Edwin A Mitchell1, John Md Thompson2, Jane Zuccollo3, Melanie MacFarlane4, Barry Taylor5, Dawn Elder6, Alistair W Stewart7, Teuila Percival8, Nick Baker9, Gabrielle K McDonald10, Bev Lawton11, Martin Schlaud12, Peter Fleming13. 1. Professorial Research Fellow, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland. 2. Epidemiologist/Statistician, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland. 3. Perinatal Pathologist, Department of Obstetrics and Gynaecology, University of Otago, Wellington. 4. Project Manager, Communio, Auckland. 5. Dean, Department of the Dean, Dunedin School of Medicine, University of Otago, Dunedin. 6. Professor and HOD, Department of Paediatrics and Child Health, University of Otago, Wellington. 7. Biostatistician, Section of Epidemiology & Biostatistics, School of Population Health, University of Auckland, Auckland. 8. Senior Lecturer, Pacific Health Section, School of Population Health, University of Auckland, Auckland. 9. Paediatrician, Nelson Hospital, Nelson. 10. Senior Lecturer, Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin. 11. Senior Research Fellow, Department of Obstetrics and Gynaecology: Women's Health Research Centre, University of Otago, Wellington. 12. Professor of Epidemiology, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany. 13. Professor of Infant Health and Developmental Physiology, School of Social and Community Medicine, University of Bristol, Bristol, England.
Abstract
BACKGROUND: Despite a major reduction in overall infant mortality, sudden unexpected death in infancy (SUDI) continues to be of concern in New Zealand, as the rate is high by international standards, and is even higher in indigenous Māori. AIM: To identify modifiable risk factors for SUDI. METHODS: A three-year (1 March 2012-28 February 2015) nationwide case-control study was conducted in New Zealand. RESULTS: There were 137 SUDI cases, giving a SUDI mortality rate of 0.76/1,000 live births. The rate for Māori was 1.41/1,000, Pacific 1.01/1,000 and non-Māori non-Pacific (predominantly European) 0.50/1,000. The parent(s) of 97% of the SUDI cases were interviewed. Six hundred and forty-nine controls were selected and 258 (40%) were interviewed. The two major risk factors for SUDI were: maternal smoking in pregnancy (adjusted OR=6.01, 95% CI=2.97, 12.15) and bed sharing (aOR=4.96, 95% CI=2.55, 9.64). There was a significant interaction (p=0.002) between bed sharing and antenatal maternal smoking. Infants exposed to both risk factors had a markedly increased risk of SUDI (aOR=32.8, 95% CI=11.2, 95.8) compared with infants not exposed to either risk factor. Infants not sharing the parental bedroom were also at increased risk of SUDI (aOR=2.77, 95% CI=1.45, 5.30). Just 21 cases over the three-year study were not exposed to smoking in pregnancy, bed sharing or front or side sleeping position. CONCLUSIONS: This study has shown that many of the risk factors that were identified in the original New Zealand Cot Death Study (1987-1989) are still relevant today. The combination of maternal smoking in pregnancy and bed sharing is extremely hazardous for infants. Furthermore, our findings indicate that the SUDI prevention messages are still applicable today and should be reinforced. SUDI mortality could be reduced to just seven p.a. in New Zealand (approximately one in 10,000 live births).
BACKGROUND: Despite a major reduction in overall infant mortality, sudden unexpected death in infancy (SUDI) continues to be of concern in New Zealand, as the rate is high by international standards, and is even higher in indigenous Māori. AIM: To identify modifiable risk factors for SUDI. METHODS: A three-year (1 March 2012-28 February 2015) nationwide case-control study was conducted in New Zealand. RESULTS: There were 137 SUDI cases, giving a SUDI mortality rate of 0.76/1,000 live births. The rate for Māori was 1.41/1,000, Pacific 1.01/1,000 and non-Māori non-Pacific (predominantly European) 0.50/1,000. The parent(s) of 97% of the SUDI cases were interviewed. Six hundred and forty-nine controls were selected and 258 (40%) were interviewed. The two major risk factors for SUDI were: maternal smoking in pregnancy (adjusted OR=6.01, 95% CI=2.97, 12.15) and bed sharing (aOR=4.96, 95% CI=2.55, 9.64). There was a significant interaction (p=0.002) between bed sharing and antenatal maternal smoking. Infants exposed to both risk factors had a markedly increased risk of SUDI (aOR=32.8, 95% CI=11.2, 95.8) compared with infants not exposed to either risk factor. Infants not sharing the parental bedroom were also at increased risk of SUDI (aOR=2.77, 95% CI=1.45, 5.30). Just 21 cases over the three-year study were not exposed to smoking in pregnancy, bed sharing or front or side sleeping position. CONCLUSIONS: This study has shown that many of the risk factors that were identified in the original New Zealand Cot Death Study (1987-1989) are still relevant today. The combination of maternal smoking in pregnancy and bed sharing is extremely hazardous for infants. Furthermore, our findings indicate that the SUDI prevention messages are still applicable today and should be reinforced. SUDI mortality could be reduced to just seven p.a. in New Zealand (approximately one in 10,000 live births).
Authors: Richard D Goldstein; Peter S Blair; Mary Ann Sens; Carrie K Shapiro-Mendoza; Henry F Krous; Torleiv O Rognum; Rachel Y Moon Journal: Forensic Sci Med Pathol Date: 2019-09-09 Impact factor: 2.007