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Prenatal and postnatal factors associated with sudden infant death syndrome: an umbrella review of meta-analyses

  • Meta-analysis
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Abstract

Background

Comprehensive quantitative evidence on the risk and protective factors for sudden infant death syndrome (SIDS) effects is lacking. We investigated the risk and protective factors related to SIDS.

Methods

We conducted an umbrella review of meta-analyses of observational and interventional studies assessing SIDS-related factors. PubMed/MEDLINE, Embase, EBSCO, and Google Scholar were searched from inception until January 18, 2023. Data extraction, quality assessment, and certainty of evidence were assessed by using A Measurement Tool Assessment Systematic Reviews 2 following PRISMA guidelines. According to observational evidence, credibility was graded and classified by class and quality of evidence (CE; convincing, highly suggestive, suggestive, weak, or not significant). Our study protocol was registered with PROSPERO (CRD42023458696). The risk and protective factors related to SIDS are presented as equivalent odds ratios (eORs).

Results

We identified eight original meta-analyses, including 152 original articles, covering 12 unique risk and protective factors for SIDS across 21 countries/regions and five continents. Several risk factors, including prenatal drug exposure [eOR = 7.84 (95% CI = 4.81–12.79), CE = highly suggestive], prenatal opioid exposure [9.55 (95% CI = 4.87–18.72), CE = suggestive], prenatal methadone exposure [9.52 (95% CI = 3.34–27.10), CE = weak], prenatal cocaine exposure [4.38 (95% CI = 1.95–9.86), CE = weak], prenatal maternal smoking [2.25 (95% CI = 1.95–2.60), CE = highly suggestive], postnatal maternal smoking [1.97 (95% CI = 1.75–2.22), CE = weak], bed sharing [2.89 (95% CI = 1.81–4.60), CE = weak], and infants found with heads covered by bedclothes after last sleep [11.01 (95% CI = 5.40–22.45), CE = suggestive], were identified. On the other hand, three protective factors, namely, breastfeeding [0.57 (95% CI = 0.39–0.83), CE = non-significant], supine sleeping position [0.48 (95% CI = 0.37–0.63), CE = suggestive], and pacifier use [0.44 (95% CI = 0.30–0.65), CE = weak], were also identified.

Conclusions

Based on the evidence, we propose several risk and protective factors for SIDS. This study suggests the need for further studies on SIDS-related factors supported by weak credibility, no association, or a lack of adequate research.

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Data availability

The data used in this review was derived from publicly available systematic reviews and meta-analyses.

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Funding

This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT; RS-2023-00248157). The funding agencies had no role in the design and conduct of the study: collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea

    Tae Hyeon Kim & Dong Keon Yon

  2. Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea

    Hyeri Lee, Selin Woo, Hayeon Lee, Jaeyu Park & Dong Keon Yon

  3. Department of Regulatory Science, Kyung Hee University, Seoul, South Korea

    Hyeri Lee, Jaeyu Park & Dong Keon Yon

  4. Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea

    Hayeon Lee

  5. CEReSS-Health Service Research and Quality of Life Center, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France

    Guillaume Fond & Laurent Boyer

  6. Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea

    Jong Woo Hahn

  7. Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea

    Jong Woo Hahn

  8. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 149 13th Street, Room 4140, Charlestown, Boston, MA, USA

    Jiseung Kang

  9. Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA

    Jiseung Kang

  10. Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea

    Dong Keon Yon

  11. Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea

    Dong Keon Yon

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  1. Tae Hyeon Kim
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Contributions

KTH and LHyeri contributed equally to this work as co-first authors. KJ and YDK contributed equally to this work as co-corresponding authors. KTH, LHyeri, KJ, and YDK contributed to study concept and design, acquisition, analysis, or interpretation of data, drafting of the manuscript, statistical analysis, and study supervision. YDK had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis, and is the guarantor for this study. All authors contributed to critical revision of the manuscript for important intellectual content and approved the final version before submission. The corresponding authors attest that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Corresponding authors

Correspondence to Jiseung Kang or Dong Keon Yon.

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Ethical approval

This systematic review article does not require Institutional Review Board approval. Our systematic review and meta-analysis protocol were registered with PROSPERO (registration number: CRD42023458696).

Conflict of interest

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article. The authors have no conflict of interest to declare.

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Kim, T.H., Lee, H., Woo, S. et al. Prenatal and postnatal factors associated with sudden infant death syndrome: an umbrella review of meta-analyses. World J Pediatr (2024). https://doi.org/10.1007/s12519-024-00806-1

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