IJE Advance Access originally published online on August 5, 2005
International Journal of Epidemiology 2005 34(5):1165-1166; doi:10.1093/ije/dyi154
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Published by Oxford University Press on behalf of the International Epidemiological Association
Letter to the Editor |
Infant sleeping position and sudden infant death syndrome: a systematic review
University of Washington School of Medicine, Seattle, WA 98195-6320, USA. E-mail: wgg{at}u.washington.edu
The systematic review and meta-analysis by Gilbert et al.,1 with chronological, graphic presentation of odds ratio with confidence intervals, provides an excellent summary of the literature that finally leads to the acceptance of the supine sleeping position for infants. But the conclusion that 60 000 infants could have been saved worldwide if only action had been taken in the early 1970s seems an overstatement, considering the reality of the way in which public health decisions are made. By 1970 only two papers had been published,2,3 and neither of them emphasized their statistics on sleep position nor did they make any recommendations to stop using the prone position. Therefore, it does not seem surprising that there was a gap of 16 years before Beal's paper4 was published in 1986 containing a clear recommendation against prone sleeping.
In the US, our failure to recognize the strength of the evidence from the British and Dutch back-to-sleep campaigns was unfortunate, to say the least. Not until 1992 did the first medical publication concerning sudden infant death syndrome (SIDS) and sleep position appear. We published, in JAMA,5 our analysis of reports from seven countries, using Hill's criteria,6 and urged a change to the supine sleeping position. Marion Willinger, the Head of the SIDS programmes for the US Public Health Service, appeared on US television one week later and announced that she did not think these statistics and recommendation should apply to American infants!
One and a half years later, we published7 follow-up statistics on US SIDS rates before and after the recommendations by the American Academy of Pediatrics.7 Willinger then convened a conference (cited by Gilbert et al. as reference 77). By the time a public announcement was made in support of the recommendation, 2 years had passed. Since the rate of SIDS in the US dropped thereafter by 
50%, nearly 5000 infant deaths from SIDS could have been avoided.
References
1 Gilbert R, Salanti G, Harden M, See S. Infant sleeping position and the sudden infant death syndrome: systematic review of observational studies and historical review of recommendations from 1940 to 2002. Int J Epidemiol 2005;34:874–87.
2 Carpenter RG, Shaddick CW. Role of infection, suffocations 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 1965;19:1–7.[Web of Science][Medline]
3 Froggatt P. Epidemiological aspects of the Northern Ireland Study. In: Bergman AB, Beckwith JB, Ray CG (eds). Sudden Infant Death Syndrome. Proceedings of the second International Conference on Causes of Sudden Death in Infants. Seattle: University of Washington Press, 1970, pp. 32–46.
4 Beal SM. Sudden infant death syndrome: epidemiological comparisons between South Australia and communities with a different incidence. Aust Paediatr J 1986;22(suppl.1):13–16.[Web of Science][Medline]
5 Guntheroth WG, Spiers PS. Sleeping prone and the risk of suddeninfant death syndrome. JAMA 1992;267:2359–62.
6 Hill AB. The environment and disease: association or causation. Proc R Soc Med 1965;58:295–300.[Web of Science][Medline]
7 American Academy of Pediatrics. Positioning and sudden infant death. Pediatrics 1992;89:1120–26.
8 Spiers PS, Guntheroth WG. Recommendations to avoid the prone sleeping position and recent statistics for sudden infant death syndrome in the United States. Arch Pediatr Adolesc Med 1994;148:141–46.
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  R. Gilbert and G. Salanti Infant sleeping position and sudden infant death syndrome: a systematic review: Authors' response to letter from Guntheroth and Spiers Int. J. Epidemiol., October 1, 2005; 34(5): 1166 - 1166. [Full Text] [PDF]
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