Factors relating to the infant's last sleep environment in sudden infant death syndrome in the Republic of Ireland

Abstract

Aim: To identify risk factors for sudden infant death syndrome (SIDS) in the sleeping environment of Irish infants. Methods: A five year population based case-control study with parental interviews conducted for each case and three controls matched for age, place of birth, and last sleep period. A total of 203 SIDS cases and 622 control infants born 1994-98 were studied. Results: In a multivariate analysis, co-sleeping significantly increased the risk of SIDS both as a usual practice (adjusted OR 4.31; 95% CI 1.07 to 17.37) and during the last sleep period (adjusted OR 16.47; 95% CI 3.73 to 72.75). The associated risk was dependent on maternal smoking (OR 21.84; 95% CI 2.27 to 209.89), and was not significant for infants who were >20 weeks of age (OR 2.63; 95% CI 0.49 to 70.10) or placed back in their own cot/bed to sleep (OR 1.07; 95% CI 0.21 to 5.41). The use of pillows, duvets, and bedding with tog value >10 were not significant risk factors when adjusted for the effects of confounding variables, including maternal smoking and social disadvantage. However, the prone sleeping position remains a significant SIDS risk factor, and among infants using soothers, the absence of soother use during the last sleep period also significantly increased the SIDS risk (OR 5.83; CI 2.37 to 14.36).Conclusion: Co-sleeping should be avoided in infants who are ,20 weeks of age, or whose mothers smoked during pregnancy. The prone position remains a factor in some SIDS deaths, and the relation between soother use and SIDS is a complex variable requiring further study.

Infant Sleep Location: Associated Maternal and Infant Characteristics with Sudden Infant Death Syndrome Prevention Recommendations

“…Soft surfaces such as sofas have been found to be particularly hazardous for infants. (13,14,35) With increased awareness of the risk factors associated with bedsharing, it is important to try to understand why people in certain demographic categories bedshare more than others. For some families, the reason may be purely economic; they lack the funds to purchase a separate crib or bassinet for their child.…”

“…(4,5) As the rate of prone positioning has declined, other previously unrecognized risk factors for sudden unexplained infant death have emerged in recent epidemiologic studies. Despite the fact that bedsharing between an infant and adult facilitates breastfeeding and enhances parent-infant interactions, (6,7) this sleeping arrangement has been identified in epidemiologic studies as being hazardous in certain situations, particularly when one or both parents are smokers, (8)(9)(10)(11)(12) on excessively soft surfaces, such as waterbeds, sofas, and armchairs, (9,10,(13)(14)(15) or when the infant is less than 2-3 months of age. (9,12,(14)(15)(16)(17) In addition, there is an increased risk for sudden unexpected infant death when there are multiple bedsharers (13) and when bedsharing occurs for the entire night.…”

Breastfeeding and dummy use have a protective effect on sudden infant death syndrome

“…We found 11 observational studies 5, 14, 18, 24, 25, 26, 27, 28, 29, 30, 31 that consistently showed a risk reduction of about 50% if the infant used a dummy (Table 2). …”

Sofas and Infant Mortality

“…8,9,[15][16][17] However, this is the first large analysis comparing The finding of a greater association between sleeping on a sofa and surface sharing may be due in part to the inherent use of this type of furniture. Sofas and similar objects are often shared with others and are meant to be used during waking hours.…”