Update On Risk Reduction And SIDS Prevention - 1996

Presentation handout of John L. Carroll, M.D.
The Johns Hopkins Children's Center
Baltimore, MD

Reprinted with permission

Data Indicate That SIDS Rate Could Be Reduced By 50% Or More:

Sudden Infant Death Syndrome (SIDS) has been intensively investigated for decades. Although massive amounts of data accumulated over the years, practical application was lacking. However, since the late 1980's this has changed. There has been a major re-orientation in the SIDS research community and a great deal of practical application of new knowledge has occurred. Current evidence suggests that the incidence of SIDS could be reduced by 50% or more with simple risk-reduction measures (1,2). The present trend in this area is towards more focus on prevention (3,4).

The major focus of recent work has been on "risk factors" in a baby's environment that might increase the risk for SIDS. Taken together, the present literature indicates that 2 risk factors stand out above all others: cigarette smoke exposure and prone sleeping position. Cigarette smoke exposure, both pre-natal (maternal) and post-natal (passive smoking) is believed to account for as much as 20-40% of SIDS (5,6,7).

The prone sleeping position for infants, at least in other (non U.S.) countries, appears to have a major influence on SIDS incidence. In several countries the SIDS incidence dropped by 50% or more following public education campaigns targeting the major risk factors, mainly cigarette smoking and prone sleeping position (8,9,10). Current estimates are that 65-70% of the observed reduction in the SIDS rate can be accounted for by a decline in the percentage of infants sleeping prone. Data are still lacking for the United States, mostly due to the fact that similar public education campaigns were started much later than in other countries and have been less effective in reducing the percentage of infants sleeping prone. The NIH National Institute of Child Health and Development strongly backs the current efforts to encourage the non-prone sleeping position for in (1,5). Current estimates are that the prone sleeping position may account for 50% or more of SIDS cases. Efforts focused on cigarette smoking and sleeping position may be able to reduce the incidence of SIDS by more than 50%. In the United States alone, a 50% reduction in the SIDS rate would save 2,500 lives/year.

It is important to emphasize that risk-reduction measures provide no guarantees. Many parents of SIDS victims have taken all recommended precautions and their infant still dies. As with other risk-reduction measures, like using smoke alarms or driving 55 miles/hour, although safety is not guaranteed, the likelihood of tragedy can be substantially reduced.

1. Willinger M: SIDS Prevention. Pediatric Annals 24(7): 358-364, 1995.

2. Ponsonby AL, Dwyer T, Kasl SV, Cochrane JA: The tasmanian SIDS case-control study - univariable and multivariable risk factor analysis. Pediatric & Perinatal Epidemiology. 9( 3):256-272, 1995.

3. Taylor JA, Sanderson M: A reexamination of the risk factors for the sudden infant death syndrome. Journal of Pediatrics. 126(6):887-891, 1995.

4. Willinger M. Hoffman HJ. Hartford RB: Infant sleep position and risk for sudden infant death syndrome - report of meeting held January 13 and 14, 1994, National Institutes of Health, Bethesda, MD. Pediatrics. 93(5):814-819, 1994.

5. Klonoff-Cohen HS. Edelstein SL. Lefkowitz ES. Srinivasan IP. Kaegi D. Chang JC. Wiley KJ: The effect of passive smoking and tobacco exposure through breast milk on sudden infant death syndrome [see comments]. CM Comment in: JAMA 1995 Mar 8;273(1 0):818-9, Comment in: JAMA 1995 Jul. 19;274(3):214-5 JAMA. 273(10):795-8, 1995

6. Poets CF. Schlaud M. Kleemann WJ. Rudolph A. Diekmann U. Sens B: Sudden infant death and maternal cigarette smoking: results from the Lower Saxony Perinatal Working Group. European Journal of Pediatrics. 154(4):326-9, 1995.

7. DiFranza JR. Lew RA: Effect of maternal cigarette smoking on pregnancy complications and sudden infant death syndrome. Journal of Family Practice. 40(4):385-94, 1995.

8. Irgens LM, Markestad T, Baste V, Schreuder P, Skjaerven R, Oyen N: Sleeping position and sudden infant death syndrome in Norway 1967-91. Arch Dis Child 72/l478-482, 1995.

9. Mitchell EA, Brunt JM, Everard C: Reduction in mortality from sudden infant death syndrome in New Zealand: 1986-1992. Arch Dis Child 70:291-294, 1994.

10. Davidson-Rada J, Caldis S, Tonkin SL: New Zealand's SIDS prevention program and reduction in infant mortality. Health Education Quarterly 22:162-171, 1995.

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