http://www.thelancet.com/journals/lancet/article/PIIS0140673606679683/ab
stract
also read this one:
http://www.thelancet.com/journals/lancet/article/PIIS0140673604161710/fu
lltext?pubType=related
The Lancet 2006; 367:314-319
Major epidemiological changes in sudden infant death syndrome: a 20-year
population-based study in the UK
Peter S Blair a, Peter Sidebotham c, P Jeremy Berry b,
Margaret Evans d and Peter J Fleming a
Summary
Background
Results of case-control studies in the past 5 years suggest that the
epidemiology of sudden infant death syndrome (SIDS) has changed since
the 1991 UK Back to Sleep campaign. The campaign's advice that parents
put babies on their back to sleep led to a fall in death rates. We used
a longitudinal dataset to assess these potential changes.
Methods
Population-based data from home visits have been collected for 369
consecutive unexpected infant deaths (300 SIDS and 69 explained deaths)
in Avon over 20 years (1984–2003). Data obtained between 1993 and 1996
from 1300 controls with a chosen “reference” sleep before interview have
been used for comparison.
Findings
Over the past 20 years, the proportion of children who died from SIDS
while co-sleeping with their parents, has risen from 12% to 50%
(p<0·0001), but the actual number of SIDS deaths in the parental bed has
halved (p=0·01). The proportion seems to have increased partly because
the Back to Sleep campaign led to fewer deaths in infants sleeping
alone—rather than because of a rise in deaths of infants who bed-shared,
and partly because of an increase in the number of deaths in infants
sleeping with their parents on a sofa. The proportion of deaths in
families from deprived socioeconomic backgrounds has risen from 47% to
74% (p=0·003), the prevalence of maternal smoking during pregnancy from
57% to 86% (p=0·0004), and the proportion of pre-term infants from 12%
to 34% (p=0·0001). Although many SIDS infants come from large families,
first-born infants are now the largest group. The age of infants who
bed-share is significantly smaller than that before the campaign, and
fewer are breastfed.
Interpretation
Factors that contribute to SIDS have changed in their importance over
the past 20 years. Although the reasons for the rise in deaths when a
parent sleeps with their infant on a sofa are still unclear, we strongly
recommend that parents avoid this sleeping environment. Most SIDS deaths
now occur in deprived families. To better understand contributory
factors and plan preventive measures we need control data from similarly
deprived families, and particularly, infant sleep environments.
Affiliations
a Institute of Child Life and Health, Department of Clinical Science,
University of Bristol, UK
b Department of Pathology and Microbiology, University of Bristol
c University of Warwick, Department of Child Health
d Department of Paediatric Pathology, St Michaels Hospital Bristol
Correspondence to: Prof Peter Fleming, Institute of Child Life and
Health, UBHT Education Building, Bristol, BS2 8AE, UK
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