Tag Archives: SUDI

SUDI – Risks

Long list of known risk factors, even though mechanism not clearly understood!

Age is probably the main risk factor – mostly 5-10 weeks of age. Very few in later infancy (although sudden death is described in all ages cf SUDEP).

From Scottish study –

So preterm, low birth weight boys with socially deprived unmarried mothers who smoke are at highest risk. But many of these factors compound and confound – 78% have at least 2 risk factors, only 0.8% have no risk factors. If you exclude “non-modifiable risk factors” (social deprivation, etc), only 5.3% have no risk factors.

Prone sleeping is no longer a major factor since it has been discouraged for years. Might be protective for preterms, where found to promote cortical arousal (CA) responses (protective in term infants). Horne 2013

36% of excess infant mortality in US South due to SUDI (90% of excess mortality in Kentucky!  59% due to non-hispanic black population).

Main risk factor now is co-sleeping, esp on sofa, although this is commonly associated with alcohol/drug use. Blair & Sidebotham BMJ 2009

Note used mattress is risk factor in Scotland – never replicated elsewhere.

Dummies are protective, even though they fall out – part of some national safe sleep recommendations but not in UK (perhaps because mechanism unclear?).

Parental mental health associated – if both have a mental health disorder, OR for SIDS =6, more if substance abuse disorder – but smoking/social deprivation explains 50% of this risk.

4% of unselected cases had long QT mutations [NZ] – increased to 16% when cases guided by cardiac genetics.  But poor uptake of screening!

A previous maltreatment report emerged as a significant predictor of SIDS and other SUID. After adjusting for baseline risk factors, the rate of SIDS was more than 3 times as great among infants reported for possible maltreatment (hazard ratio: 3.22; 95% CI: 2.66, 3.89).  [US, PMID 24139442]

SUDI – prevention

Recent NICE update [CG37, postnatal care]

Clarifies co-sleeping risks. Recognizes that co-sleeping can be intentional or unintentional. Parents/carers should be informed of association with SIDS. Plus –

  • Inform that association likely to be greater when they smoke (incl partner)
  • Inform that association may possibly be greater with recent alcohol, drug use, LBW or premature.

Quality standard (but England and Wales).

Note that the word risk is not used, just association!  Boys as being at higher risk not mentioned!

PreBotzinger complex (preBotC) is a multi-functional network that is critically involved in the response to hypoxic and hypercapnic challenges.

Note increased brain oxygen requirement during “active sleep” cf quiet sleep.  Only apparent between 2 weeks and 5 months.  [Horne 2014].

New Dutch recommendations include: (a) pre-term neonates born after 32 weeks should be placed in a supine position; (b) twins should not sleep in the same bed (‘co-bedding’); (c) use of a pacifier is recommended once breastfeeding is well underway; and (d) use of stabilization pillows is not recommended [PMID 23425715]