International Trends in Sudden Infant Death Syndrome: Stabilization of Rates Requires Further Action

International Trends in Sudden Infant Death
Syndrome: Stabilization of Rates Requires Further
PEDIATRICS 2008;122( 3): 660-666
Fern R. Hauck, Kawai O. Tanabe.

There have been impressive reductions in SIDS deaths around the world. These declines seem to be real and attributable, in large measure, to risk-reduction activities, especially placing infants supine to sleep. However, rates have stabilized in the majority of countries, and in some countries they remain unacceptably high, which highlights the need for risk-reduction activities to be continued, especially in communities with the greatest burden of SIDS. In the United States in 2004, the National Infant Sleep Position Survey revealed that 12.9% of infants were placed prone for sleep. Using the pooled odds ratios from 7 case-control studies conducted in the post–Back to Sleep period for prone sleeping position (6.02), we estimate that 47% of the annual
SIDS deaths in the United States could be attributed to prone sleeping (Appendix).Using a more conservative estimate of an odds ratio of 2.5 (based on 2 studies in the United States), an estimated 27% of SIDS deaths could be attributed to placing infants prone to sleep (Appendix). Thus, working toward eliminating the use of this position has the potential to reduce the number of SIDS deaths in the United States significantly.
Differences in rates and trends are also influenced by diagnostic shifts that have occurred. Consequently, several classifications for SIDS and SUID have been proposed as a way to achieve greater accuracy and consistency in diagnosis within and across countries.
The Nordic countries have been successful in adopting standard criteria to diminish previously identified discrepancies in SIDS rates. It is essential that more widespread consensus on the definition and classification of sudden unexpected death in infancy be achieved so that national and international comparisons are more meaningful. Several initiatives in the United States are
underway to develop a standardized approach, including development by the Centers for Disease Control and Prevention of a national surveillance system for SUIDs that would collect data on modifiable risk factors for SIDS and SUID and on the conduct and quality of the death-scene investigation and autopsy; a standardized classification scheme for cause of death will also be developed In addition, legislation is being considered that would fund this and other related activities, including training for those who investigate infant deaths and certify cause of death.