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SIDS risk factor differs between younger and older infants

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Bed sharing and rolling on object cited as risk factors

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Sudden Infant Death Syndrome (SIDS) is defined as the sudden death of an infant less than 1 year of age that cannot be explained after a thorough investigation is conducted, SIDS is the leading cause of death among infants aged 1–12 months, and is the third leading cause overall of infant mortality in the United States. Although the incidence of SIDS has decreased since 2000, rates of other sleep-related infant deaths (eg, accidental suffocation, asphyxiation) have increased.

The sleep environment can impact can increase the risk of SIDS and other sleep-related infant deaths. Little is known about the association of those risk factors at different times during infancy.

Dr. Jeffrey D. Colvin, MD, FAAP, Department of Pediatrics, at Children’s Mercy Hospitals and Clinics and the University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, along with colleagues compared differences in the sleep environment s for younger (birth through three months) and older (three months to 364 days) infants who experienced sleep-related deaths and examined differences in diagnoses for younger and older infants who experienced sleep-related deaths.

The researchers examined sleep-related infant deaths from 24 states from 2004-2012 in the case reporting system of the National Center for the Review and Prevention of Child Deaths.

Researchers divided the cases into two categories; younger (0–3 months) and older (4 months to 364 days) infants. In a total of 8,207 deaths analyzed.

The results showed the majority of the study population (69.2%) was bed sharing at time of death. Bed sharing was defined as the infant sleeping on the same surface with a person or animal. Deaths occurring in the younger infants were significantly more likely to be associated with bed-sharing, (73.8% vs. 58.9%).\

An object found in the sleep environment was associated to one-third of deaths. Objects in the sleep environment included blanket, pillow, bumper pads, hared furniture, stuffed toy, non-stuffed toy, clothing, small, soft fabric items, cord, bag other and unknown.

A higher percentage of deaths occurred in the older group who had at least one object in the sleep environment (39.4% vs 33.5%) The only objects found in over10% of deaths were blankets (24.55%) and pillows (17.6%).

Deaths in the older group were significantly more likely to be associated with the presence of blankets (26.8% vs 23.5%), stuffed toys (2.4% vs 1.2%), bags (1.2% vs 0.3%), hard furniture 0.3% vs 0.1%) and cords (0.2% vs 0.0%),

There were no differences between the two age groups for the presence of pillows, bumper pads, non-stuffed toys, clothing, or other objects.

In their conclusion the researchers write “Risk factors for sleep-related infant deaths may be different for different age groups. The predominant risk factor for younger infants is bed-sharing, whereas rolling into objects in the sleep area is the predominant risk factor for older infants. Parents should be warned about the dangers of these specific risk factors appropriate to their infant’s age.”

“although the American Academy of Pediatrics advises that infants do not need to be repositioned onto their backs if they roll into the prone position, parents should be reminded that cribs should be clear of any objects, so that if the infant rolls, there is no risk of rolling into something that may create an asphyxia environment”, write the researchers in their discussion.

This study appears in Pediatrics

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