Book contents
- Frontmatter
- Contents
- Dedication
- Acknowledgements
- Foreword
- 1 Sudden Infant Death Syndrome: Definitions
- 2 Sudden Infant Death Syndrome: An Overview
- 3 Sudden Unexplained Death in Childhood: An Overview
- 4 Sudden Infant Death Syndrome: History
- 5 Responding to Unexpected Child Deaths
- 6 The Role of Death Review Committees
- 7 Parental Perspectives
- 8 Parental Grief
- 9 Promoting Evidence-Based Public Health Recommendations to Support Reductions in Infant and Child Mortality: The Role of National Scientific Advisory Groups
- 10 Risk Factors and Theories
- 11 Shared Sleeping Surfaces and Dangerous Sleeping Environments
- 12 Preventive Strategies for Sudden Infant Death Syndrome
- 13 The Epidemiology of Sudden Infant Death Syndrome and Sudden Unexpected Infant Deaths: Diagnostic Shift and other Temporal Changes
- 14 Future Directions in Sudden Unexpected Death in Infancy Research
- 15 Observational Investigations from England: The CESDI and SWISS Studies
- 16 An Australian Perspective
- 17 A South African Perspective
- 18 A United Kingdom Perspective
- 19 A United States Perspective
- 20 A Scandinavian Perspective
- 21 Neonatal Monitoring: Prediction of Autonomic Regulation at 1 Month from Newborn Assessments
- 22 Autonomic Cardiorespiratory Physiology and Arousal of the Fetus and Infant
- 23 The Role of the Upper Airway in SIDS and Sudden Unexpected Infant Deaths and the Importance of External Airway-Protective Behaviors
- 24 The Autopsy and Pathology of Sudden Infant Death Syndrome
- 25 Natural Diseases Causing Sudden Death in Infancy and Early Childhood
- 26 Brainstem Neuropathology in Sudden Infant Death Syndrome
- 27 Sudden Infant Death Syndrome, Sleep, and the Physiology and Pathophysiology of the Respiratory Network
- 28 Neuropathology of Sudden Infant Death Syndrome: Hypothalamus
- 29 Abnormalities of the Hippocampus in Sudden and Unexpected Death in Early Life
- 30 Cytokines, Infection, and Immunity
- 31 The Genetics of Sudden Infant Death Syndrome
- 32 Biomarkers of Sudden Infant Death Syndrome (SIDS) Risk and SIDS Death
- 33 Animal Models: Illuminating the Pathogenesis of Sudden Infant Death Syndrome
10 - Risk Factors and Theories
Published online by Cambridge University Press: 20 July 2018
- Frontmatter
- Contents
- Dedication
- Acknowledgements
- Foreword
- 1 Sudden Infant Death Syndrome: Definitions
- 2 Sudden Infant Death Syndrome: An Overview
- 3 Sudden Unexplained Death in Childhood: An Overview
- 4 Sudden Infant Death Syndrome: History
- 5 Responding to Unexpected Child Deaths
- 6 The Role of Death Review Committees
- 7 Parental Perspectives
- 8 Parental Grief
- 9 Promoting Evidence-Based Public Health Recommendations to Support Reductions in Infant and Child Mortality: The Role of National Scientific Advisory Groups
- 10 Risk Factors and Theories
- 11 Shared Sleeping Surfaces and Dangerous Sleeping Environments
- 12 Preventive Strategies for Sudden Infant Death Syndrome
- 13 The Epidemiology of Sudden Infant Death Syndrome and Sudden Unexpected Infant Deaths: Diagnostic Shift and other Temporal Changes
- 14 Future Directions in Sudden Unexpected Death in Infancy Research
- 15 Observational Investigations from England: The CESDI and SWISS Studies
- 16 An Australian Perspective
- 17 A South African Perspective
- 18 A United Kingdom Perspective
- 19 A United States Perspective
- 20 A Scandinavian Perspective
- 21 Neonatal Monitoring: Prediction of Autonomic Regulation at 1 Month from Newborn Assessments
- 22 Autonomic Cardiorespiratory Physiology and Arousal of the Fetus and Infant
- 23 The Role of the Upper Airway in SIDS and Sudden Unexpected Infant Deaths and the Importance of External Airway-Protective Behaviors
- 24 The Autopsy and Pathology of Sudden Infant Death Syndrome
- 25 Natural Diseases Causing Sudden Death in Infancy and Early Childhood
- 26 Brainstem Neuropathology in Sudden Infant Death Syndrome
- 27 Sudden Infant Death Syndrome, Sleep, and the Physiology and Pathophysiology of the Respiratory Network
- 28 Neuropathology of Sudden Infant Death Syndrome: Hypothalamus
- 29 Abnormalities of the Hippocampus in Sudden and Unexpected Death in Early Life
- 30 Cytokines, Infection, and Immunity
- 31 The Genetics of Sudden Infant Death Syndrome
- 32 Biomarkers of Sudden Infant Death Syndrome (SIDS) Risk and SIDS Death
- 33 Animal Models: Illuminating the Pathogenesis of Sudden Infant Death Syndrome
Summary
Introduction
Identification of factors that increase risk of, or are protective against, sudden infant death syndrome (SIDS) has largely been accomplished through epidemiological case-control studies. Risk factors include side and prone positioning, prenatal and postnatal tobacco smoke exposure, sleeping on soft or cushioned surfaces (particularly sofas, couches, and armchairs), bed sharing, soft bedding, head covering and overheating, and prematurity. Protective factors include breastfeeding, pacifier use, and room sharing. In this chapter, we will discuss the evidence for these risk and protective factors. We will also review the leading theories for SIDS causation including the Triple Risk Hypothesis, rebreathing theory, and deficient arousal and autonomic regulation, and how these theories create a plausible explanation for the risk and protective factors for SIDS identified in casecontrol studies.
Risk Factors
Side and prone sleep position
The prone sleep position was noted in multiple case-control studies to be associated with SIDS (1-6), beginning in 1965 in the United Kingdom (UK) (7). Even before this, in 1944, Abramson reported that prone positioning was found in 68% of young infants who died of accidental mechanical suffocation in New York City (8). Public health campaigns, which first promoted non-prone positioning in the 1980s and then supine placement, only beginning in the 1990s in many Western countries, have all been associated with a decline in SIDS rates. Subsequent studies have confirmed the association of prone sleep positioning and an increased SIDS risk (adjusted odds ratio [aOR] 2.3-13.1) (9-11). Physiologic studies have demonstrated an association of prone positioning with an increased risk of hypercapnia and hypoxia (12-14), overheating (15), diminished cerebral oxygenation (16), altered autonomic control (17), and increased arousal thresholds (18).
Subsequent studies have identified that the risk of side sleep positioning is similar to that of prone positioning (aOR 2.0 and 2.6 respectively) (10). Side positioning also has a higher population-attributable risk than prone positioning (11), likely because many infants who are placed on their side are found prone (10). Placement in, or rolling to, the prone position, particularly when infants are unaccustomed to that position, places infants at extremely high risk of SIDS (aOR 8.7-45.4) (10, 19). Thus all caregivers, including childcare providers, family members, and friends, should place the infant in the supine position for every sleep.
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- SIDS Sudden Infant and Early Childhood DeathThe past, the present and the future, pp. 169 - 186Publisher: The University of Adelaide PressPrint publication year: 2018