Article Text

  1. D. R. Halloran,
  2. G. R. Alexander,
  3. M. M. Adams
  1. Birmingham, AL.


Background Sudden infant death syndrome (SIDS) remains the leading cause of postneonatal death in the United States, accounting for more than 2000 infant deaths each year. While the SIDS rate decreased from 1.3 per 1000 infants in 1991 to 0.7 in 2000, rates of prone sleep position and preterm birth increased. The purpose of this study was to identify changes in traditional risk factors for SIDS following this epidemiologic transition in the mid-1990s and assess the current relationship between preterm birth and SIDS.

Design/Methods The study cohort included all singleton, live infants born to US residents from 1996 through 1998. National linked infant birth and death files provided data for the analysis. We used multivariable logistic regression to obtain adjusted odds ratios (OR) and confidence intervals (CI) for SIDS with the following variables in the model: maternal race/ethnicity, education, age, marital status, initiation of prenatal care, smoking, alcohol use, diabetes, hypertension, parity, infant gender, region of birth, fetal growth, and gestational age. Unlike previous studies, when analyzing length of gestation, we controlled for birthweight.

Results We identified 8,199 cases of SIDS, with a rate of 0.72 per 1000 live births. The magnitude and direction of adjusted ORs did not appreciably differ from those reported in analyses of national data from the early 1990s for race, education, age, marital status, gender, smoking, alcohol use, and region of birth. Small for gestational age infants (< 10th%) were at higher risk (1.6, 95% CI 1.5, 1.7) while large for gestational age infants (> 90th%) were at lower risk (0.7, 95% CI 0.6, 0.8) than average infants. The highest odds ratio was for women with 5 or more pregnancies (3.3, 95% CI 2.9, 3.8) compared to women with a first pregnancy. The adjusted gestational-age-specific ORs were greatest at the shortest gestations and diminished as length of gestation increased (Table).

Conclusions Traditional risk factors for SIDS remain unchanged following the epidemiologic transition of the mid-1990s. Preterm delivery continues to be a risk factor for SIDS even after adjusting for birthweight. Clinicians caring for premature infants must counsel families regarding SIDS prevention.

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