Arch Dis Child Fetal Neonatal Ed doi:10.1136/archdischild-2011-300752
  • Original articles

Risk factors for early sudden deaths and severe apparent life-threatening events

  1. Christian F Poets
  1. Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany
  1. Correspondence to Christian F Poets, Department of Neonatology, Tuebingen University Hospital, Calwerstr. 7, 72076 Tuebingen, Germany; christian-f.poets{at}
  1. Contributors Anette Poets was involved in the study design, supervised the data collection and analysis and wrote the first draft of the manuscript; Michael S Urschitz was responsible for statistical analysis. Renate Steinfeldt was involved in designing the study and data collection; Christian F Poets initiated and supervised the study and revised the manuscript. Anette Poets had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Received 1 August 2011
  • Accepted 5 January 2012
  • Published Online First 31 January 2012


Objective To identify potential risk factors for unexpected sudden infant deaths (SID) and severe apparent life-threatening events (S-ALTE) within 24 h of birth.

Design Case-control study embedded in an epidemiological survey over a 2-year period.

Patients and methods Throughout 2009, every paediatric department in Germany was asked to report cases of unexplained SID or S-ALTE in term infants with a 10-min Apgar score ≥8 to the Surveillance Unit for Rare Pediatric Conditions. Throughout 2010, the inclusion criteria were extended to infants ≥35 week gestational age and those where an explanation for the deterioration had been found. For each unexplained case, hospitals were asked to fill in a questionnaire for 3 (near-)term controls with good postnatal adaptation at the age (in minutes) when the event had occurred in the case under study.

Results Of the 85 cases reported, 34 fulfilled the entry criteria; of these, two were near-term newborns and, in three cases, a cause had been identified for the event. For the 31 cases with unknown cause for the event (13 males; mean (SD) gestational age 38.9 (1.7) week), the authors gathered 93 controls (51 male infants; 38.9 (1.4) week). As significant risk factors for S-ALTE and SID, the authors could identify primipara (OR 6.22; 95% CI 2.11 to 18.32) and potentially asphyxiating position (OR 6.45; 95% CI 1.22 to 34.10).

Conclusions Close observation of newborns seems necessary, particularly in primipara; a potentially asphyxiating position should be avoided.


  • Funding Beitlich Foundation.

  • Competing interests None.

  • Ethics approval Ethics Committee of Tuebingen University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data.

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