Vaccination News Home Page

http://www.pediatrics.org/cgi/content/abstract/110/4/772

One of the questions that begs to be asked and answered is why infants on their stomachs might be at increased risk for SIDS. - SM

Full Text of this Article Reprint (PDF) Version of this Article P3Rs: Submit a response to this article Similar articles found in: Pediatrics Online PubMed PubMed Citation Search Medline for articles by: Hauck, F. R. || Rowley, D. Alert me when: new articles cite this article   Download to Citation Manager

Collections under which this article appears: Office Practice

PEDIATRICS Vol. 110 No. 4 October 2002, pp. 772-780

 

The Contribution of Prone Sleeping Position to the Racial Disparity in Sudden Infant Death Syndrome: The Chicago Infant Mortality Study

Fern R. Hauck, MD, MS^*, Cathryn Merrick Moore, CDA^*, Stanislaw M. Herman, PhD^*, Mark Donovan, MS^*, Mitra Kalelkar, MD, Katherine Kaufer Christoffel, MD, MPH, Howard J. Hoffman, MA^¶ and Diane Rowley, MD, MPH^||

^* Department of Family Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Office of the Medical Examiner of Cook County, Chicago, Illinois
Children’s Memorial Hospital and Departments of Pediatrics and Preventive Medicine, Northwestern University Medical School, Chicago, Illinois
^¶ Epidemiology, Statistics and Data Systems Branch, National Institute on Deafness and Other Communication Disorders, Bethesda, Maryland
^|| Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia

Background. Rates of sudden infant death syndrome (SIDS) are over twice as high among African Americans compared with Caucasians. Little is known, however, about the relationship between prone sleeping, other sleep environment factors, and the risk of SIDS in the United States and how differences in risk factors may account for disparities in mortality.

Objective. To assess the contribution of prone sleeping position and other potential risk factors to SIDS risk in a primarily high-risk, urban African American population.

Design, Setting, and Population. Case-control study consisting of 260 infants ages birth to 1 year who died of SIDS between November 1993 and April 1996. The control group consists of an equal number of infants matched on race, age, and birth weight. Prospectively collected data from the death scene investigation and a follow-up home interview for case infants were compared with equivalent questions for living control participants to identify risk factors for SIDS.

Main Outcome Measures. Risk of SIDS related to prone sleeping position adjusting for potential confounding variables and other risk factors for SIDS, and comparisons by race-ethnicity.

Results. Three quarters of the SIDS infants were African American. There was more than a twofold increased risk of SIDS associated with being placed prone for last sleep compared with the nonprone positions (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.6–3.7). This OR increased after adjusting for potential confounding variables and other sleep environment factors (OR: 4.0; 95% CI: 1.8–8.8). Differences were found for African Americans compared with others (OR: 1.8; 95% CI: 1.2–2.6 and OR: 10.3, 95% CI: 10.3 [3.2–33.8, respectively]). The population attributable risk was 31%. Fewer case mothers (46%) than control mothers (64%) reported being advised about sleep position in the hospital after delivery. Of those advised, a similar proportion of case mothers as control mothers were incorrectly told or recalled being told to use the prone position, but prone was recommended in a higher proportion of black mothers (cases and controls combined) compared with nonblack mothers.

Conclusions. Prone sleeping was found to be a significant risk factor for SIDS in this primarily African American urban sample, and approximately one third of the SIDS deaths could be attributed to this factor. Greater and more effective educational outreach must be extended to African American families and the health personnel serving them to reduce prone prevalence during sleep, which appears, in part, to contribute to the higher rates of SIDS among African American infants.

Key Words: sudden infant death • infant care • African Americans • sleep

Abbreviations: SIDS, sudden infant death syndrome • OR, odds ratio • CI, confidence interval • SD, standard deviation

Received for publication Aug 14, 2000; accepted Apr 26, 2002.

Copyright © 2002 by the American Academy of Pediatrics. [Disclaimer]

Vaccination News Home Page

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.