title: Thermal environment and sudden infant death syndrome: case-control study.
abstract: OBJECTIVE
  To compare the thermal environment of infants who died of the sudden infant death syndrome with that of age matched control infants.
  
  
  METHODS
  Case-control study. Infants who died were matched with two controls, one for age and one for age and birth weight. Thermal measurements were conducted at the death scene for cases and at the scene of last sleep for control infants, who were visited unexpectedly within four weeks of the index infant's death on a day of similar climatic conditions. A follow up questionnaire was administered to parents of cases and controls.
  
  
  METHODS
  The geographical area served by the professional Tasmanian state ambulance service, which includes 94% of the Tasmanian population.
  
  
  METHODS
  41 infants died of the sudden infant death syndrome at home; thermal observations at death scene were available for 28 (68%), parental questionnaire data were available for 40 (96%). 38 controls matched for age and 41 matched for age and birth weight.
  
  
  RESULTS
  Cases had more excess thermal insulation for their given room temperature (2.3 togs) than matched controls (0.6 togs) (p = 0.009). For every excess thermal insulation unit (tog) the relative risk of the sudden infant death syndrome was 1.26 (95% confidence interval 1.05 to 1.52). The average thermal bedding value calculated from parental recall was similar to that observed by attendant ambulance officers (mean difference = 0.4 tog, p = 0.39). Cases were more likely to have been found prone (odds ratio 4.58; 1.48 to 14.11). Prone sleeping position was not a confounder or effect modifier of the relation between excess thermal insulation and the syndrome.
  
  
  CONCLUSIONS
  Overheating and the prone sleeping position are independently associated with an increased risk of the sudden infant death syndrome. Further work on infant thermal balance and sudden infant death is required and guidelines for appropriate infant thermal care need to be developed.
authors.affiliation: Menzies Centre for Population Health Research, University of Tasmania, Hobart, Australia.
authors.forename: A L
authors.initials: AL
authors.lastname: Ponsonby
authors.forename: T
authors.initials: T
authors.lastname: Dwyer
authors.forename: L E
authors.initials: LE
authors.lastname: Gibbons
authors.forename: J A
authors.initials: JA
authors.lastname: Cochrane
authors.forename: M E
authors.initials: ME
authors.lastname: Jones
authors.forename: M J
authors.initials: MJ
authors.lastname: McCall
mesh_terms: D001512:Bedding and Linens; D001831:Body Temperature / Q000502:physiology; D001903:Bottle Feeding; D016022:Case-Control Studies; D003020:Clothing / Q000009:adverse effects*; D005334:Fever / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016017:Odds Ratio; D016684:Prone Position / Q000502:physiology; D012307:Risk Factors; D012890:Sleep / Q000502:physiology; D013398:Sudden Infant Death / Q000453:epidemiology / Q000209:etiology*; D013648:Tasmania / Q000453:epidemiology; D013696:Temperature