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The German case–control scene investigation study on SIDS: epidemiological approach and main results

  • Martin SchlaudEmail author
  • Maren Dreier
  • Anette S. Debertin
  • Katja Jachau
  • Steffen Heide
  • Birkhild Giebe
  • Jan P. Sperhake
  • Christian F. Poets
  • Werner J. Kleemann
Original Article

Abstract

The present study, which was part of the German SIDS Study (GeSID), enrolled sudden infant death syndrome (SIDS) cases and population controls and obtained objective scene data via specifically trained observers shortly after discovery of each dead infant. Infants who had died suddenly and unexpectedly at ages between 8 and 365 days were enrolled in five regions of Germany between November 1998 and October 2001. Shortly after discovery of each dead infant, a specially trained doctor of legal medicine visited the bereaved family at home. Data were obtained by measurements and observations. Dead infants underwent a standardised autopsy, additional information being obtained by standardised parent interviews. Investigation of the sleep environment and wake-up scene in matched controls followed the same protocol. A total of 52 SIDS cases and 154 controls were enrolled, 58% were boys, and median age of cases vs. controls was 126 vs. 129 days. Risk factors in the sleeping environment were pillow use (adjusted OR 4.3; 95%CI 1.6–11.6), heavy duvets (OR 4.4; 1.5–13.3), soft underlay (OR 3.0; 1.1–8.7), face covered by bedding (OR 15.8; 2.5–102.1) and entire body covered by bedding (OR 35.5; 5.5–228.3). Using a standardised protocol, including objective measurements of the sleep environment and a case–control design, this study was able to confirm many risk factors for SIDS.

Keywords

Sudden infant death syndrome Risk factors Sleep environment Germany 

Notes

Acknowledgement

The authors wish to thank all those persons who contributed to this study. We are particularly grateful to all parents who consented to be enrolled and who made this study possible. This study was funded from a grant of the German Federal Ministry of Science and Education (FKZ 01ED9401). This observational epidemiological study was approved by the Ethics Committees of all universities involved.

Conflict of interest statement

All authors declare that there are no competing interests.

References

  1. 1.
    Hauck FR, Moore CM, Herman SM, Donovan M, Kalelkar M, Christoffel KK, Hoffman HJ, Rowley D (2002) The contribution of prone sleeping position to the racial disparity in sudden infant death syndrome: the Chicago Infant Mortality Study. Pediatrics 110:772–780CrossRefPubMedGoogle Scholar
  2. 2.
    Montomoli C, Monti MC, Stramba-Badiale M, Marinoni A, Foglieni N, Carreri V, Amigoni M, Schwartz PJ (2004) Mortality due to sudden infant death syndrome in northern Italy, 1990–2000: a baseline for the assessment of prevention campaigns. Paediatr Perinat Epidemiol 18:336–343CrossRefPubMedGoogle Scholar
  3. 3.
    Schlaud M, Eberhard C, Trumann B, Kleemann WJ, Poets CF, Tietze KW, Schwartz FW (1999) Prevalence and determinants of the prone sleeping position in infants: results from two cross-sectional studies on risk factors for SIDS in Germany. Am J Epidemiol 150:51–57PubMedGoogle Scholar
  4. 4.
    Vennemann MM, Findeisen M, Butterfass-Bahloul T, Jorch G, Brinkmann B, Kopcke W, Bajanowski T, Mitchell EA (2005) Modifiable risk factors for SIDS in Germany: results of GeSID. Acta Paediatr 94:655–660CrossRefPubMedGoogle Scholar
  5. 5.
    Beal SM, Finch CF (1991) An overview of retrospective case-control studies investigating the relationship between prone sleeping position and SIDS. J Paediatr Child Health 27:334–339CrossRefPubMedGoogle Scholar
  6. 6.
    Guntheroth WG, Spiers PS (2001) Thermal stress in sudden infant death: is there an ambiguity with the rebreathing hypothesis? Pediatrics 107:693–698CrossRefPubMedGoogle Scholar
  7. 7.
    Mitchell EA, Scragg L, Clements M (1996) Soft cot mattresses and the sudden infant death syndrome. N Z Med J 109:206–207PubMedGoogle Scholar
  8. 8.
    Mitchell EA, Williams SM, Taylor BJ (1999) Use of duvets and the risk of sudden infant death syndrome. Arch Dis Child 81:117–119CrossRefPubMedGoogle Scholar
  9. 9.
    Klonoff-Cohen HS, Edelstein SL (1995) A case–control study of routine and death scene sleep position and sudden infant death syndrome in Southern California. JAMA 273:790–794CrossRefPubMedGoogle Scholar
  10. 10.
    Hauck FR, Herman SM, Donovan M, Iyasu S, Merrick MC, Donoghue E, Kirschner RH, Willinger M (2003) Sleep environment and the risk of sudden infant death syndrome in an urban population: the Chicago Infant Mortality Study. Pediatrics 111:1207–1214PubMedGoogle Scholar
  11. 11.
    Mitchell EA, Tuohy PG, Brunt JM, Thompson JM, Clements MS, Stewart AW, Ford RP, Taylor BJ (1997) Risk factors for sudden infant death syndrome following the prevention campaign in New Zealand: a prospective study. Pediatrics 100:835–840CrossRefPubMedGoogle Scholar
  12. 12.
    Ponsonby AL, Dwyer T, Kasl SV, Cochrane JA, Newman NM (1994) An assessment of the impact of public health activities to reduce the prevalence of the prone sleeping position during infancy: the Tasmanian Cohort Study. Prev Med 23:402–408CrossRefPubMedGoogle Scholar
  13. 13.
    Findeisen M, Vennemann M, Brinkmann B, Ortmann C, Röse I, Köpcke W, Jorch G, Bajanowski T (2004) German study on sudden infant death (GeSID): design, epidemiological and pathological profile. Int J Legal Med 118:163–169CrossRefPubMedGoogle Scholar
  14. 14.
    Bajanowski T, Brinkmann B, Mitchell EA, Vennemann MM, Leukel HW, Larsch KP, Beike J (2008) Nicotine and cotinine in infants dying from sudden infant death syndrome. Int J Legal Med 122:23–28CrossRefPubMedGoogle Scholar
  15. 15.
    Mitchell EA, Thompson JM, Becroft DM, Bajanowski T, Brinkmann B, Happe A, Jorch G, Blair PS, Sauerland C, Vennemann MM (2008) Head covering and the risk for SIDS: findings from the New Zealand and German SIDS case–control studies. Pediatrics 121:e1478–e1483CrossRefPubMedGoogle Scholar
  16. 16.
    Brinkmann B (1999) Harmonization of medico-legal autopsy rules. Committee of Ministers. Council of Europe. Int J Legal Med 113:1–14CrossRefPubMedGoogle Scholar
  17. 17.
    Taylor EM, Emery JL (1990) Categories of preventable unexpected infant deaths. Arch Dis Child 65:535–539CrossRefPubMedGoogle Scholar
  18. 18.
    Bajanowski T, Brinkmann B, Vennemann M (2006) The San Diego definition of SIDS: practical application and comparison with the GeSID classification. Int J Legal Med 120:331–336CrossRefPubMedGoogle Scholar
  19. 19.
    Winkler J, Stolzenberg H (1999) Der Sozialschichtindex im Bundes-Gesundheitssurvey. Gesundheitswesen 61:178–183Google Scholar
  20. 20.
    Henssge C (1995) Temperature-based methods II. In: Henssge C, Knight B, Krompecher T, Madea B, Nokes L (eds) The estimation of the time since death in the early postmortem period. Edward Arnold, London, pp 46–105Google Scholar
  21. 21.
    Stang A, Jockel KH (2004) Studies with low response proportions may be less biased than studies with high response proportions. Am J Epidemiol 159:204–210CrossRefPubMedGoogle Scholar
  22. 22.
    Carpenter RG, Shaddick CW (1965) Role of infection, suffocation, and bottle-feeding in cot death; an analysis of some factors in the histories of 110 cases and their controls. Br J Prev Soc Med 19:1–7PubMedGoogle Scholar
  23. 23.
    Scheers NJ, Dayton CM, Kemp JS (1998) Sudden infant death with external airways covered: case-comparison study of 206 deaths in the United States. Arch Pediatr Adolesc Med 152:540–547PubMedGoogle Scholar
  24. 24.
    Adler MR, Hyderi A, Hamilton A, Brown P (2006) What are safe sleeping arrangements for infants? J Fam Pract 55:1083–1087PubMedGoogle Scholar
  25. 25.
    McGarvey C, McDonnell M, Chong A, O'Regan M, Matthews T (2003) Factors relating to the infant's last sleep environment in sudden infant death syndrome in the Republic of Ireland. Arch Dis Child 88:1058–1064CrossRefPubMedGoogle Scholar
  26. 26.
    Thompson JM, Thach BT, Becroft DM, Mitchell EA (2006) Sudden infant death syndrome: risk factors for infants found face down differ from other SIDS cases. J Pediatr 149:630–633CrossRefPubMedGoogle Scholar
  27. 27.
    Carleton JN, Donoghue AM, Porter WK (1998) Mechanical model testing of rebreathing potential in infant bedding materials. Arch Dis Child 78:323–328CrossRefPubMedGoogle Scholar
  28. 28.
    Poets CF, Jorch G, and the Deutsche Akademie für Kinderheilkunde und Jugendmedizin (2000) Plötzlicher Säuglingstod (SID). Monatsschr Kinderheilkd 11:1064–1066Google Scholar
  29. 29.
    Anonymous (2005) The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics 116:1245–1255CrossRefGoogle Scholar
  30. 30.
    l'Hoir MP, Engelberts AC, van Well GT, McClelland S, Westers P, Dandachli T, Mellenbergh GJ, Wolters WH, Huber J (1998) Risk and preventive factors for cot death in The Netherlands, a low-incidence country. Eur J Pediatr 157:681–688CrossRefPubMedGoogle Scholar
  31. 31.
    Ponsonby AL, Dwyer T, Couper D, Cochrane J (1998) Association between use of a quilt and sudden infant death syndrome: case–control study. BMJ 316:195–196PubMedGoogle Scholar
  32. 32.
    Watson L, Potter A, Gallucci R, Lumley J (1998) Is baby too warm? The use of infant clothing, bedding and home heating in Victoria, Australia. Early Hum Dev 51:93–107CrossRefPubMedGoogle Scholar
  33. 33.
    Skadberg BT, Markestad T (1997) Consequences of getting the head covered during sleep in infancy. Pediatrics 100:E6CrossRefPubMedGoogle Scholar
  34. 34.
    Flick L, White DK, Vemulapalli C, Stulac BB, Kemp JS (2001) Sleep position and the use of soft bedding during bed sharing among African American infants at increased risk for sudden infant death syndrome. J Pediatr 138:338–343CrossRefPubMedGoogle Scholar
  35. 35.
    Bolton DP, Taylor BJ, Campbell AJ, Galland BC, Cresswell C (1993) Rebreathing expired gases from bedding: a cause of cot death? Arch Dis Child 69:187–190CrossRefPubMedGoogle Scholar
  36. 36.
    Carolan PL, Wheeler WB, Ross JD, Kemp RJ (2000) Potential to prevent carbon dioxide rebreathing of commercial products marketed to reduce sudden infant death syndrome risk. Pediatrics 105:774–779CrossRefPubMedGoogle Scholar
  37. 37.
    Colditz PB, Joy GJ, Dunster KR (2002) Rebreathing potential of infant mattresses and bedcovers. J Paediatr Child Health 38:192–195CrossRefPubMedGoogle Scholar
  38. 38.
    Guntheroth WG, Spiers PS (1996) Are bedding and rebreathing suffocation a cause of SIDS? Pediatr Pulmonol 22:335–341CrossRefPubMedGoogle Scholar
  39. 39.
    Campbell AJ, Bolton DP, Taylor BJ (1996) A potential danger of bedclothes covering the face. Acta Paediatr 85:281–284CrossRefPubMedGoogle Scholar
  40. 40.
    Kleemann WJ, Schlaud M, Poets CF, Rothämel T, Tröger HD (1996) Hyperthermia in sudden infant death. Int J Legal Med 109:139–142CrossRefPubMedGoogle Scholar
  41. 41.
    Schellscheidt J, Ott A, Jorch G (1997) Epidemiological features of sudden infant death after a German intervention campaign in 1992. Eur J Pediatr 156:655–660CrossRefPubMedGoogle Scholar
  42. 42.
    Henderson SD, Ponsonby AL, Murphy E (1998) Reducing the risk of sudden infant death syndrome: a review of the scientific literature. J Paediatr Child Health 34:213–219CrossRefGoogle Scholar
  43. 43.
    Kleemann WJ, Schlaud M, Fieguth A, Hiller AS, Rothamel T, Tröger HD (1998) Body and head position, covering of the head by bedding and risk of sudden infant death (SID). Int J Legal Med 112:22–26CrossRefGoogle Scholar
  44. 44.
    Kemp JS, Nelson VE, Thach BT (1994) Physical properties of bedding that may increase risk of sudden infant death syndrome in prone-sleeping infants. Pediatr Res 36:7–11CrossRefPubMedGoogle Scholar
  45. 45.
    Franco P, Lipshut W, Valente F, Adams S, Groswasser J, Kahn A (2003) Cardiac autonomic characteristics in infants sleeping with their head covered by bedclothes. J Sleep Res 12:125–132CrossRefPubMedGoogle Scholar
  46. 46.
    Bredemeyer SL (2004) Implementation of the SIDS guidelines in midwifery practice. Aust J Public Health 17:17–21Google Scholar
  47. 47.
    Tomashek KM, Shapiro-Mendoza C, Wingo J, Davis TW (2005) National standard for death-scene investigation of sudden, unexpected infant deaths in the United States. Letter. Pediatrics 115:823–824CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Martin Schlaud
    • 1
    • 2
    Email author
  • Maren Dreier
    • 1
  • Anette S. Debertin
    • 3
  • Katja Jachau
    • 4
  • Steffen Heide
    • 5
  • Birkhild Giebe
    • 6
    • 7
  • Jan P. Sperhake
    • 8
  • Christian F. Poets
    • 9
  • Werner J. Kleemann
    • 10
  1. 1.Department of Epidemiology, Social Medicine, and Health System ResearchHannover Medical SchoolHannoverGermany
  2. 2.Department of Epidemiology and Health ReportingRobert Koch InstituteBerlinGermany
  3. 3.Department of Legal MedicineHannover Medical SchoolHannoverGermany
  4. 4.Department of Legal MedicineUniversity of MagdeburgMagdeburgGermany
  5. 5.Department of Legal MedicineUniversity of HalleHalleGermany
  6. 6.Department of Legal MedicineUniversity of JenaJenaGermany
  7. 7.Department of Forensic Medicine StockholmThe National Board of Forensic MedicineStockholmSweden
  8. 8.Department of Legal MedicineUniversity Medical Centre Hamburg-EppendorfHamburgGermany
  9. 9.Department of NeonatologyUniversity of TübingenTübingenGermany
  10. 10.Department of Legal MedicineUniversity of LeipzigLeipzigGermany

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