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

Preview

PDF WRAP_sidebotham_Hazardous_Cosleeping2.pdf - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader Download (164Kb)

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
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
References:	1 Office for National Statistics. Infant mortality 1921-2021. Social trends 32. London: ONS, 2002. 2 Fleming PJ, Blair PS, Bacon C, Berry PJ. Sudden unexpected death in infancy. The CESDI SUDI studies 1993-1996. London: Stationery Office, 2000. 3 Fleming PJ, Blair PS, Bacon C, Bensley D, Smith I, Taylor E, et al. Environment of infants during sleep and risk of the sudden infant death syndrome: results from 1993-5 case-control study for confidential inquiry into stillbirths and deaths in infancy. BMJ 1996;313:191-5. 4 Blair PS, Fleming PJ, Bensley D, Bacon C, Smith I, Taylor E, et al. Smoking and the sudden infant death syndrome: results from 1993- 5 case-control study for confidential inquiry into stillbirths and deaths in infancy. BMJ 1996;313:195-8. 5 Tappin D, Brooke H, Ecob R, Gibson A. Used infant mattresses and sudden infant death syndrome in Scotland: case-control study. BMJ 2002;325:1007-9. 6 Hauck FR, Herman SM,DonovanM, Iyasu S,MerrickMoore C, Donoghue E, et al. Sleep environment and the risk of sudden infant death syndrome in an urban population: the Chicago Infant Mortality Study. Pediatrics 2003;111:1207-14. 7 McGarvey C,McDonnellM, Chong A, O’ReganM, Matthews T. Factors relating to the infant’s last sleep environment in sudden infant death syndrome in the Republic of Ireland. Arch Dis Child 2003;88:1058-64. 8 Carpenter PR, Irgens PL, Blair PS, England PD, Fleming PJ, Huber PJ, et al. Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet 2004;363:185-91. 9 American Academy of Pediatrics. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider reducing the risk. Pediatrics 2005;116:1245-55. 10 Blair PS, Sidebotham P, Berry PJ, EvansM, Fleming PJ.Major changes in the epidemiology of sudden infant death syndrome: a 20 year population based study of all unexpected deaths in infancy. Lancet 2006;367:314-9. 11 Blair PS, Fleming PJ, Smith IJ,Ward Platt M, Young J,Nadin P, et al. Babies sleeping with parents: case-control study of factors influencing the risk of sudden infant death syndrome. BMJ 1999;319:1457-62. 12 Fleming PJ, Blair PS, Sidebotham P, Hayler T. Investigating sudden unexpected deaths in infancy and childhood and caring for bereaved families: an integrated multiagency approach. BMJ 2004;328:331-4. 13 Von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007;335:806-8. 14 Kennedy H. Sudden unexpected death in infancy. A multi-agency protocol for care and investigation. The report of a working group convened by the Royal College of Pathologists and the Royal College of Paediatrics and Child Health. London: RCPath and RCPCH, 2004. 15 Leach CEA, Blair PS, Fleming PJ, Smith IJ,Ward Platt M, Berry PJ, et al. Epidemiology of SIDS and explained sudden infant deaths. CESDI SUDI research group. Pediatrics 1999;104(4):e43. 16 Fleming PJ, Blair PS, Pollard K, Platt MW, Leach C, Smith I, et al. Pacifier use and SIDS—results from the CESDI SUDI case-control study. Arch Dis Child 1999;81:112-6. 17 Blair PS, Mitchell EA, Heckstall-Smith EMA, Fleming PJ. Head covering: a major modifiable risk factor for sudden infant death syndrome. Arch Dis Child 2008;93:778-83. 18 Limerick SR, Bacon CJ. Terminology used by pathologists in reporting on sudden infant deaths. J Clin Path 2004;57:308-11. 19 Dattani N. Are unascertained deaths the same as sudden infant deaths? Health Stat Q 2001;10:20-4. 20 Fleming PJ, Gilbert RE, Azaz Y, Berry PJ, Rudd PT, Stewart A, et al. The interaction between bedding and sleeping position in sudden infant death syndrome: a population-based case-control study. BMJ 1990;301:85-9. 21 Van Sleuwen BE, Engelberts AC, Boere-Boonekamp MM, Kuis W, Schulpen TW, L’Hoir MP. Swaddling: a systematic review. Pediatrics 2007;120(4):e1097-106. 22 Mitchell EA, Blair PS, L’HoirMP. Should pacifiers be recommended to prevent sudden infant death syndrome? Pediatrics 2006;117:1811-2. 23 McGlashan ND. Sudden infant deaths in Tasmania, 1980-1986: a seven year prospective study. Soc Sci Med 1989;29:1015-26. 24 Scragg R, Mitchell EA, Taylor BJ, Stewart AW, Ford RP, Thompson JM, et al. Bed sharing, smoking, and alcohol in the sudden infant death syndrome. BMJ 1993;307:1312-8. 25 Klonoff-Cohen H, Edelstein SL. Bed sharing and the sudden infant death syndrome. BMJ 1995;311:1269-72. 26 Alm B, Wennergren G, Norvenius G, Skjaerven R, Oyen N, Helweg-Larsen K, et al. Caffeine and alcohol as risk factors for sudden infant death syndrome. Nordic Epidemiological SIDS Study. Arch Dis Child 1999;81:107-11. 27 King-Hele SA, Abel KM, Webb RT, Mortensen PB, Appleby L, Pickles AR. Risk of sudden infant death syndrome with parental mental illness. Arch Gen Psychiatry 2007;64:1323-30. 28 L’Hoir MP, Engelberts AC, van Well GT, Westers P, Mellenbergh GJ, WoltersWH, et al. Case-control study of current validity of previously described risk factors for SIDS in The Netherlands. Arch Dis Child 1998;79:386-93. 29 Rintahaka PJ, Hirvonen J. The epidemiology of sudden infant death syndrome in Finland in 1969-80. Forens Sci Int 1986;30:219-33. 30 Bourne AJ, Beal SM, Byard RW. Bed sharing and sudden infant death syndrome. BMJ 1994;308:537-8. 31 James C, Klenka H, Manning D. Sudden infant death syndrome: bed sharing with mothers who smoke. Arch Dis Child 2003;88:112-3. 32 Kandall SR, Gaines J, Habel L, Davidson G, Jessop D. Relationship of maternal substance abuse to subsequent sudden infant death syndrome in offspring. J Pediatr 1993;123:120-6. 33 Klonoff-Cohen H, Lam-Kruglick P. Maternal and paternal recreational drug use and sudden infant death syndrome. Arch Pediatr Adolesc Med 2001;155:765-70. 34 Aoki Y. Sudden infant death syndrome in infants of cocaine using mothers. J Clin Forensic Med 1994;1:87-91. 35 Scragg RK,Mitchell EA, Ford RP, Thompson JM, Taylor BJ, Stewart AW. Maternal cannabis use in the sudden death syndrome. Acta Paediatr 2001;90:57-60. 36 Blair PS, Fleming P. Co-sleeping and infant death. In: David TJ, ed. Recent advances in paediatrics 24. London: Royal Society of Medicine Press, 2007. 37 Glasgow JF, Thompson AJ, Ingram PJ. Sudden unexpected death in infancy: place and time of death. Ulster Med J 2006;75:65-71. 38 Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Sauerland C, Mitchell EA, et al. Sleep environment risk factors for sudden infant death syndrome: the German Sudden Infant Death Syndrome Study. Pediatrics 2009;123:1162-70.
URI:	http://wrap.warwick.ac.uk/id/eprint/2273

Data sourced from Thomson Reuters' Web of Knowledge

Request changes to a record

Actions (login required)

View Item