Milwaukee Journal Sentinel

Two decades of data collected by a team of British scientists indicates the importance of factors most likely to contribute to sudden infant death syndrome, or SIDS, have changed over time.

Two factors rose to the surface: Sleeping with an infant on a couch is one of the most worrisome and dangerous new concerns; and most SIDS deaths appear to occur in low-income families.

The results were based on a 20-year, population-based study of all unexpected deaths in Avon, England.

The researchers collected data on 369 unexpected infant deaths between 1984 and 2003. Unexpected deaths were defined as those not expected in the 24 hours before the death or before the collapse that led to death. Two hundred of these deaths were classified as SIDS, while the others were judged to have been the consequence of unrecognized infection, accidental or non-accidental injury, congenital malformations or metabolic disorders.

Since 1991, the number of SIDS deaths has decreased by 75 percent in the United Kingdom.

Of children who died of SIDS, the new report found that the proportion of those who died while sleeping with their parents had risen from 12 percent to 50 percent. However, the actual number of SIDS deaths in the parental bed was halved over this period, from a median of four deaths a year from 1984 to 1991, to two from 1992 to 2003.

The authors write that the proportional increase may be an artifact of a “Back to Sleep” campaign. As fewer infants died sleeping alone on their backs, the proportion of babies who died co-sleeping, or sleeping with a parent, increased.

The rise was also due to the number of infants who died while co-sleeping on couches, which rose fourfold over the two decades.

In 1991, the United Kingdom began a national “Back to Sleep” campaign that urged parents to lay their babies on their backs to sleep and to keep items out of the crib that could cause suffocation.

The 75 percent drop in SIDS deaths since the campaign was launched is partly the result of the change in parental behavior – safeguarding their children from SIDS – that led to the new observations made by the team.

The team found that the risk of SIDS is higher for male, pre-term and low-birth-weight infants, and those sleeping on their sides or bellies, observations that have been made before. It also found that smoking during pregnancy and infants exposed to secondary smoke were risks; again, those risks had already been established.

Curiously, they found that while firstborns were previously seen as less likely to die of SIDS, they now form the largest single group of SIDS deaths. Speculation was not offered as to why.

In a statement, Peter Fleming, lead author of the study and a researcher at the Royal Hospital for Children in Bristol, said that “although the reasons for the rise in deaths when a parent sleeps with their infant on a sofa are unclear, we strongly recommend that parents avoid this sleeping environment.”

The number of deaths of infants on sofas in the U.K. rose fourfold during this period. He added that if deaths related to sofas are excluded, the number of babies dying while in bed with their parents fell by 50 percent.

The American Association of Pediatrics recommends that babies be put to sleep on their backs, in their own beds, with a pacifier to safeguard against SIDS.

Fleming added that “SIDS is now largely confined to deprived families.”

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(c) 2006, Milwaukee Journal Sentinel.

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AP-NY-01-19-06 0622EST

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