Environment of infants during sleep and risk of the sudden infant death syndrome: results of 1993-5 case-control study for confidential inquiry into stillbirths and deaths in infancy. Confidential Enquiry into Stillbirths and Deaths Regional Coordinators and Researchers.
OBJECTIVE
To investigate the role of sleeping arrangements as risk factors for the sudden infant death syndrome after a national risk reduction campaign.


METHODS
Two year population based case-control study. Parental interviews were conducted for each infant who died and for four controls matched for age and date of interview.


METHODS
Three regions in England with a total population of 17 million people.


METHODS
195 babies who died and 780 matched controls.


RESULTS
Prone and side sleeping positions both carried increased risks of death compared with supine when adjusted for maternal age, parity, gestation, birth weight, exposure to smoke, and other relevant factors in the sleeping environment (multivariate odds ratio = 9.00 (95% confidence interval 2.84 to 28.47) and 1.84 (1.02 to 3.31), respectively). The higher incidence of side rather than prone sleeping led to a higher population attributable risk (side 18.4%, prone 14.2%). More of the infants who died were found with bed covers over their heads (21.58; 6.21 to 74.99). The use of a dummy had an apparent protective effect (0.38; 0.21 to 0.70). Bed sharing for the whole night was a significant risk factor for infants whose mothers smoked (9.25; 2.31 to 34.02). No protective effect of breast feeding could be identified on multivariate analysis.


CONCLUSIONS
This study confirms the importance of certain risk factors for the sudden infant death syndrome and identifies others-for example, covers over the head, side sleeping position-which may be amenable to change by educating and informing parents and health care professionals.
Fleming
P J
PJ
Foundation for the Study of Infant Deaths Research Unit, Royal Hospital for Sick Children, Bristol.
Blair
P S
PS
Bacon
C
C
Bensley
D
D
Smith
I
I
Taylor
E
E
Berry
J
J
Golding
J
J
Tripp
J
J
D001512:Bedding and Linens; D001942:Breast Feeding; D016022:Case-Control Studies; D002669:Child Welfare; D004739:England / Q000453:epidemiology; D006306:Health Surveys; D006358:Hot Temperature; D006801:Humans; D007223:Infant; D007224:Infant Care; D007231:Infant, Newborn; D015999:Multivariate Analysis; D011187:Posture; D016684:Prone Position; D012307:Risk Factors; D012890:Sleep / Q000502:physiology*; D013398:Sudden Infant Death / Q000209:etiology*