Estudando a síndrome da morte súbita do lactente em um país em desenvolvimento

Abstract

OBJECTIVE: To analyze whether previously identifi ed risk factors for sudden death syndrome have a signifi cant impact in a developing country. METHODS: Retrospective longitudinal case-control study carried out in Porto Alegre, Southern Brazil. Cases (N=39) were infants born between 1996 and 2000 who died suddenly and unexpectedly at home during sleep and were diagnosed with sudden death syndrome. Controls (N=117) were infants matched by age and sex who died in hospitals due to other conditions. Data were collected from postmortem examination records and questionnaires answers. A conditional logistic model was used to identify factors associated with the outcome. RESULTS: Mean age at death of cases was 3.2 months. The frequencies of infants regarding gestational age, breastfeeding and regular medical visits were similar in both groups. Sleeping position for most cases and controls was the lateral one. Supine sleeping position was found for few infants in both groups. Maternal variables, age below 20 years (OR=2, 95% CI: 1.1; 5.1) and smoking of more than 10 cigarettes per day during pregnancy (OR=3, 95% CI: 1.3; 6.4), signifi cantly increased the risk for the syndrome. Socioeconomic characteristics were similar in both groups and did not affect risk. CONCLUSIONS: Infant-maternal and socioeconomic profi les of cases in a developing country closely resembled the profi le described in the literature, and risk factors were similar as well. However, individual characteristics were identifi ed as risks in the population studied, such as smoking during pregnancy and maternal age below 20 years. DESCRIPTORS: Sudden Infant Death. Prone Position. Smoking. Risk Factors. Case-Control Studies. 397 Rev Saúde Pública 2008;42(3):396-401 Sudden infant death syndrome (SIDS) is defi ned as "the sudden death of any infant under one year of age which remains unexplained after a thorough case investigation, including complete postmortem examination, review of clinical history and examination of death scene." 23 The pathology of SIDS has not been established, but many hypotheses have been raised in the last years. 19 Advances in the knowledge about SIDS are associated with the identifi cation of environmental risk factors, the so-called "triggers," that may favor this lethal outcome in an organically predisposed child. 7 Currently, many risk factors are associated with SIDS, some of which are definitely correlated with this syndrome. The implications of other factors, however, still need to be further explored. Prone sleeping position and maternal smoking are well-established risk factors for SIDS in developed countries. A 50% reduction in SIDS incidence in countries that have adopted the recommendation of supine sleeping position is well documented in the literature. 2,4 Pediatricians and health providers in developing countries, such as Brazil, have little knowledge on risk RESUMO OBJETIVO: Analisar se fatores de risco previamente identifi cados para a síndrome da morte súbita do lactente têm impacto signifi cativo em um país em des...