title: Postnatal parental smoking: an important risk factor for SIDS.
abstract: BACKGROUND
  Sudden infant death syndrome (SIDS) is the unexpected death of an infant that remains unexplained after a thorough investigation of the circumstances, family history, paediatric investigation and complete autopsy. In Western society, it is the leading cause of post-neonatal death below 1 year of age. In the Netherlands, the SIDS incidence is very low, which offers opportunities to assess the importance of old and new environmental risk factors. For this purpose, cases were collected through pathology departments and the working group on SIDS of the Dutch Paediatrician Foundation. A total of 142 cases were included; these occurred after the parental education on sleeping position (1987), restricted to the international age criteria and had no histological explanation. Age-matched healthy controls (N = 2,841) came from a survey of the Netherlands Paediatric Surveillance Unit, completed between November 2002 and April 2003. A multivariate analysis was performed to determine the risk factors for SIDS, including sleeping position, antenatal maternal smoking, postnatal parental smoking, premature birth, gender, lack of breastfeeding and socio-economic status. Postnatal smoking was identified as an important environmental risk factor for SIDS (OR one parent = 2.5 [1.2, 5.0]; both parents = 5.77 [2.2, 15.5]; maternal = 2.7 [1.0, 6.4]; paternal = 2.4 [1.3, 4.5] ) as was prone sleeping (OR put prone to sleep = 21.5 [10.6, 43.5]; turned prone during sleep = 100 [46, 219]). Premature birth was also significantly associated with SIDS (OR = 2.4 [1.2, 4.8]).
  
  
  CONCLUSIONS
  Postnatal parental smoking is currently a major environmental risk factor for SIDS in the Netherlands together with the long-established risk of prone sleeping.
authors.affiliation: Department of Forensic Molecular Biology, Erasmus MC University Medical Center Rotterdam, 2040, 3000 CA, Rotterdam, The Netherlands. g.akkerman@erasmusmc.nl
authors.forename: Germaine
authors.initials: G
authors.lastname: Liebrechts-Akkerman
authors.forename: Oscar
authors.initials: O
authors.lastname: Lao
authors.forename: Fan
authors.initials: F
authors.lastname: Liu
authors.forename: Bregje E
authors.initials: BE
authors.lastname: van Sleuwen
authors.forename: Adèle C
authors.initials: AC
authors.lastname: Engelberts
authors.forename: Monique P
authors.initials: MP
authors.lastname: L'hoir
authors.forename: Henning W
authors.initials: HW
authors.lastname: Tiemeier
authors.forename: Manfred
authors.initials: M
authors.lastname: Kayser
mesh_terms: D000465:Algorithms; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D010290:Parents; D049590:Postpartum Period; D011203:Poverty; D016684:Prone Position; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013398:Sudden Infant Death / Q000453:epidemiology / Q000209:etiology*; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
chemical_list: D014028:Tobacco Smoke Pollution