Risk Factors for Sudden Infant Death Syndrome Following the Prevention Campaign in New Zealand: A Prospective Study

Abstract

After adjustment for potential confounders, prone and side sleeping positions, maternal smoking, and the joint exposure to bed sharing and maternal smoking were associated with statistically significant increased risk of SIDS. A change from the side to the supine sleeping position could result in a substantial reduction in SIDS. Maternal smoking is common in New Zealand and with the reduction in the prevalence of prone sleeping position is now the major risk factor in this country. However, smoking behavior has been difficult to change. Bed sharing is also a major factor but appears only to be a risk to infants of mothers who smoke. Addressing bed sharing among mothers who smoke could reduce SIDS by at least one third. Breastfeeding did not appear to offer a statistically significant reduction in SIDS risk after adjustment of potential confounders, but as breastfeeding rates are comparatively good in New Zealand, this result should be interpreted with caution as the power of this study to detect a benefit is small.

Sudden Infant Death Syndrome (SIDS) risk reduction and infant sleep location – Moving the discussion forward

“…Bed-sharing is a well-known feature of infant-care culture among New Zealand's Maori and Pacific Islander communities, but only among the Maori is bed-sharing linked with an increased SIDS-risk from smoking (Tuohy et al 1988) as Pacific Islanders bed-share but rarely smoke (Mitchell et al 1997). In contrast, although the SIDS rate in the 1990s of US Black infants were double those of white infants, the Chicago Infant Mortality Study found no interaction between bed-sharing and maternal smoking during pregnancy or postpartum; only bed-sharing with individuals other than parents was identified as a SIDSrisk (Hauck et al 2003), however data on drug-use at the time of the infant's death are not reported in publications from this study, thereby limiting interpretation of the bed-sharing data; a published conference abstract provides data indicating prenatal drug use by mothers of SIDS infants in this study was particularly high, but does not relate this to bed-sharing deaths (Hauck and Smolkin, 2009).…”

Circumstances Leading to a Change to Prone Sleeping in Sudden Infant Death Syndrome Victims

“…[1][2][3][4] Despite the marked reduction in prone sleeping world-wide, some studies have shown that the prevalence of prone sleeping increases after the second month of life. [5][6][7][8] More importantly, it has been reported in a few case series that some SIDS victims who were usually nonprone sleepers were put to sleep in the prone position shortly before they died. 9,10 There are also anecdotal reports of infants dying the first time that they were put prone to sleep, 11 or when they turned prone for the first time.…”

Pulse Oximetry Monitoring of Infants Who Require Prone Position For Sleep – Is There Evidence That This Practice Reduces SIDS?

“…[9][10][11][12][13][14] At the IWK Health Centre, infants with special medical or developmental needs who require prone lying position for sleep are currently monitored by pulse oximetry in accordance with the Infant Positioning Policy. 20 The purpose of this paper was to determine if there is any evidence in the literature demonstrating that pulse oximetry monitoring of otherwise healthy infants who require prone sleep position reduces mortality from SIDS.…”

“…8 There is an abundance of evidence suggesting that sleep in the prone as opposed to the supine position is one of the major exogenous stressors associated with SIDS. [9][10][11][12][13][14] Since 1992 the American Academy of Pediatrics (AAP) has recommended that infants be placed in the supine position for sleep in order to reduce the risk of SIDS, 2 and implementation of the 'Back to Sleep' program has reduced the incidence of SIDS deaths by over 50% worldwide. 15 In 1992 the rate of SIDS was 1.2/1,000 live births and only 13% of infants slept on their backs, whereas in 2006 the rate of SIDS dropped to 0.55/1,000 live births and more than 75% of infants slept supine.…”