Epidemiological profile and strategies for diagnosing SIDS in a developing country: a case-control study

Abstract

Objective: To describe the epidemiological profile, risk factors and best strategies for diagnosing sudden infant death syndrome (SIDS) in a developing country. Methods:Population-based, case-control study with children born between January 1st, 2001, and December 31st, 2003, in Porto Alegre, southern Brazil, who were allocated into three groups: SIDS cases (33), explained death controls (192), and living controls (192). Children in the latter two groups were age-and sex-paired with SIDS cases. Families in which an infant had died at home within the first year of life were identified, and the information available on death certificates and autopsy reports was compared to confirm the diagnosis of SIDS. Explained death controls consisted of infants who had died at city hospitals, and living controls were selected in the same neighborhood as SIDS cases. All parents were interviewed to obtain information on children's health and sleep habits. Multivariate analysis was performed to identify risk factors in the study population. Results:The incidence of SIDS in the population assessed was 0.55/1,000 live births. The analysis revealed the following risk factors: ethnicity (characterized by self-reported black skin color), prematurity, low birth weight, adolescent mother, smoking during pregnancy, and family income of less than one minimum wage. Ninety-four percent of SIDS cases were misdiagnosed in the death certificate. Conclusions:Although SIDS was misdiagnosed in official death certificates, the epidemiological profile is similar to the literature, as well as risk factors, which could be reduced with preventive campaigns. Investigating SIDS in developing countries requires special strategies to avoid misdiagnosis.J Pediatr (Rio J). 2011;87(2):115-122: SIDS, epidemiology, prone sleeping position. ResumoObjetivo: Descrever o perfil epidemiológico, os fatores de risco e as melhores estratégias para diagnosticar a síndrome da morte súbita do lactente (SMSL) em um país em desenvolvimento. Resultados: A incidência da SMSL na população avaliada foi de 0,55/1.000 nascidos vivos. A análise revelou os seguintes fatores de risco: etnia (autorreferida como negra), prematuridade, baixo peso ao nascer, mãe adolescente, tabagismo na gravidez e renda familiar abaixo de um salário mínimo. Além disso, 94% dos casos de SMSL foram maldiagnosticados na certidão de óbito. MétodosConclusões: Embora a SMSL tenha sido mal-diagnosticada, seu perfil epidemiológico é semelhante ao da literatura, assim como os fatores de risco, que poderiam ser reduzidos com campanhas preventivas. Investigar a SMSL em países em desenvolvimento requer estratégias especiais para evitar erros de diagnóstico.J Pediatr (Rio J). 2011;87(2):115-122 Não foram declarados conflitos de interesse associados à publicação deste artigo.Como citar este artigo: Pinho AP, Nunes ML. Epidemiological profile and strategies for diagnosing SIDS in a developing country. J Pediatr (Rio J). 2011;87(2):115-122.Artigo submetido em 13.09.10, aceito em 30.11.10.

Intenção das mães em colocar o bebê para dormir em decúbito dorsal: um estudo de base populacional

“…This means that these mothers are 32% less likely to put their child to sleep in this position than younger mothers. It is possible that this little inclination or even resistance of older mothers to this recommendation is due to previous favorable experience, since the SIDS is a very infrequent event, almost rare and that, moreover, shows great diagnostic difficulty 2,3 .…”

“…The risk of dying from SIDS is substantially higher among poorer families 3,6,7,10,11 . Higher levels of mothers schooling and household income provides mothers with greater knowledge, safety and independence, and this can be reflected in the intention to place the baby to sleep in the supine position.…”

“…Studies conducted in Pelotas, Ribeirão Preto and Porto Alegre showed a specific SIDS mortality coefficient of approximately 4/1,000 live births. In Passo Fundo, RS, it was 0.6/1,000 live births [3][4][5][6] . These studies, however, were affected by the lack of diagnostic precision and a reduced number of cases.…”

“…Its occurrence is greater from the second to the fourth month of age and its incidence ranges from 0.5 to 3.5/1,000 2 . These data are not available for low-income countries because of the difficulty of confirming the diagnosis 3 .…”

“…Other factors that are also significantly associated with SIDS are maternal age below 20 years, passive smoking, low birth weight, prematurity, low socioeconomic status and sleeping with a covered face, sleeping in the parents' bed or on very soft surfaces 2,3,[6][7][8][9][10] .…”