Sudden infant death syndrome risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Common risk factors in the development of SIDS include maternal factors such as age of the mother, smoking history, and prenatal care history, environmental factors which include preterm birth, prone sleeping position, bed-sharing, and overheating.

Risk Factors

Common Risk Factors

Common risk factors in the development of SIDS may be seen more often in mothers who are younger, less educated, and nonwhite, and smoked during the pregnancy.
Common risk factors in the development of Sudden infant death syndrome (SIDS) include:^[1]^[2]^[3]^[4]

Maternal risk factors

Maternal factors which include the following:
- Maternal age:
  - Mother who are very young in age are more prone to have SIDS conditions
- Maternal smoking:
  - Smoking during pregnancy increases the risk of SIDS
- Placental abnormalities:
  - Placental abnormalities which include placenta previa, abruptio placentae, premature rupture of membranes or small for gestational age increases the risk of SIDS
- Prenatal care:
  - Mothers who did not attend prenatal care are at risk of SIDS

Infant risk factors

Infant risk factors which include the following:
- Prematurity
  - When compare to term infants premature infants have higher risk of developing SIDS.^[5]^[6]^[7]
- Low birth weight
  - The risk of developing SIDS in low to very low weight infants is four times higher than normal birth weight infants^[8]
  - Gestational hypertension with smoking are associated very highly with low birth weight
- Sibling of SIDS
  - Due to biologic and/or epidemiological influence the risk of developing SIDS in siblings of SIDS infants is increased to sixfold^[9]^[10]
  - But often deaths that are related to inborn errors of metabolism and child abuse are mistaken as SIDS
- Twins
  - The risk of developing SIDS in twins is almost double than normal population
  - The risk of developing SIDS in twins in according with gestational age ≥37 weeks as follows:
    - Relative risk (RR) of SIDS is 1.31- Gestational age 37 to 38 weeks
    - Relative risk (RR) of SIDS is 1.47- Gestational age 39 to 40 weeks
    - Relative risk (RR) of SIDS is 2.09- Gestational age ≥41 weeks
- History of apnea of the infant
  - History of apnea of the infant or cyanosis is not necessarily increase the risk of SIDS.
  - Before death they are reports that the infant may become cyanotic by the SIDS victim parents.
- Sleep position of the infant
  - One of the strongest risk factors for developing SIDS is corresponding to the sleep position of the infant
  - Prone sleeping position of the infant is the the most important and vulnerable position for the infant to develop SIDS.
  - If possible try to avoid side positioning of the infant as this position might lead to the prone position and that in turn leads to the SIDS.
  - Supine positioning of the infant for every sleep of every day and every time decreases the risk of developing SIDS.
- Sleep environment of the infant^[11]^[12]^[13]
  - The following sleep environments increases the risk of developing SIDS in an infant :
    - Soft sleeping surface
      - One of the consistent risk factor for SIDS is using soft sleeping surface and the risk of developing SIDS increases when the infant is in prone position.^[14]
      - Soft cot mattresses should be avoided to prevent SIDS
    - Loose bedding accessories
      - Loose bedding accessories increases the risk of developing SIDS to maximum to fivefold and the accessories included the following :
        Blankets
        
        Quilts
        
        Pillows
        
        Stuffed toys
      - Waterproof wool underblanket reduces the risk of risk of SIDS^[15]
    - Crib bumper pads^[16]^[17]
      - According to AAP, US Consumer Product Safety Commission (CPSC) and Canadian Paediatric Society crib bumper pads and bassinet bumpers are banned from using due to increased risk of suffocation of the infant and leads to SIDS
    - Bed-sharing^[18]
      - According to the new studies there is an increased risk or an association when the infant sleeps with the parents and developing SIDS.^[19]^[20]^[21]
      - The risk of developing SIDS increases with bed sharing whose age is younger than three months of the infant or for infants of mothers who smoke.^[22]
      - Parents who are sleeping on a sofa along with the infants should be avoided and this decreases the risk of developing SIDS.^[23]
    - Car safety seats and other sitting or inclined rocking devices
      - In car due to the sitting position of the infant where the oxygenation decreases increases the risk of SIDS.
    - Overheating
      - Using more than 2 blankets or using more clotting or increased in the room temperature increases the risk of SIDS.

Overheating is one of the chief risk factors for SIDS. Parents should dress their babies warmly but not go overboard with clothing and blankets. Case courtesy by Carrie Arnold ^[24]

- - - Swaddling
      - The risk of developing SIDS with swaddling increases especially in older infants.^[25]^[26]^[27]
The risk of developing SIDS with swaddling doubles when the infant is not placed in a supine position during sleep.

References

↑ MacDorman MF, Cnattingius S, Hoffman HJ, Kramer MS, Haglund B (1997). "Sudden infant death syndrome and smoking in the United States and Sweden". Am J Epidemiol. 146 (3): 249–57. doi:10.1093/oxfordjournals.aje.a009260. PMID 9247009.
↑ Carpenter RG, Irgens LM, Blair PS, England PD, Fleming P, Huber J; et al. (2004). "Sudden unexplained infant death in 20 regions in Europe: case control study". Lancet. 363 (9404): 185–91. doi:10.1016/s0140-6736(03)15323-8. PMID 14738790.
↑ Malloy MH, Hoffman HJ, Peterson DR (1992). "Sudden infant death syndrome and maternal smoking". Am J Public Health. 82 (10): 1380–2. doi:10.2105/ajph.82.10.1380. PMC 1695879. PMID 1415865.
↑ Getahun D, Amre D, Rhoads GG, Demissie K (2004). "Maternal and obstetric risk factors for sudden infant death syndrome in the United States". Obstet Gynecol. 103 (4): 646–52. doi:10.1097/01.AOG.0000117081.50852.04. PMID 15051553.
↑ Ostfeld BM, Schwartz-Soicher O, Reichman NE, Teitler JO, Hegyi T (2017). "Prematurity and Sudden Unexpected Infant Deaths in the United States". Pediatrics. 140 (1). doi:10.1542/peds.2016-3334. PMID 28759397.
↑ Malloy MH, Hoffman HJ (1995). "Prematurity, sudden infant death syndrome, and age of death". Pediatrics. 96 (3 Pt 1): 464–71. PMID 7651779.
↑ Thompson JM, Mitchell EA, New Zealand Cot Death Study Group (2006). "Are the risk factors for SIDS different for preterm and term infants?". Arch Dis Child. 91 (2): 107–11. doi:10.1136/adc.2004.071167. PMC 2082673. PMID 15871984.
↑ Bigger HR, Silvestri JM, Shott S, Weese-Mayer DE (1998). "Influence of increased survival in very low birth weight, low birth weight, and normal birth weight infants on the incidence of sudden infant death syndrome in the United States: 1985-1991". J Pediatr. 133 (1): 73–8. doi:10.1016/s0022-3476(98)70181-7. PMID 9672514.
↑ Guntheroth WG, Lohmann R, Spiers PS (1990). "Risk of sudden infant death syndrome in subsequent siblings". J Pediatr. 116 (4): 520–4. doi:10.1016/s0022-3476(05)81596-3. PMID 2319397.
↑ Oyen N, Skjaerven R, Irgens LM (1996). "Population-based recurrence risk of sudden infant death syndrome compared with other infant and fetal deaths". Am J Epidemiol. 144 (3): 300–5. doi:10.1093/oxfordjournals.aje.a008925. PMID 8686699.
↑ Erck Lambert AB, Parks SE, Cottengim C, Faulkner M, Hauck FR, Shapiro-Mendoza CK (2019). "Sleep-Related Infant Suffocation Deaths Attributable to Soft Bedding, Overlay, and Wedging". Pediatrics. 143 (5). doi:10.1542/peds.2018-3408. PMC 6637427 Check |pmc= value (help). PMID 31010907.
↑ Scheers NJ, Dayton CM, Kemp JS (1998). "Sudden infant death with external airways covered: case-comparison study of 206 deaths in the United States". Arch Pediatr Adolesc Med. 152 (6): 540–7. doi:10.1001/archpedi.152.6.540. PMID 9641706.
↑ TASK FORCE ON SUDDEN INFANT DEATH SYNDROME (2016). "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment". Pediatrics. 138 (5). doi:10.1542/peds.2016-2938. PMID 27940804.
↑ Mitchell EA, Scragg L, Clements M (1996). "Soft cot mattresses and the sudden infant death syndrome". N Z Med J. 109 (1023): 206–7. PMID 8668299.
↑ Wilson CA, Taylor BJ, Laing RM, Williams SM, Mitchell EA (1994). "Clothing and bedding and its relevance to sudden infant death syndrome: further results from the New Zealand Cot Death Study". J Paediatr Child Health. 30 (6): 506–12. doi:10.1111/j.1440-1754.1994.tb00722.x. PMID 7865263.
↑ Thach BT, Rutherford GW, Harris K (2007). "Deaths and injuries attributed to infant crib bumper pads". J Pediatr. 151 (3): 271–4, 274.e1–3. doi:10.1016/j.jpeds.2007.04.028. PMID 17719936.
↑ Scheers NJ, Woodard DW, Thach BT (2016). "Crib Bumpers Continue to Cause Infant Deaths: A Need for a New Preventive Approach". J Pediatr. 169: 93–7.e1. doi:10.1016/j.jpeds.2015.10.050. PMID 26621044.
↑ Ruys JH, de Jonge GA, Brand R, Engelberts AC, Semmekrot BA (2007). "Bed-sharing in the first four months of life: a risk factor for sudden infant death". Acta Paediatr. 96 (10): 1399–403. doi:10.1111/j.1651-2227.2007.00413.x. PMID 17714547.
↑ Blair PS, Fleming PJ, Smith IJ, Platt MW, Young J, Nadin P; et al. (1999). "Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. CESDI SUDI research group". BMJ. 319 (7223): 1457–61. doi:10.1136/bmj.319.7223.1457. PMC 28288. PMID 10582925.
↑ Tappin D, Ecob R, Brooke H (2005). "Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: a case-control study". J Pediatr. 147 (1): 32–7. doi:10.1016/j.jpeds.2005.01.035. PMID 16027691.
↑ Vennemann MM, Hense HW, Bajanowski T, Blair PS, Complojer C, Moon RY; et al. (2012). "Bed sharing and the risk of sudden infant death syndrome: can we resolve the debate?". J Pediatr. 160 (1): 44–8.e2. doi:10.1016/j.jpeds.2011.06.052. PMID 21868032. Review in: Evid Based Nurs. 2012 Oct;15(4):115-6
↑ Lahr MB, Rosenberg KD, Lapidus JA (2005). "Bedsharing and maternal smoking in a population-based survey of new mothers". Pediatrics. 116 (4): e530–42. doi:10.1542/peds.2005-0354. PMID 16199682.
↑ Horsley T, Clifford T, Barrowman N, Bennett S, Yazdi F, Sampson M; et al. (2007). "Benefits and harms associated with the practice of bed sharing: a systematic review". Arch Pediatr Adolesc Med. 161 (3): 237–45. doi:10.1001/archpedi.161.3.237. PMID 17339504. Review in: Evid Based Nurs. 2007 Oct;10(4):119
↑ "New Risk Factor for SIDS? Peaks in Cot Deaths Associated with Heat Waves".
↑ Pease AS, Fleming PJ, Hauck FR, Moon RY, Horne RS, L'Hoir MP; et al. (2016). "Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis". Pediatrics. 137 (6). doi:10.1542/peds.2015-3275. PMID 27244847.
↑ Richardson HL, Walker AM, Horne RS (2010). "Influence of swaddling experience on spontaneous arousal patterns and autonomic control in sleeping infants". J Pediatr. 157 (1): 85–91. doi:10.1016/j.jpeds.2010.01.005. PMID 20227720.
↑ Richardson HL, Walker AM, Horne RS (2009). "Minimizing the risks of sudden infant death syndrome: to swaddle or not to swaddle?". J Pediatr. 155 (4): 475–81. doi:10.1016/j.jpeds.2009.03.043. PMID 19540517.

Template:WH Template:WS

[pmid9247009-1] MacDorman MF, Cnattingius S, Hoffman HJ, Kramer MS, Haglund B (1997). "Sudden infant death syndrome and smoking in the United States and Sweden". Am J Epidemiol. 146 (3): 249–57. doi:10.1093/oxfordjournals.aje.a009260. PMID 9247009.

[pmid14738790-2] Carpenter RG, Irgens LM, Blair PS, England PD, Fleming P, Huber J; et al. (2004). "Sudden unexplained infant death in 20 regions in Europe: case control study". Lancet. 363 (9404): 185–91. doi:10.1016/s0140-6736(03)15323-8. PMID 14738790.

[pmid1415865-3] Malloy MH, Hoffman HJ, Peterson DR (1992). "Sudden infant death syndrome and maternal smoking". Am J Public Health. 82 (10): 1380–2. doi:10.2105/ajph.82.10.1380. PMC 1695879. PMID 1415865.

[pmid15051553-4] Getahun D, Amre D, Rhoads GG, Demissie K (2004). "Maternal and obstetric risk factors for sudden infant death syndrome in the United States". Obstet Gynecol. 103 (4): 646–52. doi:10.1097/01.AOG.0000117081.50852.04. PMID 15051553.

[pmid28759397-5] Ostfeld BM, Schwartz-Soicher O, Reichman NE, Teitler JO, Hegyi T (2017). "Prematurity and Sudden Unexpected Infant Deaths in the United States". Pediatrics. 140 (1). doi:10.1542/peds.2016-3334. PMID 28759397.

[pmid7651779-6] Malloy MH, Hoffman HJ (1995). "Prematurity, sudden infant death syndrome, and age of death". Pediatrics. 96 (3 Pt 1): 464–71. PMID 7651779.

[pmid15871984-7] Thompson JM, Mitchell EA, New Zealand Cot Death Study Group (2006). "Are the risk factors for SIDS different for preterm and term infants?". Arch Dis Child. 91 (2): 107–11. doi:10.1136/adc.2004.071167. PMC 2082673. PMID 15871984.

[pmid9672514-8] Bigger HR, Silvestri JM, Shott S, Weese-Mayer DE (1998). "Influence of increased survival in very low birth weight, low birth weight, and normal birth weight infants on the incidence of sudden infant death syndrome in the United States: 1985-1991". J Pediatr. 133 (1): 73–8. doi:10.1016/s0022-3476(98)70181-7. PMID 9672514.

[pmid2319397-9] Guntheroth WG, Lohmann R, Spiers PS (1990). "Risk of sudden infant death syndrome in subsequent siblings". J Pediatr. 116 (4): 520–4. doi:10.1016/s0022-3476(05)81596-3. PMID 2319397.

[pmid8686699-10] Oyen N, Skjaerven R, Irgens LM (1996). "Population-based recurrence risk of sudden infant death syndrome compared with other infant and fetal deaths". Am J Epidemiol. 144 (3): 300–5. doi:10.1093/oxfordjournals.aje.a008925. PMID 8686699.

[pmid31010907-11] Erck Lambert AB, Parks SE, Cottengim C, Faulkner M, Hauck FR, Shapiro-Mendoza CK (2019). "Sleep-Related Infant Suffocation Deaths Attributable to Soft Bedding, Overlay, and Wedging". Pediatrics. 143 (5). doi:10.1542/peds.2018-3408. PMC 6637427 Check |pmc= value (help). PMID 31010907.

[pmid9641706-12] Scheers NJ, Dayton CM, Kemp JS (1998). "Sudden infant death with external airways covered: case-comparison study of 206 deaths in the United States". Arch Pediatr Adolesc Med. 152 (6): 540–7. doi:10.1001/archpedi.152.6.540. PMID 9641706.

[pmid27940804-13] TASK FORCE ON SUDDEN INFANT DEATH SYNDROME (2016). "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment". Pediatrics. 138 (5). doi:10.1542/peds.2016-2938. PMID 27940804.

[pmid8668299-14] Mitchell EA, Scragg L, Clements M (1996). "Soft cot mattresses and the sudden infant death syndrome". N Z Med J. 109 (1023): 206–7. PMID 8668299.

[pmid7865263-15] Wilson CA, Taylor BJ, Laing RM, Williams SM, Mitchell EA (1994). "Clothing and bedding and its relevance to sudden infant death syndrome: further results from the New Zealand Cot Death Study". J Paediatr Child Health. 30 (6): 506–12. doi:10.1111/j.1440-1754.1994.tb00722.x. PMID 7865263.

[pmid17719936-16] Thach BT, Rutherford GW, Harris K (2007). "Deaths and injuries attributed to infant crib bumper pads". J Pediatr. 151 (3): 271–4, 274.e1–3. doi:10.1016/j.jpeds.2007.04.028. PMID 17719936.

[pmid26621044-17] Scheers NJ, Woodard DW, Thach BT (2016). "Crib Bumpers Continue to Cause Infant Deaths: A Need for a New Preventive Approach". J Pediatr. 169: 93–7.e1. doi:10.1016/j.jpeds.2015.10.050. PMID 26621044.

[pmid17714547-18] Ruys JH, de Jonge GA, Brand R, Engelberts AC, Semmekrot BA (2007). "Bed-sharing in the first four months of life: a risk factor for sudden infant death". Acta Paediatr. 96 (10): 1399–403. doi:10.1111/j.1651-2227.2007.00413.x. PMID 17714547.

[pmid10582925-19] Blair PS, Fleming PJ, Smith IJ, Platt MW, Young J, Nadin P; et al. (1999). "Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. CESDI SUDI research group". BMJ. 319 (7223): 1457–61. doi:10.1136/bmj.319.7223.1457. PMC 28288. PMID 10582925.

[pmid16027691-20] Tappin D, Ecob R, Brooke H (2005). "Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: a case-control study". J Pediatr. 147 (1): 32–7. doi:10.1016/j.jpeds.2005.01.035. PMID 16027691.

[pmid21868032-21] Vennemann MM, Hense HW, Bajanowski T, Blair PS, Complojer C, Moon RY; et al. (2012). "Bed sharing and the risk of sudden infant death syndrome: can we resolve the debate?". J Pediatr. 160 (1): 44–8.e2. doi:10.1016/j.jpeds.2011.06.052. PMID 21868032. Review in: Evid Based Nurs. 2012 Oct;15(4):115-6

[pmid16199682-22] Lahr MB, Rosenberg KD, Lapidus JA (2005). "Bedsharing and maternal smoking in a population-based survey of new mothers". Pediatrics. 116 (4): e530–42. doi:10.1542/peds.2005-0354. PMID 16199682.

[pmid17339504-23] Horsley T, Clifford T, Barrowman N, Bennett S, Yazdi F, Sampson M; et al. (2007). "Benefits and harms associated with the practice of bed sharing: a systematic review". Arch Pediatr Adolesc Med. 161 (3): 237–45. doi:10.1001/archpedi.161.3.237. PMID 17339504. Review in: Evid Based Nurs. 2007 Oct;10(4):119

[24] "New Risk Factor for SIDS? Peaks in Cot Deaths Associated with Heat Waves".

[pmid27244847-25] Pease AS, Fleming PJ, Hauck FR, Moon RY, Horne RS, L'Hoir MP; et al. (2016). "Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis". Pediatrics. 137 (6). doi:10.1542/peds.2015-3275. PMID 27244847.

[pmid20227720-26] Richardson HL, Walker AM, Horne RS (2010). "Influence of swaddling experience on spontaneous arousal patterns and autonomic control in sleeping infants". J Pediatr. 157 (1): 85–91. doi:10.1016/j.jpeds.2010.01.005. PMID 20227720.

[pmid19540517-27] Richardson HL, Walker AM, Horne RS (2009). "Minimizing the risks of sudden infant death syndrome: to swaddle or not to swaddle?". J Pediatr. 155 (4): 475–81. doi:10.1016/j.jpeds.2009.03.043. PMID 19540517.

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