Oyen, Nina, Markestad, Trond, Skjaerven, Rolv, Irgens, Lorentz M., Helweg-Larsen, Karin, Alm, Bernt, Norvenius, Gunnar, and Wennergren, Goran
Infants who have risk factors for sudden infant death syndrome (SIDS) such as low birth weight and prematurity may be at even greater risk than previously thought if placed on their stomach or side when sleeping position. Two hundred forty-four infants who died of SIDS were compared to a control group of 869 babies who died of other causes. Both stomach and side sleeping were strongly associated with an increased risk of SIDS. When these sleeping positions were combined with other risk factors, the incidence of death by SIDS increased significantly. It is possible that in an infant predisposed to SIDS, these sleeping positions may trigger the event., Objective. Prone sleeping is a strong risk factor for sudden infant death syndrome (SIDS). We investigated whether the combined effect of prone sleeping position and prenatal risk factors further increased the SIDS risk. Methods. In the Nordic Epidemiological SIDS Study, parents of SIDS victims in Denmark, Norway, and Sweden completed a questionnaire on potential risk factors for SIDS. Forensic pathologists verified the SIDS diagnosis. Four controls of the same gender, age, and place of birth were selected. This matched case-control study, which included 244 SIDS cases and 869 controls from 1992 to 1995, was analyzed by conditional logistic regression. Results. Odds ratios (ORs) for prone and side sleeping compared with supine sleeping for the last sleep were 13.9 (95% confidence interval 8.2-24) and 3.5 (2.1-5.7). Infants 13 to 24 weeks old had particularly high risk in prone and side sleeping at 28.5 (7.9-107) and 5.9 (1.6-22). OR for prone sleeping was higher in girls, at 30.4 (11-88), than in boys, 10.3 (5.5-19). We found strong combined effects of sleeping position and prenatal risk factors (more than multiplicative). The OR for prone and side sleeping was increased for infants with birth weight [is less than] 2500 & at 83 (25-276) and 36.6 (13-107); for preterm infants, at 48.8 (19-128) and 40.5 (14-115); and for intrauterine growth retarded, at 38.8 (14-108) and 9.6 (4.3-22), compared with supine position in infants without these prenatal factors. The combined effect of nonsupine positions and intrauterine growth retarded was highest among 13- to 24-week-old infants. Effects of combined presence of nonsupine sleeping positions and each of the factors of smoking in pregnancy, young maternal age, higher parity, low level of maternal education, and single motherhood were more than additive. Attributable fractions in the population for prone and side sleeping were 18.5% and 26.0%. Conclusions. Both prone and side sleeping increased the risk of SIDS. The risk was increased further in low birth weight infants, preterm infants, and infants at the age of 13 to 24 weeks, suggesting that SIDS may be triggered by nonsupine sleeping in infants with prenatal risk factors during a vulnerable period of postnatal development. Pediatrics 1997;100:613-621; birth weight, fetal growth retardation, gestational age, infant mortality, infant, premature, prone position, sudden infant death., The Nordic countries experienced a dramatic increase in sudden infant death syndrome (SIDS) during the 1980s, concurrent with an increase in total postperinatal deaths.[1-3] The highest incidence was observed in [...]