The following is a summary of the Centers for Disease Control &
Prevention publication MMWR Vol.45/No.40 (10/11/96)  I have the entire
article available for e-mail if you are interested, but I thought in
general, Lactnetters would be interested in the highlights:
Sudden infant death syndrome (SIDS) is "the sudden death of an infant
under 1 year of age which remains unexplained after a thorough case
investigation, including performance of an autopsy, examination of the
death scene, and review of the clinical history."  Although SIDS is a
diagnosis of exclusion and of unknown etiology, it is the leading cause
of postneonatal mortality in the United States, accounting for
approximately one-third of all such deaths.  This report analyzes age-,
race-, and region-specific trends for SIDS in the United States during
1983-1994 (the latest year for which final data are available) and
indicates that annual rates of SIDS declined more than three times
faster during 1990-1994 than during 1983-1989.
During 1983-1994, SIDS was listed as the underlying cause of death for
61,882 infants.  During 1983-1990, the rate of SIDS decreased an average
of 1.6% per year; during 1990-1994, the rate decreased an average of
5.6% per year.
Most SIDS cases occurred during the postneonatal period; 93.7% and 92.4%
of cases occurred in this age group in 1994 and 1983, respectively.
Rates were highest among infants aged 1-3 months at death: in 1994,
deaths in this group accounted for 68.4% of all cases.
From 1983-1989 through 1990-1994, SIDS rate for female infants declined
16.5%, and the rate for male infants declined 13.5%.  Male infants were
50% more likely to die from SIDS than female infants during 1990-1994.
From 1983-1989 through 1990-1994, the SIDS rate for black infants
decreased 10.4% and rate for white infants decreased 16.7%.  The average
annual decline in the rate of SIDS was 4.1% during 1994 for black
infants and 6.3% for white infants.
Decreases during the two time periods also differed by region. Decreases
were greater in the West and Northeast than in the Midwest and South.
Infants in the Midwest were 2.6 times more likely to die from SIDS than
infants in the Northeast during 1990-1994.
During 1994, the national "Back to Sleep" campaign began promoting the
nonprone sleeping position as well as other modifiable risk factors
(e.g., breastfeeding was encouraged and exposure to tobacco smoke and
overheating was discouraged). Studies in other countries indicated SIDS
rates declined approximatel 50% concurrent with decreases in the
prevalence of prone sleeping. Although the prevalence of breastfeeding
did not change substantially during the study period, birth-certificate
data indicate that during 1989-1994, the prevalence of cigarette smoking
during pregnancy declined by approximately 25%.
Race/ethnicity-specific differences most likely reflect variations in
the prevalence of risk factors for SIDS, including socioeconomic and
demographic factors.  Based on preliminary data, the black/white ratio
for SIDS in 1995 was higher than any other year since 1983, indicating
that racial/ethnic disparities in SIDS may be increasing.
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Kimberly Elms
Arizona State University
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A hundred years from now it will not matter what my bank account was,
the sort of house I lived in or the kind of car I drove...
But the world may be different because I was important in the life of a
child.