Can the SIDS Rate Be Reduced Further?
Can the SIDS Rate Be Reduced Further?
Ostfeld BM, Esposito L, Perl H, Hegyi T
Pediatrics. 2010;125:447-453
The guidelines of the American Academy of Pediatrics for sudden infant death syndrome (SIDS) describe known risk factors for SIDS, but Ostfeld and colleagues noted that many issues potentially affect how well providers know the information and counsel families. The "Back to Sleep" campaign began in 1994 and has been credited with a marked reduction in SIDS cases in the United States, largely by reducing the risk factor of the "nonsupine" sleep position.
This study sought to identify the percentage of SIDS cases, after the national Back to Sleep campaign, that were associated with risk factors. The goal was to make a stronger case that education to eliminate risk factors is now the best option to further reduce deaths from SIDS. The data represent SIDS cases in New Jersey from 1996 to 2000. From case files, the investigators tallied the modifiable and nonmodifiable risk factors associated with each case of SIDS that was reviewed. Modifiable risk factors included nonsupine placement at the time when the infant was put to sleep; smoking by parents; bedsharing with an adult; and a general term of "scene risks," which included excessive bedding, blankets, pillows, or placement of the infant on a couch for sleep. The 2 nonmodifiable risks were prematurity (< 37 weeks' gestational age) and the presence of an upper respiratory infection.
The investigators were able to obtain data on 97% of SIDS cases in New Jersey during the study period (n = 244). Only 9 infants (3.7%) had no risk factors, but the records of 7 of these infants revealed missing data on multiple risk factors, raising the question of whether these infants were truly free of risk. Excluding these infants, < 1% of infants with SIDS had no risk factors; 18% had 1 risk factor; and 78% had multiple risk factors. Among modifiable risk factors, 70% of infants were put down to sleep in the nonsupine position; 60% were exposed to tobacco smoke by at least 1 parent; 39% had been bedsharing; and 32% had scene risks. Nonmodifiable risks were generally less common: 44% for upper respiratory infection and 27% for gestational age < 37 weeks. The investigators concluded that SIDS was rare in the absence of risk factors; most cases exhibited multiple risks; and many infants had both modifiable and nonmodifiable risks.
This study represents one of the largest series to review causes of SIDS in the years since the Back to Sleep campaign. The fact that more than 75% of the SIDS cases had multiple risk factors suggests that education can still provide some potential improvement in SIDS frequency. The investigators rightly point out that the education must be multifactorial, beginning prenatally, continuing in the nursery, and then by the primary care providers after discharge. Providers should focus on changing the modifiable risk factors, especially in children who begin life with a nonmodifiable risk factor such as prematurity.
Abstract
Concurrent Risks in Sudden Infant Death Syndrome
Ostfeld BM, Esposito L, Perl H, Hegyi T
Pediatrics. 2010;125:447-453
Study Summary
The guidelines of the American Academy of Pediatrics for sudden infant death syndrome (SIDS) describe known risk factors for SIDS, but Ostfeld and colleagues noted that many issues potentially affect how well providers know the information and counsel families. The "Back to Sleep" campaign began in 1994 and has been credited with a marked reduction in SIDS cases in the United States, largely by reducing the risk factor of the "nonsupine" sleep position.
This study sought to identify the percentage of SIDS cases, after the national Back to Sleep campaign, that were associated with risk factors. The goal was to make a stronger case that education to eliminate risk factors is now the best option to further reduce deaths from SIDS. The data represent SIDS cases in New Jersey from 1996 to 2000. From case files, the investigators tallied the modifiable and nonmodifiable risk factors associated with each case of SIDS that was reviewed. Modifiable risk factors included nonsupine placement at the time when the infant was put to sleep; smoking by parents; bedsharing with an adult; and a general term of "scene risks," which included excessive bedding, blankets, pillows, or placement of the infant on a couch for sleep. The 2 nonmodifiable risks were prematurity (< 37 weeks' gestational age) and the presence of an upper respiratory infection.
The investigators were able to obtain data on 97% of SIDS cases in New Jersey during the study period (n = 244). Only 9 infants (3.7%) had no risk factors, but the records of 7 of these infants revealed missing data on multiple risk factors, raising the question of whether these infants were truly free of risk. Excluding these infants, < 1% of infants with SIDS had no risk factors; 18% had 1 risk factor; and 78% had multiple risk factors. Among modifiable risk factors, 70% of infants were put down to sleep in the nonsupine position; 60% were exposed to tobacco smoke by at least 1 parent; 39% had been bedsharing; and 32% had scene risks. Nonmodifiable risks were generally less common: 44% for upper respiratory infection and 27% for gestational age < 37 weeks. The investigators concluded that SIDS was rare in the absence of risk factors; most cases exhibited multiple risks; and many infants had both modifiable and nonmodifiable risks.
Viewpoint
This study represents one of the largest series to review causes of SIDS in the years since the Back to Sleep campaign. The fact that more than 75% of the SIDS cases had multiple risk factors suggests that education can still provide some potential improvement in SIDS frequency. The investigators rightly point out that the education must be multifactorial, beginning prenatally, continuing in the nursery, and then by the primary care providers after discharge. Providers should focus on changing the modifiable risk factors, especially in children who begin life with a nonmodifiable risk factor such as prematurity.
Abstract
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