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Am Fam Physician. 2003;68(7):1375-1376

What are the effects of interventions to reduce the risk of sudden infant death syndrome?

BENEFICIAL

Advice to Avoid Prone Sleeping

Several observational studies found that campaigns involving advice to encourage nonprone sleeping positions were followed by a reduced incidence of sudden infant death syndrome (SIDS). Randomized controlled trials (RCTs) are unlikely to be conducted.

LIKELY TO BE BENEFICIAL

Advice to Avoid Tobacco Smoke Exposure

Several observational studies found limited evidence that campaigns to reduce several risk factors for sudden infant death, which included tobacco smoke exposure, were followed by a reduced incidence of SIDS. RCTs are unlikely to be conducted.

UNKNOWN EFFECTIVENESS

Advice to Avoid Bed Sharing

One observational study found that a campaign to reduce several risk factors for sudden infant death, which included advice to avoid bed sharing, was followed by a reduced incidence of SIDS. RCTs are unlikely to be conducted.

Advice to Avoid Over Heating or Over Wrapping

Three observational studies found limited evidence that campaigns to reduce several risk factors for sudden infant death, which included over wrapping, were followed by a reduced incidence of SIDS. RCTs are unlikely to be conducted.

Advice to Avoid Soft Sleep Surfaces

We found no evidence on the effects of avoiding soft sleeping surfaces in the prevention of SIDS.

Advice to Breastfeed

One nonsystematic review of observational studies and three additional observational studies found that campaigns to reduce several risk factors for sudden infant death, which included advice to breastfeed, were followed by a reduced incidence of SIDS. In some countries, however, incidence had begun to fall before the national advice campaigns. RCTs are unlikely to be conducted.

Advice to Promote Soother Use

We found insufficient evidence on soother use in the prevention of SIDS.

Definition

SIDS is the sudden death of an infant younger than one year that remains unexplained after review of the clinical history, examination of the scene of death, and postmortem.

Incidence/Prevalence

The incidence of SIDS has varied over time and among nations (incidence per 1,000 live births of SIDS in 1996: Netherlands, 0.3; Japan, 0.4; Canada, 0.5; England and Wales, 0.7; United States, 0.8; and Australia, 0.9).1

Etiology/Risk Factors

By definition, the cause of SIDS is not known. Observational studies have found an association between SIDS and several risk factors, including prone sleeping position,2,3 prenatal or postnatal exposure to tobacco smoke,4 soft sleeping surfaces,5,6 hyperthermia or over wrapping,7,8 bed sharing (particularly with mothers who smoke),9,10 lack of breastfeeding,11,12 and soother use.7,13

Prognosis

Although by definition prognosis is not applicable for an affected infant, the incidence of SIDS is increased in the siblings of that infant.14,15

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