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Multicenter Study
. 2009 Oct 13:339:b3666.
doi: 10.1136/bmj.b3666.

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

Peter S Blair  1 , Peter Sidebotham, Carol Evason-Coombe, Margaret Edmonds, Ellen M A Heckstall-Smith, Peter Fleming
Affiliations
Multicenter Study

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

Peter S Blair et al. BMJ. .

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.

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Conflict of interest statement

Competing interests: None declared.

Figures

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Fig 1 Occupation of random control mothers compared with 1991 census data on mothers with dependent children from Avon
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Fig 2 Age distribution of SIDS (sudden infant death syndrome) infants at time of death and of control infants at time of home visit and investigation of sleep scene
See this image and copyright information in PMC

Comment in

  • Risk factors for SIDS.
    Mitchell EA. Mitchell EA. BMJ. 2009 Oct 13;339:b3466. doi: 10.1136/bmj.b3466. BMJ. 2009. PMID: 19826173 No abstract available.

References

    1. Office for National Statistics. Infant mortality 1921-2021. Social trends 32. London: ONS, 2002.
    1. Fleming PJ, Blair PS, Bacon C, Berry PJ. Sudden unexpected death in infancy. The CESDI SUDI studies 1993-1996. London: Stationery Office, 2000.
    1. 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. - PMC - PubMed
    1. 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. - PMC - PubMed
    1. 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. - PMC - PubMed

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