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Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England

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Blair, Peter S., Sidebotham, Peter, Evason-Coombe, Carol, Edmonds, M. (Margaret), Heckstall-Smith, Ellen M. A. and Fleming, Peter J.. (2009) Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. BMJ, Vol.339 . b3666. ISSN 0959-535X

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Official URL: http://dx.doi.org/10.1136/bmj.b3666

Abstract

Objectives: To investigate the factors associated with sudden infant death syndrome (SIDS) from birth to age 2 years, whether recent advice has been followed, whether any new risk factors have emerged, and the specific circumstances in which SIDS occurs while cosleeping (infant sharing the same bed or sofa with an adult or child).

Design: Four year population based case-control study. Parents were interviewed shortly after the death or after the reference sleep (within 24 hours) of the two control groups.

Setting: South west region of England (population 4.9 million, 184 800 births).

Participants: 80 SIDS infants and two control groups weighted for age and time of reference sleep: 87 randomly selected controls and 82 controls at high risk of SIDS (young, socially deprived, multiparous mothers who smoked).

Results: The median age at death (66 days) was more than three weeks less than in a study in the same region a decade earlier. Of the SIDS infants, 54% died while cosleeping compared with 20% among both control groups. Much of this excess may be explained by a significant multivariable interaction between cosleeping and recent parental use of alcohol or drugs (31% v 3% random controls) and the increased proportion of SIDS infants who had coslept on a sofa (17% v 1%). One fifth of SIDS infants used a pillow for the last sleep (21% v 3%) and one quarter were swaddled (24% v 6%). More mothers of SIDS infants than random control infants smoked during pregnancy (60% v 14%), whereas one quarter of the SIDS infants were preterm (26% v 5%) or were in fair or poor health for the last sleep (28% v 6%). All of these differences were significant in the multivariable analysis regardless of which control group was used for comparison. The significance of covering the infant’s head, postnatal exposure to tobacco smoke, dummy use, and sleeping in the side position has diminished although a significant proportion of SIDS infants were still found prone (29% v 10%).

Conclusions: Many of the SIDS infants had coslept in a hazardous environment. The major influences on risk, regardless of markers for socioeconomic deprivation, are amenable to change and specific advice needs to be given, particularly on use of alcohol or drugs before cosleeping and cosleeping on a sofa.

Item Type:	Journal Article
Subjects:	R Medicine > RJ Pediatrics
Divisions:	Faculty of Medicine > Warwick Medical School > Mental Health and Wellbeing Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Sudden infant death syndrome -- Risk factors -- Great Britain, Co-sleeping -- Great Britain, Infants -- Care -- Great Britain, Passive smoking in infants -- Great Britain
Journal or Publication Title:	BMJ
Publisher:	BMJ Group
ISSN:	0959-535X
Official Date:	13 October 2009
Volume:	Vol.339
Number of Pages:	11
Page Range:	b3666
Identification Number:	10.1136/bmj.b3666
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Funder:	Foundation for the Study of Infant Deaths (Great Britain), Babes in Arms, University Hospitals Bristol
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URI:	http://wrap.warwick.ac.uk/id/eprint/2273