Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England.
Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England.
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DOI：
10.1136/bmj.b3666
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发表时间：
2009-10-13
期刊：
影响因子：
--
通讯作者：
Fleming P
中科院分区：
文献类型：
--
作者：
Blair PS;Sidebotham P;Evason-Coombe C;Edmonds M;Heckstall-Smith EM;Fleming P
目的 调查从出生到2岁与婴儿猝死综合征（SIDS）相关的因素，近期的建议是否得到遵循，是否出现了任何新的风险因素，以及同床共眠（婴儿与成人或儿童同睡一张床或沙发）时发生SIDS的具体情况。
设计 为期4年的基于人群的病例对照研究。在死亡发生后不久或两个对照组的参照睡眠（24小时内）后对家长进行访谈。
地点 英格兰西南部地区（人口490万，出生184800人）。
参与者 80例SIDS婴儿和两个按年龄和参照睡眠时间加权的对照组：87例随机选取的对照组和82例SIDS高风险对照组（年轻、社会贫困、多产且吸烟的母亲）。
结果 死亡时的中位年龄（66天）比10年前在同一地区进行的一项研究中的年龄少3周多。在SIDS婴儿中，54%在同床共眠时死亡，而两个对照组中这一比例为20%。这种过量情况在很大程度上可由同床共眠与父母近期饮酒或使用药物之间显著的多变量相互作用（31%对3%的随机对照组）以及在沙发上同床共眠的SIDS婴儿比例增加（17%对1%）来解释。五分之一的SIDS婴儿在最后一次睡眠中使用了枕头（21%对3%），四分之一被包裹（24%对6%）。与随机对照组婴儿相比，更多SIDS婴儿的母亲在孕期吸烟（60%对14%），而四分之一的SIDS婴儿早产（26%对5%）或在最后一次睡眠时健康状况一般或较差（28%对6%）。在多变量分析中，无论使用哪个对照组进行比较，所有这些差异均具有统计学意义。尽管仍有相当比例的SIDS婴儿被发现俯卧（29%对10%），但覆盖婴儿头部、产后接触烟草烟雾、使用安抚奶嘴以及侧卧睡眠的重要性已降低。
结论 许多SIDS婴儿在危险环境中同床共眠。无论社会经济贫困的标志如何，对风险的主要影响因素是可以改变的，并且需要给出具体的建议，特别是关于同床共眠前饮酒或使用药物以及在沙发上同床共眠的问题。
Objectives To investigate the factors associated with sudden infant death syndrome (SIDS) from birth to age 2 years, whether recent advice has been followed, whether any new risk factors have emerged, and the specific circumstances in which SIDS occurs while cosleeping (infant sharing the same bed or sofa with an adult or child). Design Four year population based case-control study. Parents were interviewed shortly after the death or after the reference sleep (within 24 hours) of the two control groups. Setting South west region of England (population 4.9 million, 184 800 births). Participants 80 SIDS infants and two control groups weighted for age and time of reference sleep: 87 randomly selected controls and 82 controls at high risk of SIDS (young, socially deprived, multiparous mothers who smoked). Results The median age at death (66 days) was more than three weeks less than in a study in the same region a decade earlier. Of the SIDS infants, 54% died while cosleeping compared with 20% among both control groups. Much of this excess may be explained by a significant multivariable interaction between cosleeping and recent parental use of alcohol or drugs (31% v 3% random controls) and the increased proportion of SIDS infants who had coslept on a sofa (17% v 1%). One fifth of SIDS infants used a pillow for the last sleep (21% v 3%) and one quarter were swaddled (24% v 6%). More mothers of SIDS infants than random control infants smoked during pregnancy (60% v 14%), whereas one quarter of the SIDS infants were preterm (26% v 5%) or were in fair or poor health for the last sleep (28% v 6%). All of these differences were significant in the multivariable analysis regardless of which control group was used for comparison. The significance of covering the infant’s head, postnatal exposure to tobacco smoke, dummy use, and sleeping in the side position has diminished although a significant proportion of SIDS infants were still found prone (29% v 10%). Conclusions Many of the SIDS infants had coslept in a hazardous environment. The major influences on risk, regardless of markers for socioeconomic deprivation, are amenable to change and specific advice needs to be given, particularly on use of alcohol or drugs before cosleeping and cosleeping on a sofa.
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影响因子：
105.7
作者：
FLEMING, PJ;GILBERT, R;HALL, E
通讯作者：
HALL, E
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5.1
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影响因子：
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作者：
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