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© 1996 Oxford University Press
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Sudden Infant Death Syndrome: Insulation from Bedding and Clothing and its Effect Modifiers
,
* Department of Preventive and Social Medicine, University of Otago Medical School Box 913, Dunedin, New Zealand.
** Department of Paediatrics, University of Otago Medical School Box 913, Dunedin, New Zealand.
Department of Paediatrics, University of Auckland New Zealand.
R Scragg, University of Auckland
BACKGROUND: Thermal stress related to excessive insulation from bedding and clothing has been postulated to be associated with sudden infant death syndrome (SIDS).
METHODS: The parents of 393 (81%) of the infants who died of SIDS in the post neonatal period were interviewed at home. Interviews were also completed with the parents of 1592 (88.4% of total) controls, a representative sample of all hospital births. The study was conducted in regions of both the North and South Island of New Zealand in which 78% of all New Zealand births occurred in 1987–1990. Temperatures for the infant's bedroom estimated from the outside temperature and a model were used to predict the appropriate insulation for the lower critical temperature(temperature below which the metabolic rate is likely to increase).
RESULTS: Sudden infant death syndrome was associated with extra thermal insulation of >2 tog above the lower critical value, the odds ratio (OR) was 1.70 (95% confidence interval (CI): 1.31–2.20) after adjusting for season. After adjusting for a number of confounding factors the OR was reduced to 1.35 (95% CI : 0.97–1.87). Also associated with SIDS was too little thermal insulation OR = 1.67 (95% CI: 1.13–2.48), and 2.63 (95% CI : 1.61–4.30) when adjustments were made for the confounding factors. The interaction effect between infants sleeping prone and >2 tog extra thermal insulation was significant (OR = 6.07, 95% CI : 3.83–9.60). Infants with too little thermal insulation were at increased risk if they were not tightly wrapped (OR = 3.81, 95% CI : 2.04–7.09). There were also small additive interaction effects if the mother smoked and the infants had >2 tog extra thermal insulation, or If they were ill and had >4 tog extra insulation. Interaction effects between thermal insulation and other factors were not significant.
CONCLUSIONS: More thermal insulation than was necessary to maintain the lower critical temperature increased the risk of SIDS primarily among infants in the prone sleep position, and to a lesser degree in infants whose mothers smoked and in infants who were unwell.
Keywords sudden infant death syndrome, thermal stress, post neonatal prone position, maternal smoking, cot death
Revised 1 August 1995
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