Sudden Infant Death Syndrome

DAVID CREERY; ANGELO MIKROGIANAKIS

DAVID CREERY, M.D., AND ANGELO MIKROGIANAKIS, M.D., Children's Hospital of Eastern Ontario, Ottawa, Canada

Am Fam Physician. 2003;68(7):1375-1376

What are the effects of interventions to reduce the risk of sudden infant death syndrome?

BENEFICIAL

Advice to Avoid Prone Sleeping

Several observational studies found that campaigns involving advice to encourage nonprone sleeping positions were followed by a reduced incidence of sudden infant death syndrome (SIDS). Randomized controlled trials (RCTs) are unlikely to be conducted.

LIKELY TO BE BENEFICIAL

Advice to Avoid Tobacco Smoke Exposure

Several observational studies found limited evidence that campaigns to reduce several risk factors for sudden infant death, which included tobacco smoke exposure, were followed by a reduced incidence of SIDS. RCTs are unlikely to be conducted.

UNKNOWN EFFECTIVENESS

Advice to Avoid Bed Sharing

One observational study found that a campaign to reduce several risk factors for sudden infant death, which included advice to avoid bed sharing, was followed by a reduced incidence of SIDS. RCTs are unlikely to be conducted.

Advice to Avoid Over Heating or Over Wrapping

Three observational studies found limited evidence that campaigns to reduce several risk factors for sudden infant death, which included over wrapping, were followed by a reduced incidence of SIDS. RCTs are unlikely to be conducted.

Advice to Avoid Soft Sleep Surfaces

We found no evidence on the effects of avoiding soft sleeping surfaces in the prevention of SIDS.

Advice to Breastfeed

One nonsystematic review of observational studies and three additional observational studies found that campaigns to reduce several risk factors for sudden infant death, which included advice to breastfeed, were followed by a reduced incidence of SIDS. In some countries, however, incidence had begun to fall before the national advice campaigns. RCTs are unlikely to be conducted.

Advice to Promote Soother Use

We found insufficient evidence on soother use in the prevention of SIDS.

Definition

SIDS is the sudden death of an infant younger than one year that remains unexplained after review of the clinical history, examination of the scene of death, and postmortem.

Incidence/Prevalence

The incidence of SIDS has varied over time and among nations (incidence per 1,000 live births of SIDS in 1996: Netherlands, 0.3; Japan, 0.4; Canada, 0.5; England and Wales, 0.7; United States, 0.8; and Australia, 0.9).¹

Etiology/Risk Factors

By definition, the cause of SIDS is not known. Observational studies have found an association between SIDS and several risk factors, including prone sleeping position,^2,3 prenatal or postnatal exposure to tobacco smoke,⁴ soft sleeping surfaces,^5,6 hyperthermia or over wrapping,^7,8 bed sharing (particularly with mothers who smoke),^9,10 lack of breastfeeding,^11,12 and soother use.^7,13

Prognosis

Although by definition prognosis is not applicable for an affected infant, the incidence of SIDS is increased in the siblings of that infant.^14,15

Canadian Bureau of Reproductive and Child Health/Laboratory Centre for Disease Control/Canadian Perinatal Surveillance System (CPSS); Fact sheet: www.hcsc.gc.ca/hpb/lcdc/brch/factshts/sids_e.html (Accessed August 28, 2003).

Beal SM, Finch CF. An overview of retrospective case-control studies investigating the relationship between prone sleeping position and SIDS. J Paediatr Child Health. 1991;27:334-9.

American Academy of Pediatrics. AAP Task Force on Infant Positioning and SIDS: Positioning and SIDS. Pediatrics. 1992;89(6 pt 1):1120-6.

Anderson HR, Cook DG. Passive smoking and sudden infant death syndrome: review of the epidemiological evidence. Thorax. 1997;52:1003-9.

Mitchell EA, Thompson JM, Ford RP, et al. Sheepskin bedding and the sudden infant death syndrome. New Zealand Cot Death Study Group. J Pediatr. 1998;133:701-4.

Ponsonby AL, Dwyer T, Gibbons LE, et al. Factors potentiating the risk of sudden infant death syndrome associated with the prone position. N Engl J Med. 1993;329:377-82.

Fleming PJ, Blair PS, Bacon C, et al. Environment of infants during sleep and risk of the sudden infant death syndrome: results of the 1993–5 case-control study for confidential enquiry into stillbirths and deaths on infancy. Confidential Enquiry into Stillbirths and Deaths Regional Coordinators and Researchers. BMJ. 1997;313:85-9.

Ponsonby AL, Dwyer T, Gibbons LE, et al. Thermal environment and sudden infant death syndrome: case-control study. BMJ. 1992;304:277-82.

Mitchell EA, Tuohy PG, Brunt JM, et al. Risk factors for sudden infant death syndrome following the prevention campaign in New Zealand: a prospective study. Pediatrics. 1997;100:835-40.

Scragg R, Mitchell EA, Taylor BJ, et al. Bed sharing, smoking, and alcohol in the sudden infant death syndrome. New Zealand Cot Death Study Group. BMJ. 1993;307:1312-8.

Mitchell EA, Taylor BJ, Ford RP, et al. Four modifiable and other major risk factors for cot death: the New Zealand study. J Paediatr Child Health. 1992;28(suppl 1):S3-8.

Wennergren G, Alm B, Oyen N, et al. The decline in the incidence of SIDS in Scandinavia and its relation to risk-intervention campaigns. Nordic Epidemiological SIDS Study. Acta Paediatr. 1997;86:963-8.

L'Hoir MP, Engelberts AC, van Well GT, et al. Risk and preventive factors for cot death in The Netherlands, a low-incidence country. Eur J Pediatr. 1998;157:681-8.

Oyen N, Skjaerven R, Irgens LM. Population-based recurrence risk of sudden infant death syndrome compared with other infant and fetal deaths. Am J Epidemiol. 1996;144:300-5.

Guntheroth WG, Lohmann R, Spiers PS. Risk of sudden infant death syndrome in subsequent siblings. J Pediatr. 1990;116:520-4.