Sudden unexplained infant death in 20 regions in Europe: case control
study
R G Carpenter, L M Irgens, P S Blair, P D England, P Fleming, J Huber, G
Jorch, P Schreuder
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Medical Statistics Unit, Department of Epidemiology and Population Health,
London School of Hygiene and Tropical Medicine, London, UK (Prof R G
Carpenter PhD, P D England PhD); Medical Birth Registry of Norway,
University of Bergen, Norway (Prof L M Irgens PhD, P Schreuder BA);
Institute of Child Health, Royal Hospital for Children, Bristol, UK (Prof P
Fleming FRCPCH, P S Blair PhD); University Hospital for Children and Youth,
Utrecht, Netherlands (Prof J Huber FRCP); Clinic for General Pediatrics and
Neonatology, University of Magdeburg, Magdeburg, Germany (Prof G Jorch MD)
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Correspondence to: Prof R G Carpenter, Medical Statistics Unit, Department
of Epidemiology and Population Health, London School of Hygiene and
Tropical Medicine, London WC1E 7HT, UK
(e-mail:[log in to unmask])
Summary
Background After striking changes in rates of sudden unexplained infant
death (SIDS) around 1990, four large case-control studies were set up to re-
examine the epidemiology of this syndrome. The European Concerted Action on
SIDS (ECAS) investigation was planned to bring together data from these and
new studies to give an overview of risk factors for the syndrome in Europe.
Methods We undertook case-control studies in 20 regions. Data for more than
60 variables were extracted from anonymised records of 745 SIDS cases and
2411 live controls. Logistic regression was used to calculate odds ratios
(ORs) for every factor in isolation, and to construct multivariate models.
Findings Principal risk factors were largely independent. Multivariately
significant ORs showed little evidence of intercentre heterogeneity apart
from four outliers, which were eliminated. Highly significant risks were
associated with prone sleeping (OR 13·1 [95% CI 8·51-20·2]) and with
turning from the side to the prone position (45·4 [23·4-87·9]). About 48%
of cases were attributable to sleeping in the side or prone position. If
the mother smoked, significant risks were associated with bed-sharing,
especially during the first weeks of life (at 2 weeks 27·0 [13·3-54·9]).
This OR was partly attributable to mother's consumption of alcohol.
Mother's alcohol consumption was significant only when baby bed-shared all
night (OR increased by 1·66 [1·16-2·38] per drink). For mothers who did not
smoke during pregnancy, OR for bed-sharing was very small (at 2 weeks 2·4
[1·2-4·6]) and only significant during the first 8 weeks of life. About 16%
of cases were attributable to bed-sharing and roughly 36% to the baby
sleeping in a separate room.
Interpretation Avoidable risk factors such as those associated with
inappropriate infants' sleeping position, type of bedding used, and
sleeping arrangements strongly suggest a basis for further substantial
reductions in SIDS incidence rates.
Lancet 2004; 363: 185-91
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