Risk Factor Changes for Sudden Infant Death Syndrome After Initiation of Back-to-Sleep Campaign

• Published in: Pediatrics (Evanston) Vol. 129; no. 4; pp. 630 - 638
• Main Authors: TRACHTENBERG, Felicia L, HAAS, Elisabeth A, KINNEY, Hannah C, STANLEY, Christina, KROUS, Henry F
• Format: Journal Article
• Language: English
• Published: Elk Grove Village, IL American Academy of Pediatrics 01-04-2012
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Causes of; Control; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Epidemiology; Female; General aspects; Health aspects; Health Promotion; Health risk assessment; Hospital beds; Humans; Infant; Infant, Newborn; Intensive care medicine; Male; Medical sciences; Mothers; Pediatrics; Prevalence; Prone Position; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Risk Factors; SIDS; Sleep; Smoking in pregnancy; Sudden Infant Death - epidemiology; Sudden Infant Death - etiology; Sudden infant death syndrome; Tobacco Smoke Pollution - adverse effects; United States - epidemiology; United States; Pediatrics; Brain stem; Central nervous system; Tobacco smoking; Infant; Risk; Epidemiology; Encephalon; Mother; bed-sharing; Sudden infant death syndrome; brainstem; Sleep wake cycle; maternal smoking; triple-risk model; Initiation; Human; Serotonin; Sudden death; Change; Tobacco; Sleep; Risk factor; Neurotransmitter; Models; prone sleep
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2011-1419

To test the hypothesis that the profile of sudden infant death syndrome (SIDS) changed after the Back-to-Sleep (BTS) campaign initiation, document prevalence and patterns of multiple risks, and determine the age profile of risk factors.
The San Diego SIDS/Sudden Unexplained Death in Childhood Research Project recorded risk factors for 568 SIDS deaths from 1991 to 2008 based upon standardized death scene investigations and autopsies. Risks were divided into intrinsic (eg, male gender) and extrinsic (eg, prone sleep).
Between 1991-1993 and 1996-2008, the percentage of SIDS infants found prone decreased from 84.0% to 48.5% (P < .001), bed-sharing increased from 19.2% to 37.9% (P < .001), especially among infants <2 months (29.0% vs 63.8%), prematurity rate increased from 20.0% to 29.0% (P = .05), whereas symptoms of upper respiratory tract infection decreased from 46.6% to 24.8% (P < .001). Ninety-nine percent of SIDS infants had at least 1 risk factor, 57% had at least 2 extrinsic and 1 intrinsic risk factor, and only 5% had no extrinsic risk. The average number of risks per SIDS infant did not change after initiation of the BTS campaign.
SIDS infants in the BTS era show more variation in risk factors. There was a consistently high prevalence of both intrinsic and especially extrinsic risks both before and during the Back-to-Sleep era. Risk reduction campaigns emphasizing the importance of avoiding multiple and simultaneous SIDS risks are essential to prevent SIDS, including among infants who may already be vulnerable.