Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis.

Pease AS, Fleming PJ, Hauck FR, Moon RY, Horne RS, L'Hoir MP, Ponsonby AL, Blair PS.
Pediatrics. 2016 Jun;137(6). pii: e20153275. doi: 10.1542/peds.2015-3275. Epub

2016 May 9.

CONTEXT: Swaddling is a traditional practice of wrapping infants to promote calming and sleep. Although the benefits and risks of swaddling in general have been studied, the practice in relation to sudden infant death syndrome remains unclear.

OBJECTIVE: The goal of this study was to conduct an individual-level meta-analysis of sudden infant death syndrome risk for infants swaddled for sleep.

DATA SOURCES: Additional data on sleeping position and age were provided by authors of included studies.

STUDY SELECTION: Observational studies that measured swaddling for the last or reference sleep were included.

DATA EXTRACTION: Of 283 articles screened, 4 studies met the inclusion criteria.

RESULTS: There was significant heterogeneity among studies (I(2) = 65.5%; P = .03), and a random effects model was therefore used for analysis. The overall age-adjusted pooled odds ratio (OR) for swaddling in all 4 studies was 1.58 (95%  confidence interval [CI], 0.97-2.58). Removing the most recent study conducted in the United Kingdom reduced the heterogeneity (I(2) = 28.2%; P = .25) and provided a pooled OR (using a fixed effects model) of 1.38 (95% CI, 1.05-1.80). Swaddling  risk varied according to position placed for sleep; the risk was highest for prone sleeping (OR, 12.99 [95% CI, 4.14-40.77]), followed by side sleeping (OR, 3.16 [95% CI, 2.08-4.81]) and supine sleeping (OR, 1.93 [95% CI, 1.27-2.93]).

Limited evidence suggested swaddling risk increased with infant age and was associated with a twofold risk for infants aged >6 months.

LIMITATIONS: Heterogeneity among the few studies available, imprecise definitions of swaddling, and difficulties controlling for further known risks make interpretation difficult.

CONCLUSIONS: Current advice to avoid front or side positions for sleep especially applies to infants who are swaddled. Consideration should be given to an age after which swaddling should be discouraged.

Updated Swedish advice on reducing the risk of sudden infant death syndrome

Updated Swedish advice on reducing the risk of sudden infant
death syndrome
http://onlinelibrary.wiley.com/doi/10.1111/apa.12966/epdf

Acta Paediatrica Volume 104, Issue 5 Pages 433 - 537, e187 - e234, May 2015

Göran Wennergren, Kerstin Nordstrand, Bernt Alm, Per Möllborg, Anna Öhman, Anita Berlin, Miriam Katz-Salamon and Hugo Lagercrantz
Article first published online: 13 MAR 2015 | DOI: 10.1111/apa.12966

ABSTRACT
This article reviews updated advice and factual material from the Swedish National Board of
Health and Welfare on reducing the risk of sudden infant death syndrome. Issues covered
by the guidance for parents and healthcare professionals include sleeping positions,
smoking, breastfeeding, bed sharing and using pacifiers.
Conclusion: The guidelines conclude that infants under three months of age are safest

sleeping in their own cot and that a pacifier can be used when they are going to sleep.http://onlinelibrary.wiley.com/doi/10.1111/apa.12966/epdf

Bed-Sharing in the Absence of Hazardous Circumstances: Is There a Risk of Sudden Infant Death Syndrome? An Analysis from Two Case-Control Studies Conducted in the UK

Bed-Sharingin the Absence of Hazardous Circumstances: Is There a Risk of Sudden InfantDeath Syndrome? An Analysis from Two Case-Control Studies Conducted in the UK

Cita:

Blair PS, Sidebotham P, Pease A, Fleming PJ (2014) Bed-Sharing in the Absence of Hazardous Circumstances: Is There a Risk of Sudden Infant Death Syndrome? An Analysis from Two Case-Control Studies Conducted in the UK. PLoS ONE 9(9): e107799. doi:10.1371/journal.pone.0107799

Abstract

Objective

The risk of sudden infant death syndrome (SIDS) among infants who co-sleep in the absence of hazardous circumstances is unclear and needs to be quantified.

Design

Combined individual-analysis of two population-based case-control studies of SIDS infants and controls comparable for age and time of last sleep.

Setting

Parents of 400 SIDS infants and 1386 controls provided information from five English health regions between 1993–6 (population: 17.7 million) and one of these regions between 2003–6 (population:4.9 million).

Results

Over a third of SIDS infants (36%) were found co-sleeping with an adult at the time of death compared to 15% of control infants after the reference sleep (multivariate OR = 3.9 [95% CI: 2.7–5.6]). The multivariable risk associated with co-sleeping on a sofa (OR = 18.3 [95% CI: 7.1–47.4]) or next to a parent who drank more than two units of alcohol (OR = 18.3 [95% CI: 7.7–43.5]) was very high and significant for infants of all ages. The risk associated with co-sleeping next to someone who smoked was significant for infants under 3 months old (OR = 8.9 [95% CI: 5.3–15.1]) but not for older infants (OR = 1.4 [95% CI: 0.7–2.8]). The multivariable risk associated with bed-sharing in the absence of these hazards was not significant overall (OR = 1.1 [95% CI: 0.6–2.0]), for infants less than 3 months old (OR = 1.6 [95% CI: 0.96–2.7]), and was in the direction of protection for older infants (OR = 0.1 [95% CI: 0.01–0.5]). Dummy use was associated with a lower risk of SIDS only among co-sleepers and prone sleeping was a higher risk only among infants sleeping alone.

Conclusion

These findings support a public health strategy that underlines specific hazardous co-sleeping environments parents should avoid. Sofa-sharing is not a safe alternative to bed-sharing and bed-sharing should be avoided if parents consume alcohol, smoke or take drugs or if the infant is pre-term.

Cosleeping Has Become More Common

http://www.jwatch.org/na32517/2013/10/21/cosleeping-has-become-more-common?query=etoc_jwpeds
 Cornelius W. Van Niel, MD reviewing Colson ER et al. JAMA Pediatr 2013 Sep 30. Bergman AB. JAMA Pediatr 2013 Sep 30.

The rate of infant bed sharing has doubled since 1993.

The American Academy of Pediatrics strongly recommends against bed sharing for infants (JW Pediatr Adolesc Med Nov 16 2011). The National Infant Sleep Position Study conducted telephone surveys with caregivers of >1000 infants (median age, 4 months) each year since the start of the 1993 back-to-sleep campaign aimed at decreasing sudden infant death syndrome (SIDS). Caregivers were predominantly white (83%), older, and more educated than the general population.
- See more at: http://www.jwatch.org/na32517/2013/10/21/cosleeping-has-become-more-common?query=etoc_jwpeds#sthash.TjoOwIZs.dpuf

Cornelius W. Van Niel, MD reviewing Colson ER et al. JAMA Pediatr 2013 Sep 30. Bergman AB. JAMA Pediatr 2013 Sep 30.

The rate of infant bed sharing has doubled since 1993.

The American Academy of Pediatrics strongly recommends against bed sharing for infants (JW Pediatr Adolesc Med Nov 16 2011). The National Infant Sleep Position Study conducted telephone surveys with caregivers of >1000 infants (median age, 4 months) each year since the start of the 1993 back-to-sleep campaign aimed at decreasing sudden infant death syndrome (SIDS). Caregivers were predominantly white (83%), older, and more educated than the general population.

- See more at: http://www.jwatch.org/na32517/2013/10/21/cosleeping-has-become-more-common?query=etoc_jwpeds#sthash.TjoOwIZs.dpuf

Suffocation Deaths Associated with Use of Infant Sleep Positioners — United States, 1997–2011

Morbidity and Mortality Weekly Report (MMWR)
November 23, 2012 / 61(46);933-937

Unintentional suffocation is the leading cause of injury death among children aged less than 1 year in the United States, accounting for nearly 1,000 infant deaths annually. Since 1984, an estimated fourfold increase has been observed in accidental suffocation and strangulation in bed, with many of these deaths linked to unsafe sleep environments (1,2). Infant sleep positioners (ISPs) are devices intended to keep an infant in a specific position while sleeping, yet ISPs have been reported to have been present in the sleep environment in some cases of unintentional infant suffocation (Figure).
To characterize infant deaths associated with ISPs, FDA, the U.S. Consumer Product Safety Commission (CPSC), and CDC examined information reported to CPSC about 13 infant deaths in the past 13 years associated with the use of ISPs.

Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome?

Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome?
M.M. Vennemann, MD, MPH, PD^a, T. Bajanowski, MD, PD^b, B. Brinkmann, MD, PD^a, G. Jorch, MD, PD^c, K. Yücesan, MD^a, C. Sauerland, MSc^d, E.A. Mitchell, FRACP, DSc^e and the GeSID Study Group
PEDIATRICS Vol. 123 No. 3 March 2009, pp. e406-e410

BACKGROUND. In the last 20 years, the prevention campaigns to reduce the risk of
sudden infant death syndrome were very successful. In some countries the advice to
breastfeed is included in the campaigns’ messages, but in other countries it is not.
OBJECTIVE. To examine the association between type of infant feeding and sudden
infant death syndrome.
METHODS. The German Study of Sudden Infant Death is a case-control study of 333
infants who died of sudden infant death syndrome and 998 age-matched controls.
RESULTS.A total of 49.6% of cases and 82.9% of controls were breastfed at 2 weeks of
age. Exclusive breastfeeding at 1 month of age halved the risk, partial breastfeeding
at the age of 1 month also reduced the risk of sudden infant death syndrome, but
after adjustment this risk was not significant. Being exclusively breastfed in the last
month of life/before the interview reduced the risk, as did being partially breastfed.
Breastfeeding survival curves showed that both partial breastfeeding and exclusive
breastfeeding were associated with a reduced risk of sudden infant death syndrome.
CONCLUSIONS. This study shows that breastfeeding reduced the risk of sudden infant
death syndrome by 50% at all ages throughout infancy. We recommend including
the advice to breastfeed through 6 months of age in sudden infant death syndrome
risk-reduction messages

Benefits and harms associated with the practice of bed sharing: a systematic review.

Horsley T, Clifford T, Barrowman N, Bennett S, Yazdi F, Sampson M, Moher D,
Dingwall O, Schachter H, Cote A.
Arch Pediatr Adolesc Med. 2007 Mar;161(3):237-45.
(Comment in: Arch Pediatr Adolesc Med. 2007 Mar;161(3):305-6.)

OBJECTIVE: To examine evidence of benefits and harms to children associated with bed sharing, factors (eg, smoking) altering bed sharing risk, and effective strategies for reducing harms associated with bed sharing.
DATA SOURCES: MEDLINE, CINAHL, Healthstar, PsycINFO, the Cochrane Library, Turning Research Into Practice, and Allied and Alternative Medicine databases between January 1993 and January 2005. STUDY SELECTION: Published, English-language records investigating the practice of bed sharing (defined as a child sharing a sleep surface with another individual) and associated benefits and harms in children 0 to 2 years of age.
DATA EXTRACTION: Any reported benefits or harms (risk
factors) associated with the practice of bed sharing.
DATA SYNTHESIS: Forty observational studies met our inclusion criteria. Evidence consistently suggests that there may be an association between bed sharing and sudden infant death syndrome (SIDS) among smokers (however defined), but the evidence is not as consistent among nonsmokers. This does not mean that no association between bed sharing and SIDS exists among nonsmokers, but that existing data do not convincingly establish such an association. Data also suggest that bed sharing may be more strongly associated with SIDS in younger infants. A positive
association between bed sharing and breastfeeding was identified. Current data
could not establish causality. It is possible that women who are most likely to
practice prolonged breastfeeding also prefer to bed share.
CONCLUSION: Well-designed, hypothesis-driven prospective cohort studies are warranted to improve our understanding of the mechanisms underlying the relationship between bed sharing, its benefits, and its harms.