Customs child health, public wellness, and epidemiology

Sudden infant death syndrome: bed sharing with mothers who smoke

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  1. C Jamesone,
  2. H Klenkatwo,
  3. D Manningthree
  1. 1Alder Hey Children'due south Hospital, Liverpool, Great britain
  2. 2Child Development Centre, Clatterbridge Hospital, Clatterbridge, Wirral, UK
  3. 3Arrowe Park Infirmary, Upton, Wirral, United kingdom of great britain and northern ireland
  1. Correspondence to:
    Dr C James, Alder Hey Children's Infirmary, Eaton Road, Liverpool L12 2AP, UK;
    chrisjames{at}doctors.org.uk

Abstruse

Aim: To examine the sleeping arrangements of sudden infant death syndrome (SIDS) cases on the Wirral. In detail to determine the prevalence of bed sharing with mothers who fume, a known run a risk gene for SIDS.

Methods: Retrospective study of postmortem determined cases of SIDS from 1995 to 2000 on the Wirral peninsula (population 350 000, 3500 annual births). Ambulance coiffure reports, case notes, health company reports, postmortem reports, and case word records were studied for each case.

Results: In that location were 25 cases of SIDS in the postneonatal age group over the six year period. In 9 cases the baby was bed sharing with the mother, of whom vii were smokers. 5 of these mothers reported using alcohol or illicit drugs on the dark of their infant's decease. In two further cases the babe slept on a sofa with a parent.

Conclusions: Bed sharing and smoking remain important risk factors for SIDS. Mothers should exist advised ante- and postnatally of this combination of hazard factors. Such advice should also include a recommendation non to sleep with their babe if under the influence of alcohol or illicit drugs, and never to sleep on a sofa with their baby. All "Child Health Record" books given to parents on the Wirral now include this advice. "Reduce the Adventure" advice leaflets given to parents pre- and postnatally also now carry the recommendation, and health visitors and midwives have been educated with respect to these additions.

  • alcohol
  • bed sharing
  • SIDS, smoking
  • sudden infant decease syndrome

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  • alcohol
  • bed sharing
  • SIDS, smoking
  • sudden baby expiry syndrome

Despite the fall in incidence of sudden infant death syndrome (SIDS) in the UK, particularly following the "Dorsum to Sleep" entrada in 1991, information technology remains the largest single group of causes of expiry in infancy.1

Before the reduction in incidence there was alien testify on the effect of bed sharing equally a risk factor for SIDS.2– four The Foundation for the Study of Infant Deaths provides written information on "Reducing the Risk of Cot Death", which is readily available to parents and includes the post-obit recommendations: to place the baby on his/her back to sleep, to reduce or terminate smoking in pregnancy, to avoid smoking in the same room as the baby, to not permit the babe to get too hot, to place the baby with his/her feet at the foot of the cot, and to seek medical communication if the infant is unwell.5

While the benefits of following this communication accept been known for some time, contempo studies in New Zealand and the United kingdom of great britain and northern ireland highlight bed sharing with mothers who smoke as a further reducible risk factor.6– 8 Despite this finding, national and local advice given to mothers does not warn them that if they smoke, sharing a bed with their baby essentially increases the run a risk of SIDS.

The Wirral is a peninsula in northwest England with a population of 350 000 and around 3500 annual births. At the time of written report, less than i% of the population were from ethnic minorities and 27% of live births were to mothers living in the nigh deprived quartile of enumeration districts, with 22% in the least deprived quartile (unpublished data), equally determined by Townsend impecuniousness scores.9

In the knowledge that mothers who smoke on the Wirral were, until at present, not advised that bed sharing increases the risk of SIDS, we investigated its contribution to SIDS on the Wirral.

METHODS

Data were examined for each infant death where a postmortem had given sudden infant death syndrome every bit the cause of death between Jan 1995 and December 2000. Cases where a postmortem examination concluded that the cause of death was "unascertained" were included in the study to ensure that all available cases were analysed.

Information was obtained from ambulance coiffure reports, accident and emergency documentation, paediatric case notes, health visitor reports prior to death, the postmortem written report, and notes fabricated at the case discussion following expiry.

Each example give-and-take involved a consultant paediatrician, general practitioner, midwife, and the relevant health visitors.

For each instance the sleeping arrangements on the night of death were noted, as was the mother'southward smoking habit, and whether the female parent volunteered that booze or illicit drugs were taken around the time of expiry.

Townsend deprivation scores were assigned to each case according to postcode and were available for the rest of our population.

RESULTS

Between 1995 and 2000 at that place were 25 cases of SIDS on the Wirral, a rate of 1.2/1000 alive births. In nine of the cases the baby was found expressionless in bed with the mother, vii of whom were smokers. In four of these cases the mother reported taking booze before going to bed with her baby. In improver, ane mother reported taking a benzodiazepine before taking her infant to bed. In two further cases the infant was sleeping on the sofa with a parent.

Of the 14 cases where the infant was not found in the parental bed or on the sofa with a parent, 11 were infants of smoking mothers, and i mother reported consuming booze before going to bed. None of these mothers reported the employ of illicit drugs on the nighttime of their infant's expiry.

Fifteen of the 25 SIDS cases were from the most deprived quartile of Townsend impecuniousness scores, with just one case from the to the lowest degree deprived quartile.

DISCUSSION

Research in recent years has identified hazard factors for SIDS, some of which are potentially modifiable, and others which are non. The identification of modifiable risk factors is important in disease prevention and assists in the quest to understand the pathogenesis of SIDS. In U.k., SIDS rates have fallen dramatically since the "Dorsum to Sleep" campaign in 1991five in which parents were brash to place their babies on their backs to sleep with their feet at the bottom of the cot, to cut smoking in pregnancy and in the aforementioned room as their babe, to avoid overheating, and to seek medical advice if their baby becomes unwell.

The national incidence of SIDS (expressed per thou alive births) was 1.vii in 1990 and fell to 0.6 in 1995. In 1996 and 1997 the incidence of cot deaths rose for the first time in 8 years; an increase of 6 per cent to 0.7/thousand live births.10 Despite falling once again since 1997, the incidence of SIDS has not fallen beneath 0.v/thou live births.11 The reason for our disability to reduce the incidence of SIDS further is unknown. A major possibility, however, is that while we educate our mothers most the same adventure factors, not addressing others has resulted in an increment in their relative importance.

Three papers in recent years take highlighted bed sharing with mothers who fume every bit a risk factor for SIDS.half dozen– 8 Fleming et al showed that this chance was independent of socioeconomic variables and that smoking mothers who bed shared carried more than twice the take chances of SIDS compared to smoking mothers who did not.six Fleming et al reported that 26% of SIDS cases in 3 regions of England involved babies sharing a bed with their mothers, 86% of whom were smokers.vii Our written report on the Wirral reports even higher figures, with 36% of our SIDS cases occurring when the infants were sharing a bed with the female parent, 78% of whom were smokers.

The studies of Fleming and colleagues6, 7 also showed a much greater chance of SIDS if the bed sharing female parent had recently consumed over ii units of alcohol or if the babe slept on a sofa with 1 of the parents. They showed an association between previous use of illicit drugs and co-sleeping with SIDS just, unlike our report, information were not available for the use of such substances on the night of decease. In our study, 4 of the nine bed sharing mothers admitted to having consumed alcohol on the nighttime that death occurred, and i volunteered the use of illicit drugs. Consumption of alcohol or illicit drugs on the dark of death may be under-reported.

The express number of cases and lack of controls in this study would normally make interpretation difficult, but given that the study follows on from larger national case-control studies,v– 7 the findings can be put into context.

The incidence of SIDS on the Wirral betwixt 1995 and 2000 was one.2/k live births, twice the national incidence of 0.54–0.7/1000.10 This high incidence of SIDS on the Wirral is not confined to the period of study. The reason behind this is not certain, although local inspect suggests that well-nigh cases occur within pockets of extreme socioeconomic deprivation amidst the most deprived Townsend quartile of enumeration districts (unpublished data, H Klenka). That so many cases are from a deprived population is unsurprising given the results of the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) study.v

Sharing a bed with your infant if you smoke, or take consumed alcohol or illicit drugs, and sleeping with your baby on a sofa are now proven modifiable risk factors for SIDS. Despite this, national and, until recently, local communication given to parents does not inform them of these risks.

As a event of our findings, all "Child Health Record" books and "Reduce the Hazard" leaflets given to mothers on the Wirral now advises them of these additional risk factors. Midwives and health visitors have been alerted accordingly.

CONCLUSIONS

A significant proportion of SIDS cases on the Wirral between 1995 and 2000 involved the baby sleeping in the same bed as the mother, most of whom were smokers. It is time to recommend that mothers who fume do non share a bed with their baby. Similarly, mothers should be brash not to share a bed with their baby if they take consumed alcohol or illicit drugs, and under no circumstances should they sleep on a sofa with their baby.

Future studies volition reveal whether this modify in practice produces a reduction in the incidence of SIDS locally and the prevalence of bed sharing with mothers who smoke as a risk factor.

REFERENCES

  1. ↵

    Wigfield R, Fleming PJ. The prevalence of chance factors for SIDS: impact of an intervention campaign. In: Rognum TO, ed. Sudden babe death syndrome: new trends in the nineties. Oslo: Scandinavian University Printing, 1995:124–8.

  2. ↵

    Luke JL. Sleeping arrangements of sudden baby decease syndrome victims in the District of Columbia—a preliminary report. J Forensic Sci 1978;23:379–83.

  3. Klonoff-Cohen HS, Edelstein SL. Bed sharing and the sudden infant decease syndrome. BMJ 1995;311:1269–72.

  4. ↵

    Lee NNY, Chan YF, Davis DP, et al. Sudden infant death syndrome in Hong Kong: confirmation of a low incidence. BMJ 1989;298:721–2.

  5. ↵

    Section of Health. Confidential Enquiry into Stillbirths and Deaths in Infancy, 3rd Almanac Report. Executive summary and recommendations concentrating on the first two years of combined studies on sudden unexpected deaths in infancy. London: HMSO, 1996.

  6. ↵

    Blair PS, Fleming PJ, Smith IJ, et al. Babies sleeping with parents: instance-command written report of factors influencing the risk of the sudden infant expiry syndrome. BMJ 1999;319:1457–61.

  7. ↵

    Fleming PJ, Blair PS, Bacon C, et al. Environment of infants during sleep and risk of the sudden baby death syndrome: results of the 1993–v case-control study for confidential enquiry into stillbirths and deaths in infancy. BMJ 1996;313:191–5.

  8. ↵

    Mitchell EA, Tuohy PG, Burden JM, et al. Take chances factors for sudden infant decease syndrome post-obit the prevention campaign in New Zealand: a prospective study. Pediatrics 1997;100:835–40.

  9. ↵

    Townsend P, Philimore P, Beattie A. Health and deprivation: inequality and the North. London: Croom Helm, 1988.

  10. ↵

    Foundation for the Study of Infant Deaths. Cot deaths rise by 6 per cent. FSID News: Newsletter of the Foundation for the Study of Babe Deaths Spring 1998, Number 57:3.

  11. ↵

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Copyright 2003 Athenaeum of Disease in Babyhood