Blair, Peter S., Sidebotham, Peter, Berry, Jeremy, Evans, Margaret and Fleming, Peter J.. (2006) Major epidemiological changes in sudden infant death syndrome : a 20-year population-based study in the UK. Lancet, Vol.367 (No.9507). pp. 314-319. ISSN 0140-6736

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Abstract

Background Results of case-control studies in the past 5 years suggest that the epidemiology of sudden infant death syndrome (SIDS) has changed since the 1991 UK Back to Sleep campaign. The campaign's advice that parents put babies on their back to sleep led to a fall in death rates. We used a longitudinal dataset to assess these potential changes. Methods Population-based data from home visits have been collected for 369 consecutive unexpected infant deaths (300 SIDS and 69 explained deaths) in Avon over 20 years (1984—2003). Data obtained between 1993 and 1996 from 1300 controls with a chosen “reference” sleep before interview have been used for comparison. Findings Over the past 20 years, the proportion of children who died from SIDS while co-sleeping with their parents, has risen from 12% to 50% (p<0·0001), but the actual number of SIDS deaths in the parental bed has halved (p=0·01). The proportion seems to have increased partly because the Back to Sleep campaign led to fewer deaths in infants sleeping alone—rather than because of a rise in deaths of infants who bed-shared, and partly because of an increase in the number of deaths in infants sleeping with their parents on a sofa. The proportion of deaths in families from deprived socioeconomic backgrounds has risen from 47% to 74% (p=0·003), the prevalence of maternal smoking during pregnancy from 57% to 86% (p=0·0004), and the proportion of pre-term infants from 12% to 34% (p=0·0001). Although many SIDS infants come from large families, first-born infants are now the largest group. The age of infants who bed-share is significantly smaller than that before the campaign, and fewer are breastfed. Interpretation Factors that contribute to SIDS have changed in their importance over the past 20 years. Although the reasons for the rise in deaths when a parent sleeps with their infant on a sofa are still unclear, we strongly recommend that parents avoid this sleeping environment. Most SIDS deaths now occur in deprived families. To better understand contributory factors and plan preventive measures we need control data from similarly deprived families, and particularly, infant sleep environments.

Item Type:	Journal Article
Subjects:	R Medicine > RJ Pediatrics
Divisions:	Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Sudden infant death syndrome -- Great Britain, Infants -- Mortality -- Great Britain
Journal or Publication Title:	Lancet
Publisher:	The Lancet Publishing Group
ISSN:	0140-6736
Date:	21 January 2006
Volume:	Vol.367
Number:	No.9507
Page Range:	pp. 314-319
Identification Number:	10.1016/S0140-6736(06)67968-3
Status:	Peer Reviewed
Access rights to Published version:	Open Access
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Arch Dis Child. 2003 Dec;88(12):1058-64. 7 Carpenter PR, Irgens PL, Blair PS, England PD, Fleming PJ, Huber PJ, Schreuder P. Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet 2004;363(9404):185-191. 8 Blair P, Fleming P. Epidemiological investigations of Sudden Infant Death Syndrome infants – recommendations for future studies. Child : care, health and development 2002;28(1):49-54. 9. Limerick SR, Bacon CJ. Terminology used by pathologists in reporting on sudden infant deaths. J Clin Pathol. 2004 Mar;57(3):309-11. 10. Kennedy H, Epstein J , Fleming P.J, .Fox J, Moore I, Pollard J., Risdon RA, Stickle D , Sills J, Stoddart J., Webb A. 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. RCPath & RCPCH, London 2004. (www.rcpch.ac.uk) 11. Fleming PJ, .Blair P., Sidebotham P., Hayler T. Investigating sudden unexpected deaths in infancy and childhood and caring for bereaved families : an integrated multiagency approach. BMJ. 2004;328:331-334. 12. Office of the Deputy Prime Minister "2000 Index of Local Deprivation - Local Authority District Scores and Values on 12 Indicators". http://www.urban.odpm.gov.uk/research/98ild/ 13. Gilbert RE, Rudd PT, Berry PJ, Fleming P J, Hall E, White DG Orreffo, VOC, James.P P Combined effect of infection and heavy wrapping on the risk of sudden infant death. Arch. Dis. Child 1992;67:272-277 14 Boyd P. Health research and the data protection act 1998. J.Health Serv Res Policy. 2003;8:S1. 24-27 15. Leach CEA, Blair PS, Fleming PJ, Smith IJ, Ward Platt M, Berry PJ, Golding J. Sudden Unexpected Deaths in Infancy: Similarities and differences in the epidemiology of SIDS and explained deaths. Pediatrics 1999;104(4). URL:http://www.pediatrics.org/cgi/content/full/104/4/e43. 16. Fleming P. J., .Blair P.S, Ward Platt M., Tripp J., Smith I.J. Sudden Infant Death Syndrome and Social Deprivation . J. Paed Perinatal Epid. 2003; 17:272-280 17. Altman DG, Machin D, Bryant T, Gardner MJ 1989. Statistics with confidence (second edition). BMJ Books. 46-48. ISBN 0 7279 13751 18. Wigfield RE, Fleming P J, Berry PJ, PT Rudd, Golding J. Can the fall in Avon's sudden infant death rate be explained by the observed sleeping position changes? BMJ1992;304:282-283 19. Fleming P J, Gilbert RE, Azaz, Y Berry PJ, Rudd PT, Stewart A, Hall E. The interaction between bedding and sleeping position in sudden infant death syndrome: A population-based case-control study. BMJ 1990;301:85-89 20. Fleming PJ, Blair PS, Bacon C, Bensley D, Smith I, Taylor E, Golding J, Berry J, Tripp J. 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 July 1996; 313:191-5. 21. Rose M, Murphy M, Macfarlane JA et al. ‘Back to sleep’ : the position in Oxfordshire and Northampton. Paediatr Perinat Epidemiol 1998;12(2);217-227. 22. Fleming PJ, Blair PS. Sudden unexpected deaths after discharge from the neonatal intensive care unit. Seminars in Neonatology 2003;8:159-167. 23. Tappin D, Brooke H, Ecob R. Bedsharing and sudden infant death syndrome (SIDS) in Scotland, UK. Lancet. 2004 Mar 20;363(9413):994. 24. Blair PS, Fleming PJ, Smith IJ, Ward Platt M, Young J, Nadin P, Berry PJ, Golding J and the CESDI SUDI research group. Babies sleeping with parents : case-control study of factors influencing the risk of sudden infant death syndrome. BMJ December 1999;319: 1457-1462. 25. Blair PS & Ball HL. The prevalence and characteristics associated with parent-infant bed-sharing in England. Arch Dis Child. 2004 Dec;89(12):1106-10 26. Goldwater PN. Sudden infant death syndrome: a critical review of approaches to research. Arch Dis Child. 2003 Dec;88(12):1095-100. 27. 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URI:	http://wrap.warwick.ac.uk/id/eprint/281

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