Sudden Infant Death Syndrome in Korea: A Retrospective Analysis of Autopsy-Diagnosed Cases

Abstract

This study aimed to elucidate the demographic and sleeping environmental factors associated with sudden infant death syndrome (SIDS) in Korea. The autopsy reports of all SIDS cases reported to the National Forensic Service and Seoul National University College of Medicine between 1996 and 2008 were reviewed for data collection and analysis to identify the risk factors for SIDS. Analysis of the 355 SIDS cases reported within the study period revealed that of the 168 (47.3%) cases for which sleeping position before death had been reported, 75 (44.7%) cases had occurred after placement in prone or side position. Of the 204 (57.5%) cases for which bed-sharing situation had been reported, 121 (59.3%) deaths had occurred during bed-sharing, of which 54 (44.6%) infants were under 3 months of age, a significantly younger age than that of the non-bed-sharing cases (P = 0.0279). Analysis of the results indicated no tendency toward an increase or decrease in the use of a prone or side position. Rather, there was a statistically significant increasing trend for bed-sharing over the study period (OR, 1.087; 95% CI, 1.004-1.177; P = 0.04). These findings indicate the need for nationwide educational programs promoting a safe sleeping environment to enhance SIDS prevention.

Risk Factors for Sudden Infant Death Syndrome and Sleeping Practices in Korea

“…Bedding practices vary by child-care philosophies, sleeping habits, and home architecture [20]. A soft mattress has frequently been reported as a risk factor in Western countries and prominently included in campaigns against SIDS.…”

“…A soft mattress has frequently been reported as a risk factor in Western countries and prominently included in campaigns against SIDS. However, this factor is unlikely to be directly applicable in the Korean context, since Koreans generally prefer harder bedding such as floor-like surfaces, which makes co-sleeping easy [20]. In Western countries, people rarely sleep on the floor, and their bodies tend to be relatively large and heavy.…”

“…Additionally, sleeping places such as couches and sofas may be significant contributors to SIDS when a bed is not available [8,15]. However, Koreans are used to sleeping on the floor, which provides a wide sleeping surface for several persons [20,21]. Even when sleeping on a bed, Koreans generally use very firm mattresses with surfaces made of wood, red clay, or stone.…”

Bed Sharing Deaths In Infancy - Sids or Asphyxia?

“…The paper by Yoo et al (1) draws attention to the significant numbers of unexpected infant deaths that are occurring in shared sleeping situations. It is now well-recognized that the more comprehensively cases of unexpected infant death are investigated, the greater is the number of cases where deaths are attributed to something other than sudden infant death syndrome (SIDS) (2, 3).…”

“…It is now well-recognized that the more comprehensively cases of unexpected infant death are investigated, the greater is the number of cases where deaths are attributed to something other than sudden infant death syndrome (SIDS) (2, 3). However, although bed sharing deaths are still often universally attributed to SIDS (1, 4), the possibility of an asphyxial mechanism of death in some cases must be recognised (5, 6). In support of this, a recent study in South Australia demonstrated that the male to female ratio in infants who died alone was approximately 2:1, as is typical of SIDS deaths.…”