I do not have access to all the article to be able to comment. Sincerely,
Toby Gish RN, IBCLC
http://pediatrics.aappublications.org/cgi/content/abstract/112/4/883?etoc
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PEDIATRICS Vol. 112 No. 4 October 2003, pp. 883-889
Where Should Infants Sleep? A Comparison of Risk for Suffocation of Infants
Sleeping in Cribs, Adult Beds, and Other Sleeping Locations
N. J. Scheers, PhD*, George W. Rutherford, MS and James S. Kemp, MD
* Office of Planning and Evaluation, the Consumer Product Safety Commission,
Bethesda, Maryland, and Loyola College, Baltimore, Maryland
Consumer Product Safety Commission, Directorate for Epidemiology, Bethesda,
Maryland
Pulmonary Medicine Division, Department of Pediatrics, St Louis University
School of Medicine, St Louis, Missouri
Objectives. To ascertain whether the number of sudden infant deaths as a
result of suffocation in cribs, in adult beds, on sofas or chairs, and on
other sleep surfaces was increasing whether attributable to increased
reporting, diagnostic shift, or an actual increase in suffocation deaths and
to compare the risk of reported accidental suffocation for infants on sleep
surfaces designed for infants with the risk on adult beds.
Methods. We reviewed all accidental suffocation deaths among infants 11
months of age reported to the United States Consumer Product Safety
Commission from 1980 through 1983 and 1995 through 1998. We compared infants
' ages and other demographic data, the sleep location and surface used, and
the reported mechanism or pattern of death. For 1995-1998, we used data on
sleep location from an annual survey of randomly selected households of
living infants younger than 8 months, collected as part of the National
Infant Sleep Position Study at the National Institute of Child Health and
Human Development, to calculate risk for death as a result of suffocation in
cribs, in adult beds, and on sofas or chairs.
Methods. The number of reported suffocation deaths by location were compared
between the 1980s and 1990s using logistic regression modeling to calculate
odds ratios (OR), 95% confidence intervals (CI), and P values. Comparative
risks for suffocation deaths on a given sleep surface for infants in the
1990s were examined by calculating rates of death per 100 000 exposed
infants and comparing the 95% CI for overlap.
Results. From the 1980s, 513 cases of infant suffocation were considered;
from the 1990s, 883 cases. The number of reported suffocation deaths in
cribs fell from 192 to 107, the number of reported deaths in adult beds
increased from 152 to 391, and the number of reported deaths on sofas or
chairs increased from 33 to 110. Using cribs as the reference group and
adjusting for potential confounders, the multivariate ORs showed that infant
deaths in adult beds were 8.1 times more likely to be reported in the 1990s
than in the 1980s (95% CI: 3.2-20.3), and infant deaths on sofas and chairs
were 17.2 times more likely to be reported in the 1990s than in the 1980s
(95% CI: 5.0-59.3). The sleep location of a subset of cases from the 1990s,
348 infants younger than 8 months at death, was compared with the sleep
location of 4220 living infants younger than 8 months. The risk of
suffocation was approximately 40 times higher for infants in adult beds
compared with those in cribs. The increase in risk remained high even when
overlying deaths were discounted (32 times higher) or the estimate of rates
of bedsharing among living infants doubled (20 times higher).
Conclusions. Reported deaths of infants who suffocated on sleep surfaces
other than those designed for infants are increasing. The most conservative
estimate showed that the risk of suffocation increased by 20-fold when
infants were placed to sleep in adult beds rather than in cribs. The public
should be clearly informed of the attendant risks.
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Key Words: sudden death . infant; suffocation . infant; consumer product
safety; sleep . infant
Abbreviations: SIDS, sudden infant death syndrome . CPSC, US Consumer
Product Safety Commission . NICHD, National Institute of Child Health and
Human Development . e-code, external cause of death . CI, confidence
interval . NCHS, National Center for Health Statistics . OR, odds ratio
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Received for publication Apr 22, 2003; accepted Jun 16, 2003.
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Copyright © 2003 by the American Academy of Pediatrics. [Disclaimer]
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