Dear Colleagues,

On the pacifier and SIDS issue, please find attached an asbtract from a 2005
meta-analysis published in PEDIATRICS (10th October - can get the full paper
for free online via
http://pediatrics.aappublications.org/cgi/content/abstract/peds.2004-2631v1

Good for parents are aware of the evidence underlying recommendations as
well as subsequent recommendations themselves? A useful contribution to
decision making on this issue?

Kind regards to all,


Marko.


Dr Marko Kerac MRCPCH MPH,
Academic Clinical Fellow, Public Health
UCL Centre for International Health & Development, Institute of Child
Health, 30 Guilford Street, London WC1N 1EH, UK

**************************************************************
Published online October 10, 2005
PEDIATRICS (doi:10.1542/peds.2004-2631) REVIEW ARTICLE

Do Pacifiers Reduce the Risk of Sudden Infant Death Syndrome? A
Meta-analysis 
Fern R. Hauck, MD, MS*, Olanrewaju O. Omojokun, MD and Mir S. Siadaty, MD,
MS 

OBJECTIVE.: Pacifier use has been reported to be associated with a reduced
risk of sudden infant death syndrome (SIDS), but most countries around the
world, including the United States, have been reluctant to recommend the use
of pacifiers because of concerns about possible adverse effects. This
meta-analysis was undertaken to quantify and evaluate the protective effect
of pacifiers against SIDS and to make a recommendation on the use of
pacifiers to prevent SIDS. 

METHODS.: We searched the Medline database (January 1966 to May 2004) to
collect data on pacifier use and its association with SIDS, morbidity, or
other adverse effects. The search strategy included published articles in
English with the Medical Subject Headings terms "sudden infant death
syndrome" and "pacifier" and the keywords "dummy" and "soother." Combining
searches resulted in 384 abstracts, which were all read and evaluated for
inclusion. For the meta-analysis, articles with data on the relationship
between pacifier use and SIDS risk were limited to published original
case-control studies, because no prospective observational reports were
found; 9 articles met these criteria. Two independent reviewers evaluated
each study on the basis of the 6 criteria developed by the American Academy
of Pediatrics Task Force on Infant Positioning and SIDS; in cases of
disagreement, a third reviewer evaluated the study, and a consensus opinion
was reached. We developed a script to calculate the summary odds ratio (SOR)
by using the reported ORs and respective confidence intervals (CI) to weight
the ORs. We then pooled them together to compute the SOR. We performed the
Breslow-Day test for homogeneity of ORs, Cochran-Mantel-Haenszel test for
the null hypothesis of no effect (OR = 1), and the Mantel-Haenszel common OR
estimate. The consistency of findings was evaluated and the overall
potential benefits of pacifier use were weighed against the potential risks.
Our recommendation is based on the taxonomy of the 5-point (A-E) scale
adopted by the US Preventive Services Task Force. 

RESULTS.: Seven studies were included in the meta-analysis. The SOR
calculated for usual pacifier use (with univariate ORs) is 0.90 (95%
confidence interval [CI]: 0.79-1.03) and 0.71 (95% CI: 0.59-0.85) with
multivariate ORs. For pacifier use during last sleep, the SORs calculated
using univariate and multivariate ORs are 0.47 (95% CI: 0.40-0.55) and 0.39
(95% CI: 0.31-0.50), respectively. 

CONCLUSIONS.: Published case-control studies demonstrate a significant
reduced risk of SIDS with pacifier use, particularly when placed for sleep.
Encouraging pacifier use is likely to be beneficial on a population-wide
basis: 1 SIDS death could be prevented for every 2733 (95% CI: 2416-3334)
infants who use a pacifier when placed for sleep (number needed to treat),
based on the US SIDS rate and the last-sleep multivariate SOR resulting from
this analysis. Therefore, we recommend that pacifiers be offered to infants
as a potential method to reduce the risk of SIDS. The pacifier should be
offered to the infant when being placed for all sleep episodes, including
daytime naps and nighttime sleeps. This is a US Preventive Services Task
Force level B strength of recommendation based on the consistency of
findings and the likelihood that the beneficial effects will outweigh any
potential negative effects. In consideration of potential adverse effects,
we recommend pacifier use for infants up to 1 year of age, which includes
the peak ages for SIDS risk and the period in which the infant's need for
sucking is highest. For breastfed infants, pacifiers should be introduced
after breastfeeding has been well established.

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome