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Risk Factors for Sudden Infant Death Syndrome Following the Prevention Campaign in New Zealand: A Prospective Study

Mitchell, Edwin A., Tuohy, Patrick G., Brunt, Jan M., Thompson, John M. D., Clements, Mark S., Stewart, Alistair W., Ford, Rodney P. K., Taylor, Barry J.·1997·Pediatrics
DOI 10.1542/peds.100.5.835
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Abstract

Objectives. To identify the risk factors for sudden infant death syndrome (SIDS) following a national campaign to prevent SIDS. Methods. For 2 years (October 1, 1991 through September 30, 1993) data were collected by community child health nurses on all infants born in New Zealand at initial contact and at 2 months. Results. There were 232 SIDS cases in the postneonatal age group (2.0/1000 live births) and these were compared with 1200 randomly selected control subjects. Information was available for 127 cases (54.7%) and 922 (76.8%) of controls. The previously identified modifiable risk factors were examined. The prevalence of prone sleeping position of the infant was very low (0.7% at initial contact and 3.0% at 2 months), but was still associated with an increased risk of SIDS. In addition, the side sleeping position was also found to have an increased risk of SIDS compared with the supine sleeping position (at 2 months: adjusted odds ratio (OR) = 6.57; 95% confidence interval (CI) = 1.71, 25.23). Maternal smoking was found to be the major risk factor for SIDS. Bed sharing was also associated with an increased risk of SIDS. There was an interaction between maternal smoking and bed sharing on the risk of SIDS. Compared with infants not exposed to either bed sharing or maternal smoking, the adjusted OR for infants of mothers who smoked was 5.01 (95% CI = 2.01, 12.46) for bed sharing at the initial contact and 5.02 (95% CI = 1.05, 24.05) for bed sharing at 2 months. In this study breastfeeding was not associated with a statistically significant reduction in the risk of SIDS. The other risk factors for SIDS identified were: unmarried mother, leaving school at a younger age, young mother, greater number of previous pregnancies, late attendance for antenatal care, smoking in pregnancy, male infant, Maori ethnicity, low birth weight, and shorter gestation. Conclusions. After adjustment for potential confounders, prone and side sleeping positions, maternal smoking, and the joint exposure to bed sharing and maternal smoking were associated with statistically significant increased risk of SIDS. A change from the side to the supine sleeping position could result in a substantial reduction in SIDS. Maternal smoking is common in New Zealand and with the reduction in the prevalence of prone sleeping position is now the major risk factor in this country. However, smoking behavior has been difficult to change. Bed sharing is also a major factor but appears only to be a risk to infants of mothers who smoke. Addressing bed sharing among mothers who smoke could reduce SIDS by at least one third. Breastfeeding did not appear to offer a statistically significant reduction in SIDS risk after adjustment of potential confounders, but as breastfeeding rates are comparatively good in New Zealand, this result should be interpreted with caution as the power of this study to detect a benefit is small.

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Research works printed but not linked: 26

  1. Mitchell, 1994, Reduction in mortality from sudden infant death syndrome in New Zealand: 1986–1992., Arch Dis Child., 70, 291, 10.1136/adc.70.4.291 · DOI
  2. Mitchell, 1992, Further evidence supporting a causal relationship between prone sleeping position and SIDS., J Paediatr Child Health., 28(suppl 1), S9, 10.1111/j.1440-1754.1992.tb02732.x · DOI
  3. Mitchell, 1991, Results from the first year of the New Zealand cot death study., N Z Med J., 104, 71
  4. Mitchell, 1992, Four modifiable and other major risk factors for cot death: the New Zealand Study., J Paediatr Child Health., 28(suppl 1), S3, 10.1111/j.1440-1754.1992.tb02729.x · DOI
  5. Mitchell, 1992, The National Cot Death Prevention Programme in New Zealand., Aust J Public Health., 16, 158, 10.1111/j.1753-6405.1992.tb00045.x · DOI
  6. Mitchell, 1993, Publicity and infants' sleeping position., Br Med J., 306, 858, 10.1136/bmj.306.6881.858-b · DOI
  7. Scragg, 1993, Bed spring, smoking and alcohol in the sudden infant death syndrome: results from the New Zealand cot death study., Br Med J., 307, 1312, 10.1136/bmj.307.6915.1312 · DOI
  8. Scragg, 1995, Public health policy on bed sharing and smoking in the sudden infant death syndrome., N Z Med J., 108, 218, 10.1111/j.1445-5994.1995.tb01526.x · DOI
  9. Schouten, 1993, Risk ratio and rate estimation in case-cohort designs: hypertension and cardiovascular mortality., Stat Med., 12, 1733, 10.1002/sim.4780121808 · DOI
  10. Mehta, 1985, Computing an exact confidence interval for the common odds ratio in several 2x2 contingency tables., J Am Stat Assoc., 80, 969
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  13. de Jonge, 1993, Sleeping position for infants and cot death in the Netherlands 1985–1991., Arch Dis Child., 69, 660, 10.1136/adc.69.6.660 · DOI
  14. Engelberts, 1991, An analysis of trends in the incidence of sudden infant death in the Netherlands 1969–1989., J Paediatr Child Health., 27, 329, 10.1111/j.1440-1754.1991.tb00413.x · DOI
  15. Fleming, 1996, Environment of infants during sleep and risk of the sudden infant death syndrome: results from 1993–1995 case-control study for confidential inquiry into stillbirths and deaths in infancy., Br Med J., 313, 191, 10.1136/bmj.313.7051.191 · DOI
  16. Ford, 1993, Breast feeding and the risk of sudden infant death syndrome., Int J Epidemiol., 22, 885, 10.1093/ije/22.5.885 · DOI
  17. Luke, 1977, Sleeping arrangements of sudden infant death syndrome victims in the District of Columbia–a preliminary report., J Forensic Sci., 23, 379, 10.1520/JFS10772J · DOI
  18. Lee, 1989, Sudden infant death syndrome in Hong Kong: confirmation of low incidence., Br Med J., 298, 721, 10.1136/bmj.298.6675.721 · DOI
  19. Kelmanson, 1993, An assessment of the microsocial environment of children diagnosed as “sudden infant death” using the “process” inventory., Eur J Pediatr., 152, 686, 10.1007/BF01955249 · DOI
  20. Klonoff-Cohen, 1995, Bed sharing and the sudden infant death syndrome., Br Med J., 311, 1269, 10.1136/bmj.311.7015.1269 · DOI
  21. Mitchell, 1993, Smoking and the sudden infant death syndrome., Pediatrics., 91, 893, 10.1542/peds.91.5.893 · DOI · Paper page
  22. Blair, 1996, Smoking and the sudden infant death syndrome: results from 1993–1995 case-control study for confidential inquiry into stillbirths and deaths in infancy., Br Med J., 313, 195, 10.1136/bmj.313.7051.195 · DOI
  23. Gilbert, 1994, The changing epidemiology of SIDS., Arch Dis Child., 70, 445, 10.1136/adc.70.5.445 · DOI
  24. Helweg-Larsen, 1994, Overheating and sudden infant death. Temperature regulation in relation to the prone position, the possible pathogenesis of sudden infant death., Ugeskr Laeger., 156, 7193
  25. Forsdahl, 1995, Crib death and infant mortality in the Nordic countries 1988–1993., Tidsskr Nor Laegeforen., 115, 3482
  26. Dwyer, 1995, The contribution of changes in the prevalence of prone sleeping position to the decline in sudden infant death syndrome in Tasmania., JAMA., 273, 783, 10.1001/jama.1995.03520340039033 · DOI

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Metadata

Authors
Mitchell, E. A., Tuohy, P. G., Brunt, J. M., Thompson, J. M. D., Clements, M. S., Stewart, A. W., Ford, R. P. K., & Taylor, B. J.
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
1997-11-01
Volume
100
Issue
5
Pages
835-840
ISSN
  • 1098-4275
  • 0031-4005
DOI
10.1542/peds.100.5.835
Cited by
224
References
0
Language
en

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CoChat. (2026). Citation check: Risk Factors for Sudden Infant Death Syndrome Following the Prevention Campaign in New Zealand: A Prospective Study. https://app.cochat.ai/papers/10.1542/peds.100.5.835
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Mitchell, E. A., Tuohy, P. G., Brunt, J. M., Thompson, J. M. D., Clements, M. S., Stewart, A. W., Ford, R. P. K., & Taylor, B. J. (1997). Risk Factors for Sudden Infant Death Syndrome Following the Prevention Campaign in New Zealand: A Prospective Study. Pediatrics. https://doi.org/10.1542/peds.100.5.835