Maternal Age, the Disparity across Regions and Their Correlation to Sudden Infant Death Syndrome in Taiwan: A Nationwide Cohort Study

Abstract

Sudden infant death syndrome (SIDS) has always been a regrettable issue for families. After sleeping in the supine position was proposed, the incidence of SIDS declined dramatically worldwide. However, SIDS still accounts for the top 10 causes of infant deaths in Taiwan. Recognizing the risk factors and attempting to minimize these cases are imperative. We obtained information on cases with SIDS from the National Health Insurance Research Database in Taiwan and interconnected it with the Taiwan Maternal and Child Health Database to acquire infant–maternal basal characteristics between 2004 and 2017. The SIDS subjects were matched 1:10 considering gestational age to normal infants. After case selection, a total of 953 SIDS cases were included. Compared with healthy infants, SIDS infants had younger parents, lower birth weight, and lower Apgar scores. After adjusting for potential confounders, infants with mothers aged <20 years had 2.81 times higher risk of SIDS. Moreover, infants in the non-eastern region had a significantly lower risk of SIDS than those in the eastern region. We concluded that infants of young mothers (especially maternal age <20 years) and infants in the eastern region of Taiwan had a higher risk of SIDS than their counterparts.

The San Diego SIDS definition—20 Years on

“…Research papers are being published where cases have been classified as SIDS without even an autopsy being performed. 23,24 This raises two important questions: (a) How can we correctly interpret conclusions relating to SIDS research and, (b) How can we accurately monitor trends in SIDS mortality. The obvious conclusion to both of these issues is that at present we cannot, and that the answer to the question posed recently 'Is academic rigour in sudden infant death syndrome (SIDS) research in decline?'…”

“…Thus, although we have an internationally accepted definition of SIDS determined by a consensus of experts that came out of the San Diego meeting two decades ago, it is clearly not being uniformly applied, with the possibility of significant diagnostic shift occurring. Research papers are being published where cases have been classified as SIDS without even an autopsy being performed 23,24 . This raises two important questions: (a) How can we correctly interpret conclusions relating to SIDS research and, (b) How can we accurately monitor trends in SIDS mortality.…”

Is academic rigor in Sudden Infant Death Syndrome (SIDS) research in decline?

“…A request for clarification on how many of the reported cases had undergone autopsies and so could be properly classified as SIDS has been made 4 . A further study on maternal age and SIDS stated that the “diagnosis of SIDS is made by pediatricians” apparently without autopsy examinations 5 . This is despite the three standard international definitions of SIDS that have been accepted for half a century clearly specifying the requirement for an autopsy examination, and reviews of SIDS in the literature for many decades emphasising the necessity for consistently applying established definitions 6,7 : The Second International Conference on Causes of Sudden Death in Infants in 1969 defined SIDS as “the sudden 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 for death” (The Seattle definition) 8 …”

“…4 A further study on maternal age and SIDS stated that the "diagnosis of SIDS is made by pediatricians" apparently without autopsy examinations. 5 This is despite the three standard international definitions of SIDS that have been accepted for half a century clearly specifying the requirement for an autopsy examination, and reviews of SIDS in the literature for many decades emphasising the necessity for consistently applying established definitions 6,7 :…”

New and Old Challenges in Pediatric Health Policies

“…Moreover, in this Special Issue, Rutter critically evaluates the underlying concepts in the application of the adverse childhood experiences international questionnaire (ACE-IQ) as a policy tool, highlighting that the tool successfully covers school attendance and parental supervision, which mainly pertain to Western concerns, whereas global concerns, namely forced economic migration and famine, are not taken into account [ 12 ]. Huang et al also focus on early life mortality, analyzing risk factors for Sudden Infant Death Syndrome (SIDS) in a case–control study on 953 SIDS cases and 1:10 matched controls, showing that the odds of SIDS were higher among offspring of younger mothers (aged less than 20 years) and infants in the eastern region of Taiwan [ 13 ].…”