Elsevier

The Journal of Pediatrics

Volume 132, Issue 2, February 1998, Pages 340-343
The Journal of Pediatrics

Abandoning prone sleeping: Effect on the risk of sudden infant death syndrome,☆☆,,★★

https://doi.org/10.1016/S0022-3476(98)70456-1Get rights and content

Abstract

Objective: This study was designed to evaluate the long-term effect of a campaign to avoid prone sleeping on the sudden infant death syndrome (SIDS) mortality rate and on parents' choice of sleeping position for young infants. Before the campaign, 64% of infants usually slept prone and the SIDS rate was 3.5 (95% CI, 2.64 to 4.36) per 1000 live births. Study design: Population-based case reference study of infants dying suddenly and unexpectedly at the ages of 1 week to 1 year, and of 493 healthy infants between 2 and 6 months of age, starting 4 years after an intervention program to avoid prone sleeping. Results: The SIDS rate was 0.3 per 1000 live births (95% CI, 0.05 to 0.54). One of five (20%) SIDS victims usually slept prone, three of five (60%) were placed prone for their last sleep, and five of six were found dead in the prone position. Of the reference infants, 1.4% were usually placed prone to sleep, although all had previously accepted a non-prone position. Nearly half of the infants (49.1%) were usually placed supine, 22.7% usually on the side, and 26.8% in variable positions of which 2.0% occasionally included prone. The side position was the least stable position. After the age of 1 week, 59.4% of infants had been found with their heads covered on at least one occasion. Conclusions: SIDS is rare when prone sleeping is avoided. Infants at the age of particular risk for SIDS may spontaneously turn from the side to the prone position, and they commonly slip under the bedding during sleep. (J Pediatr 1998;132:340-3)

Section snippets

Methods

This population-based case reference study was carried out in the county of Hordaland, Norway (population, 416,000; 10% of the population of Norway) during the 3-year period 1993 to 1995. The demographic characteristics are similar to the rest of Norway, and the yearly migration rate is only 1.6%.7 The annual number of live births varied between 6229 and 6390, and 80% of infants were born at one major maternity hospital. The study was approved by the Regional Committee on Medical Research

RESULTS

During the study period, six sudden unexpected deaths were identified, which is a rate of 0.3 per 1000 live births (95% confidence interval, 0.05 to 0.54). All had autopsies performed. The usual sleeping position and position placed to sleep for the last time were unknown for one infant. One of five SIDS victims usually slept prone, but another two were placed prone for their last sleep (Table). These three infants had infant colic, and the prone position was chosen to reduce fussiness.

Two of

DISCUSSION

In the county of study, the incidence of SIDS dropped from 3.5 per 1000 live births (95% CI, 2.64 to 4.36) in a 3-year period before a campaign to avoid prone sleeping in January 1990 to 1.5 per 1000 (95% CI, 0.95 to 2.05) in the 3-year period after the campaign. Simultaneously, the rate of prone as the preferred sleeping position dropped from 64% to 8%, and the relative risk of prone sleeping increased from 2.0 to 12.6.1 In the subsequent 3-year period addressed in this study, the prone

Acknowledgements

We thank Professor Lorenz M. Irgens, of The Norwegian Birth Registry, for providing information on infants' deaths.

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Cited by (0)

From the Departments of Pediatrics and Forensic Medicine, University Hospital of Bergen, Norway.

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Supported by the Norwegian Research Council for Science and the Humanities, the Norwegian SIDS Society, and the local SIDS Society.

Reprint requests: Britt T. Skadberg, Department of Pediatrics, University Hospital of Bergen, N-5021 Bergen, Norway.

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0022-3476/98/$5.00 + 0  9/22/84642

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