.Many studies, including several r...

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“…Several of the above-mentioned authors (e.g. Fleming et al 2000); Skadberg et al 1998;Wigfield, et al 1992) have noted that infants sleeping alone who are positioned laterally may roll forwards into the prone position (thereby increasing their risk of SIDS), however an infant sleeping in a lateral position next to its mother"s body is unable to roll forwards. It is currently unknown whether lateral sleeping in this context is also associated with an increased SIDS risk.…”

Section: Discussionmentioning

confidence: 99%

Parent-infant bed-sharing behavior

Ball

2006

Hum Nat

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Ball, H. L. (2006) 'Parent-infant bed-sharing behavior : e ects of feeding type, and presence of father.', Human nature : an interdisciplinary biosocial perspective., 17 (3). pp. 301-318. Further information on publisher's website:http://dx.doi.org/10.1007/s12110-006-1011-1Publisher's copyright statement:The original publication is available at www.springerlink.com Additional information: Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-pro t purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. breastfeeding families were filmed for 3 nights (adjustment, dyadic and triadic nights) for 8 hours per night. For breastfed infants, mother-infant orientation, sleep position, frequency of feeding, arousal and synchronous arousal were all consistent with previous sleep-lab studies of mother-infant bed-sharing behaviour, but significant differences were found between formula and breastfed infants. While breastfeeding mothers bed-shared with their infants in a characteristic manner that provided several safety benefits, formula-feeding mothers bedshared in a more variable manner with consequences for infant safety. Paternal bed-sharing behaviour introduced further variability. Epidemiological case-control studies examining bed-sharing risks and benefits do not normally control for behavioural variables that an evolutionary viewpoint would deem crucial. This study demonstrates how parental behaviour affects the bed-sharing experience and indicates that cases and controls in epidemiological studies should be matched for behavioural, as well as socio-demographic, variables.

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Can the fall in Avon's sudden infant death rate be explained by changes in sleeping position?

Abstract: for information about the thermal insulation of clothing 14 Nelson EAS, Taylor BJ, Weatherall IL. Sleeping position and infant bedding may predispose to hyperthermia and the sudden inf'ant death syndrome.

Cited by 138 publications

References 5 publications

Risk factors for sudden infant death syndrome in a developing country

Risk factors for sudden infant death syndrome in a developing country

Unsafe Sleep Practices and an Analysis of Bedsharing Among Infants Dying Suddenly and Unexpectedly: Results of a Four-Year, Population-Based, Death-Scene Investigation Study of Sudden Infant Death Syndrome and Related Deaths

Parent-infant bed-sharing behavior

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