Abstract
Background: The incidence of Sudden Unexpected Death in Infancy (SUDI) is low in the Netherlands, with an incidence rate of 0.18 per 1,000 live births. Therefore, prevention advice may receive less attention, potentially leading to increasing incidence rates. It is currently unknown whether the risks for SUDI changed in the Netherlands, and if other risk factors might be present. The aim of this study was to examine the current risks and preventive factors for SUDI in Dutch infants, in order to determine if it is necessary to adapt the prevention advice toward the current needs.Methods: A case-control study was conducted comparing SUDI cases aged <12 months from 2014–2020 in the Netherlands (n = 47), to a Dutch national survey control group from 2017 including infants <12 months of age (n = 1,192).Results: Elevated risks for several well-known factors were observed, namely: duvet use (aOR = 8.6), mother smoked during pregnancy (aOR = 9.7), or after pregnancy (aOR = 5.4) and the prone sleeping position (aOR = 4.6). Reduced risks were observed for the well-known factors: room-sharing (aOR = 0.3), sleep sack use (aOR = 0.3), breastfeeding (aOR = 0.3), and the use of a pacifier (aOR = 0.4). For infants <4 months, the risk for SUDI was higher when bed-sharing (aOR = 3.3), and lower when room-sharing (aOR = 0.2) compared to older infants. For older infants, the sleep sack was found to be more protective (aOR = 0.2). A high risk for SUDI when bed-sharing was found when mother smoked, smoked during pregnancy, or if the infant did not receive any breastfeeding (respectively aOR = 17.7, aOR = 10.8, aOR = 9.2).Conclusions: Internationally known factors related to the sudden unexpected death of infants were also found in this study. Relatively new findings are related to specific groups of infants, in which the strengths of these risk factors differed. In a low-incidence country like the Netherlands, renewed attention to the current prevention advice is needed. Furthermore, additional attention for prevention measures in low educated groups, and additional advice specifically targeting high-risk groups is recommended.
Highlights
Sudden Unexpected Death in Infancy (SUDI) is a broad term used to describe the sudden unexpected death of an infant without an apparent cause, which includes Sudden Infant Death Syndrome (SIDS)
Between 2002 and 2010, low incidence rates were observed in the Netherlands (0.19 per 1,000 live born infants) [3]
The case group consisted of SUDI cases aged 0–12 months who died in the period 2014 up to 2020 in the Netherlands, and were reported to the SUDI Expert Group of the Dutch Pediatric Society
Summary
Sudden Unexpected Death in Infancy (SUDI) is a broad term used to describe the sudden unexpected death of an infant without an apparent cause, which includes Sudden Infant Death Syndrome (SIDS). Taylor et al [3], proposed a set of six codes from the International Classification of Diseases-10 (ICD-10), to encompass the majority of SUDI in eight high-income countries, to ensure better international comparison This set includes SIDS (R95), and for example accidental suffocation or strangulation in bed (W75) and other ill-defined and unspecified causes (R99). Both the incidence of SIDS and SUDI have largely declined in high-income countries since the 1980s, when the advice was given not to place infants to sleep prone [4]. Prevention advice may receive less attention, potentially leading to increasing incidence rates It is currently unknown whether the risks for SUDI changed in the Netherlands, and if other risk factors might be present. The aim of this study was to examine the current risks and preventive factors for SUDI in Dutch infants, in order to determine if it is necessary to adapt the prevention advice toward the current needs
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