Sleeping Prone and the Risk of Sudden Infant Death Syndrome

Guntheroth, Warren G.; Spiers, Philip S.

doi:10.1001/jama.1992.03480170085034

Cited by 95 publications

(33 citation statements)

References 36 publications

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“…Given the complexity, rapidity, and extent in brain growth, and inherent in stability in the rapid transitions in homeostat ic control, subtle perturbations may be devas tating [1], The concept that an external stres sor precipitates sudden death is derived from epidemiologic studies indicating that minor respiratory or gastrointestinal illness occurs around the time of death in the majority of SIDS victims [10]. Other potential stressors linked to SIDS include fever, hyperthermia induced by over-blanketing, and prone sleep ing position [10][11][12],…”

Section: The Triple-risk Model Of Sidsmentioning

confidence: 99%

“…In this way, the triple risk model helps explain the apparently asymptomatic behavior of most SIDS victims prior to death, and helps explain why elimi nating an external stressor, e.g. prone sleeping position, may reduce the incidence of SIDS [12]. Given that the stressor must match the infant's vulnerability, the model helps explain why the same stressor is not present in every case, exemplified by recognition that SIDS victims die in both prone and supine posi tions, and the overwhelming majority of in fants who sleep prone do not die of SIDS.…”

Section: The Triple-risk Model Of Sidsmentioning

confidence: 99%

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A Perspective on Neuropathologic Findings in Victims of the Sudden Infant Death Syndrome: The Triple-Risk Model

1994

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Neuropathologic studies in SIDS victims support the concept that they are not entirely ‘normal’ prior to death, but rather possess underlying vulnerabilities which put them at risk for sudden death. This concept forms a key link in a triple-risk model for the pathogenesis of SIDS proposed by us. According to this model, sudden death in SIDS results from the intersection of three overlapping factors: (1) a vulnerable infant; (2) a critical developmental period in homeostatic control, and (3) an exogenous stressor(s). An infant will die of SIDS only if he/she possesses all three factors; the infant’s vulnerability lies latent until he/she enters the critical period and is subject to an exogenous stressor. According to this model, heterogeneous disorders may make the infant vulnerable to sudden death during the critical period, as potentially exemplified by two previously reported lesions in SIDS brains (arcuate nucleus hypoplasia and subtle hypomyelination). Nevertheless, the triple-risk model does not preclude the possibility that the majority of SIDS deaths will be explained by a single common pathway upon which multiple stressors impinge to produce sudden death during the critical period.

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Section: The Triple-risk Model Of Sidsmentioning

confidence: 99%

Section: The Triple-risk Model Of Sidsmentioning

confidence: 99%

A Perspective on Neuropathologic Findings in Victims of the Sudden Infant Death Syndrome: The Triple-Risk Model

1994

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“…In subsequent foreign studies, sleep position was implicated as a risk factor for SIDS. [3][4][5][6][7][8] Publicity that discouraged the prone sleeping position in Australia, the Netherlands, New Zealand, and Great Britain was associated with a decrease in the incidence of SIDS ranging from 20% to Ͼ50%. 4,9 -16 The evidence of these reports was so persuasive that in 1992 the American Academy of Pediatrics (AAP) recommended the use of either the supine or the lateral position for placing healthy infants down to sleep.…”

mentioning

confidence: 99%

Infant Sleep Position Instruction and Parental Practice: Comparison of a Private Pediatric Office and an Inner-city Clinic

et al. 1997

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ABSTRACT. Objective. To determine infant sleep instructions that hospital personnel in our community were giving to parents and actual positions practiced after the April 15, 1992 American Academy of Pediatrics recommendation for nonprone positioning.Design. Survey of mothers of infants 4 months of age from November 1993 to March 1994 with follow-up survey of selected birth hospitals.Setting. A private practice (PP) serving predominantly white middle-and upper-income children and a pediatric clinic (CY) serving inner-city predominantly African-American low-income children in Louisville, Kentucky.Patients. Fifty infants from each practice site. Outcome Measure. The sleep instructions given and practiced, and other risk factors for sudden infant death syndrome (SIDS).Results. Nonprone sleeping instructions were received by 72% of the PP and only 48% of the CY parents, with 72% of the PP and 54% of the CY following the nonprone recommendations. Infants were more likely to be in smoking households (60% vs 12%) from the CY practice than the PP practice.Conclusions. Our study showed that, despite having a higher prevalence of SIDS risk factors, there was a greater delay in discontinuing prone positioning instructions in the hospital serving the CY infants. The evidence suggests that this population is as likely as the PP group to follow medical advice given. Pediatrics 1997;99(5). URL: http://www.pediatrics.org/cgi/content/full/99/5/e12; infant sleep position, SIDS, sleep instruction.ABBREVIATIONS. SIDS, sudden infant death syndrome; AAP, American Academy of Pediatrics; CY, Children and Youth Project; PP, private practice.The sleep position of infants was most often viewed in the past as a trivial aspect of infant care. It has recently received serious attention because of the reported association of the prone sleeping position with sudden infant death syndrome (SIDS). In the United States in the early 1990s, the prone position was most commonly used when placing an infant down for sleep. 1 However, as early as 1985, 2 the prone position has been challenged as "unsafe." In subsequent foreign studies, sleep position was implicated as a risk factor for SIDS. [3][4][5][6][7][8] Publicity that discouraged the prone sleeping position in Australia, the Netherlands, New Zealand, and Great Britain was associated with a decrease in the incidence of SIDS ranging from 20% to Ͼ50%. 4,9 -16 The evidence of these reports was so persuasive that in 1992 the American Academy of Pediatrics (AAP) recommended the use of either the supine or the lateral position for placing healthy infants down to sleep. 1 Two years after such a recommendation, the AAP Task Force on Infant Positioning and SIDS noted that "although pediatricians have heard the recommendations, many children's physicians and allied health care workers are not actively recommending nonprone sleeping for their patients." 17 In addition to the prone position, several studies have reported the association of SIDS with infant hyperthermia, 18 -23 swaddling, 23 and suffocation....

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“…A recent review, which considered data from 10 studies, showed a highly significant relationship between prone sleeping position and the risk of SIDS, with relative risks as high as 9.3 being reported [54]. There is also evidence of a decline in SIDS incidence following the introduction of campaigns encouraging mothers to avoid the use of the prone position when putting their babies to sleep.…”

Section: Discussionmentioning

confidence: 99%

Parental Smoking and Sudden Infant Death Syndrome: A Review of the Evidence

Thornton

1998

Indoor Built Environ

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This paper reviews evidence relating parental smoking to sudden infant death syndrome (SIDS) risk in their offspring, based on English-language papers covering the period 1966–1996. Twenty-eight prospective and case-control studies provided suitable data. The studies mainly considered maternal smoking during pregnancy, but some studies provided data for maternal smoking before pregnancy, at the time of conception or postnatally, for paternal smoking at various times and/or for postnatal smoking by other household members and day-care providers. Tables were constructed listing unadjusted and covariate-adjusted relative risk estimates for each index of exposure. Associations between SIDS and maternal smoking both during and after pregnancy were consistently observed. Relationships with paternal smoking and with other sources of exposure were also reported in a number of studies. Dose-response relationships were seen for various exposure indices. Several studies found that adjustment for numerous potential confounders very substantially weakened the association between SIDS and parental smoking. Although the possibility of a causal explanation of the associations observed cannot be excluded, the existence of various study weaknesses and the likelihood of residual confounding means that one cannot infer with confidence that parental smoking actually does increase the risk of SIDS.

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Sleeping Prone and the Risk of Sudden Infant Death Syndrome

Cited by 95 publications

References 36 publications

A Perspective on Neuropathologic Findings in Victims of the Sudden Infant Death Syndrome: The Triple-Risk Model

A Perspective on Neuropathologic Findings in Victims of the Sudden Infant Death Syndrome: The Triple-Risk Model

Infant Sleep Position Instruction and Parental Practice: Comparison of a Private Pediatric Office and an Inner-city Clinic

Parental Smoking and Sudden Infant Death Syndrome: A Review of the Evidence

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