Sleep Environment and the Risk of Sudden Infant Death Syndrome in an Urban Population: The Chicago Infant Mortality Study

Abstract

Objective. To examine risk factors for sudden infant death syndrome (SIDS) with the goal of reducing SIDS mortality among blacks, which continues to affect this group at twice the rate of whites. Methods. We analyzed data from a population-based case-control study of 260 SIDS deaths that occurred in Chicago between 1993 and 1996 and an equal number of matched living controls to determine the association between SIDS and factors in the sleep environment and other variables related to infant care. Results. The racial/ethnic composition of the study groups was 75.0% black; 13.1% Hispanic white; and 11.9% non-Hispanic white. Several factors related to the sleep environment during last sleep were associated with higher risk of SIDS: placement in the prone position (unadjusted odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.7–3.4), soft surface (OR: 5.1; 95% CI: 3.1–8.3), pillow use (OR: 2.5; 95% CI: 1.5–4.2), face and/or head covered with bedding (OR: 2.5; 95% CI: 1.3–4.6), bed sharing overall (OR: 2.7; 95% CI: 1.8–4.2), bed sharing with parent(s) alone (OR: 1.9; 95% CI: 1.2–3.1), and bed sharing in other combinations (OR: 5.4; 95% CI: 2.8–10.2). Pacifier use was associated with decreased risk (unadjusted OR: 0.3; 95% CI: 0.2–0.5), as was breastfeeding either ever (OR: 0.2; 95% CI: 0.1–0.3) or currently (OR: 0.2; 95% CI: 0.1–0.4). In a multivariate model, several factors remained significant: prone sleep position, soft surface, pillow use, bed sharing other than with parent(s) alone, and not using a pacifier. Conclusions. To lower further the SIDS rate among black and other racial/ethnic groups, prone sleeping, the use of soft bedding and pillows, and some types of bed sharing should be reduced.

Knowledge Assessment of Correct Infant Sleep Practices and Sudden Infant Death Syndrome Among Mothers

“…Soft mattresses, pillows, and cot buffers have been associated with a 2-to-3-fold increased risk of SIDS [26]. An even greater risk results from combining multiple risk factors exist, for example, sleeping in the prone position in soft bedding has been associated with a 20-fold increased risk of SIDS [27]. In this study, 65% of mothers used pillows, 91.5% used soft mattresses, and 78% used cot buffers for the infant's crib.…”

Factors Associated with Safe Infant Sleep Practices in Saudi Arabia

“… 31–33 At the same time, unplanned sleeping or sleeping with babies in unsafe places such as sofas or couches are associated with a high risk of SIDS. 30 , 31 …”

“…Using soft bedding, duvets, bumpers, and pillows are associated with higher risk of covering the baby’s head and, therefore, increase the risk of SIDS. 30 , 34 , 35 Infants who sleep with soft bedding have a five-fold increased risk of sudden infant mortality regardless of sleep position, and a 21-fold increased risk if they sleep prone. 30 According to AAP guidelines, infants should be put on a firm, flat sleep surface covered by a fitted sheet with no other bedding or soft objects to reduce the risk of SIDS and suffocation.…”

“… 30 , 34 , 35 Infants who sleep with soft bedding have a five-fold increased risk of sudden infant mortality regardless of sleep position, and a 21-fold increased risk if they sleep prone. 30 According to AAP guidelines, infants should be put on a firm, flat sleep surface covered by a fitted sheet with no other bedding or soft objects to reduce the risk of SIDS and suffocation. Infants should never be left to sleep on sofas or on any furniture designed for sitting.…”

“…Of the mothers who slept in the same room as their babies, 34.7% shared a bed while the rest had a separate bed or cot for the baby. Although room-sharing lowers the risk of SIDS, [30][31][32] at the same time, parents should be aware not to share their bed with their babies as it is a high-risk practice associated with SIDS. [31][32][33] At the same time, unplanned sleeping or sleeping with babies in unsafe places such as sofas or couches are associated with a high risk of SIDS.…”