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Since
then, a lot has been learnt about risk factors, and parents are now advised to
reduce the risk of death by placing infants on their back to sleep, placing
infants in the “feet to foot” position at the bottom of the cot, and keeping
infants in a smoke-free environment.
But it is not clear which risk messages have been taken on board in different
social or cultural groups, and little is known about the emergence of new or
previously unrecognised risk factors.
So a team of researchers at the Universities of Bristol and Warwick studied all
unexpected infant deaths from birth to two years in the southwest region of
England from January 2003 to December 2006.
To investigate a possible link between SIDS and socioeconomic deprivation, they
compared these deaths with a control group at ‘high risk’ for SIDS (young,
socially deprived mothers who smoked) as well as a randomly selected control
group.
Parents were interviewed shortly after the death and information was collected
on alcohol and drug use. A detailed investigation of the scene and circumstances
of death was also conducted by trained professionals.
Of the 80 SIDS deaths analysed, more than half (54%) occurred whilst co-sleeping
compared to 20% co-sleeping rate amongst both control groups.
Much of this risk may be explained by the combination of parental alcohol or
drug use prior to co-sleeping (31% compared with 3% random controls), and the
high proportion of co-sleeping deaths on a sofa (17% compared with 1% random
controls), say the authors.
A fifth of SIDS infants were found with a pillow for the last sleep and a
quarter were swaddled, suggesting potentially new risk factors emerging.
The risk factors were similar whichever group the SIDS cases were compared with,
suggesting that these risk factors for SIDS apply to all sections of the
community and are not just a consequence of social deprivation.
Some of the risk reduction messages seem to be getting across and may have
contributed to the continued fall in the SIDS rate, say the authors. However,
the majority of the co-sleeping SIDS deaths occurred in a hazardous sleeping
environment. The safest place for an infant to sleep is in a cot beside the
parental bed in the first six months of life, they write.
Parents need to be advised to never put themselves in a situation where they
might fall asleep with a young infant on a sofa. They also need to be reminded
that they should never co-sleep with an infant in any environment if they have
been drinking or taking drugs.
We have learnt that SIDS is largely preventable, says Edwin Mitchell, Professor
of Child Health Research at the University of Auckland, in an accompanying
editorial. It is important to monitor parents’ knowledge and infant care
practices to inform health education and promotion.
Implementing what we already know has the potential to eliminate SIDS, the
challenge now is how to change behaviour, he concludes.
Contacts:
Research: Peter Fleming,
Professor
of Infant Health and Development Physiology, Department of Community Based
Medicine,
University
of Bristol, UK.
Tel (office): +44 (0)117 342 5144
Mobile:
+44 (0)7976 704320
Editorial: Edwin Mitchell,
Professor
of Child Health Research, Department of Paediatrics,
University
of Auckland, New Zealand.
Please note, the author is on holiday but will be checking email intermittently
Mobile: +64 272 779 354
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