Zespół nagłej śmierci łóżeczkowej niemowląt (sids)

Zespół nagłej śmierci łóżeczkowej niemowląt (sids)
Epidemiologia

Zespół Nagłej Śmierci Łóżeczkowej Niemowląt (SIDS) definiowany jest jako nagła, niewyjaśniona śmierć dziecka poniżej 1 roku życia, najczęściej podczas snu, bez oznak walki. SIDS stanowi około 80% wszystkich nagłych i nieoczekiwanych zgonów niemowląt (SUID/SUDI) i jest najczęstszą przyczyną zgonów niemowląt w krajach zachodnich między 1 a 12 miesiącem życia. Wskaźniki SIDS różnią się geograficznie i etnicznie, np. w USA w 2022 roku odnotowano 1529 zgonów z powodu SIDS, a najwyższe ryzyko obserwuje się wśród rdzennych Amerykanów i populacji afroamerykańskiej. Największa zachorowalność przypada na wiek 2-4 miesięcy, a 90% przypadków występuje przed 6 miesiącem życia. Kluczowe czynniki ryzyka to pozycja snu na brzuchu (zwiększająca ryzyko nawet sześciokrotnie), spanie na miękkich powierzchniach, współspanie, palenie matki w ciąży, niska masa urodzeniowa, brak karmienia piersią oraz przegrzanie. Kampanie prewencyjne, takie jak „Back to Sleep”, znacząco obniżyły wskaźniki SIDS, np. w USA z 1,2 do 0,56 na 1000 żywych urodzeń w latach 1992-2001.

Definicja i znaczenie Zespołu Nagłej Śmierci Łóżeczkowej Niemowląt (SIDS)
Epidemiologia SIDS – globalny przegląd

Trendy czasowe w epidemiologii SIDS
Różnice etniczne i rasowe w epidemiologii SIDS
Czynniki demograficzne w epidemiologii SIDS

Nadzór i monitorowanie SIDS

Systemy nadzoru i monitorowania
Wyzwania w nadzorze i monitorowaniu

Czynniki ryzyka i charakterystyka epidemiologiczna SIDS

Różnice geograficzne i środowiskowe
Czynniki genetyczne i biologiczne
Model potrójnego ryzyka w epidemiologii SIDS

Kampanie prewencyjne i ich wpływ na epidemiologię SIDS

Aktualne zalecenia i strategie prewencyjne
Wyzwania i ograniczenia kampanii prewencyjnych

Nowe kierunki badań nad epidemiologią SIDS

Nowe odkrycia w epidemiologii SIDS
Wyzwania i przyszłe kierunki w nadzorze epidemiologicznym SIDS
Kolejne rozdziały

Definicja i znaczenie Zespołu Nagłej Śmierci Łóżeczkowej Niemowląt (SIDS)

Zespół Nagłej Śmierci Łóżeczkowej Niemowląt (SIDS, ang. Sudden Infant Death Syndrome) definiuje się jako nagłą i nieoczekiwaną śmierć dziecka poniżej 1 roku życia, która pozostaje niewyjaśniona nawet po dokładnym badaniu, obejmującym kompletną sekcję zwłok, badanie miejsca zgonu oraz szczegółowy przegląd historii klinicznej i społecznej¹². SIDS występuje najczęściej podczas snu i zwykle nie ma żadnych oznak walki czy hałasu³. Jest to najczęstsza przyczyna zgonów niemowląt w krajach zachodnich pomiędzy 1 miesiącem a 1 rokiem życia, stanowiąc około połowy wszystkich zgonów w okresie postneonatalnym⁴³.

SIDS jest częścią szerszej kategorii nagłych nieoczekiwanych zgonów niemowląt (SUID – Sudden Unexpected Infant Deaths lub SUDI – Sudden Unexpected Death in Infancy), które obejmują również inne przyczyny nagłych zgonów, takie jak przypadkowe uduszenie, nieznane przyczyny oraz zgony z powodu chorób genetycznych czy infekcji⁵⁶. SIDS stanowi około 80% wszystkich nagłych i nieoczekiwanych zgonów niemowląt³.

Epidemiologia SIDS – globalny przegląd

W skali globalnej SIDS spowodował około 19 200 zgonów w 2015 roku, co oznacza spadek w porównaniu do 22 000 zgonów w 1990 roku⁷. Częstość występowania SIDS różni się znacząco w zależności od kraju – od 0,05 na 1000 żywych urodzeń w Hongkongu do 6,7 na 1000 wśród rdzennych Amerykanów⁷. W 2022 roku w Stanach Zjednoczonych odnotowano około 3700 przypadków nagłych nieoczekiwanych zgonów niemowląt (SUID), z czego 1529 zgonów przypisano bezpośrednio zespołowi SIDS⁸.

Wskaźniki SIDS znacząco różnią się w zależności od kraju, a także między różnymi grupami etnicznymi i rasowymi w obrębie tych samych krajów. Najwyższe wskaźniki obserwuje się wśród rdzennych społeczności w krajach o wysokich dochodach oraz wśród populacji afroamerykańskiej w Stanach Zjednoczonych⁹¹⁰. W Wielkiej Brytanii w 2022 roku odnotowano 171 niewyjaśnionych zgonów niemowląt, co daje wskaźnik 0,28 zgonu na 1000 żywych urodzeń, co stanowi spadek z 0,30 zgonów na 1000 żywych urodzeń w 2021 roku¹¹.

Trendy czasowe w epidemiologii SIDS

Od lat 90. XX wieku, po wprowadzeniu kampanii zalecających układanie niemowląt do snu na plecach (tzw. kampanie „Back to Sleep”), odnotowano znaczący spadek liczby przypadków SIDS w wielu krajach⁵⁶. W Stanach Zjednoczonych wskaźnik SIDS spadł z 1,2 na 1000 żywych urodzeń w 1992 roku do 0,56 na 1000 w 2001 roku, podczas gdy odsetek niemowląt układanych do snu na plecach wzrósł z 13% do 72%¹².

W latach 1983-1994 w USA SIDS był przyczyną 61 882 zgonów niemowląt. W okresie 1983-1990 wskaźnik SIDS zmniejszał się średnio o 1,6% rocznie, natomiast w latach 1990-1994 – już o 5,6% rocznie¹³. Badania prowadzone w Australii, Anglii i Walii oraz Stanach Zjednoczonych wykazały, że część spadku wskaźników SIDS pod koniec lat 90. była prawdopodobnie spowodowana zmianą diagnostyczną – gdy wskaźniki SIDS malały, jednocześnie rosły wskaźniki zgonów przypisywanych innym przyczynom, takim jak przypadkowe urazy (np. uduszenie) oraz stany niewyjaśnione (np. przyczyny nieustalone, nieznane)⁹.

W niektórych krajach, takich jak Australia, Kanada, Anglia i Walia, Niemcy, Japonia i Holandia, śmiertelność niemowląt z powodu SIDS stale spadała w pierwszej dekadzie XXI wieku, podczas gdy w innych, zwłaszcza w USA i Nowej Zelandii, utrzymywała się na stabilnym poziomie⁶¹⁰.

Różnice etniczne i rasowe w epidemiologii SIDS

Istotne różnice w częstości występowania SIDS obserwuje się między różnymi grupami etnicznymi i rasowymi. W Stanach Zjednoczonych wskaźniki SIDS są wyższe wśród niemowląt czarnoskórych i rdzennych Amerykanów w porównaniu do niemowląt rasy białej²¹⁰. Niemowlęta czarnoskóre mają trzy razy większe prawdopodobieństwo zgonu niż niemowlęta latynoskie i dwa razy większe niż niemowlęta białe¹⁴.

W latach 1983-1989 oraz 1990-1994 wskaźnik SIDS dla niemowląt czarnoskórych zmniejszył się o 10,4%, a dla niemowląt białych o 16,7%. Średni roczny spadek wskaźnika SIDS dla niemowląt czarnoskórych wynosił 2,1% w latach 1983-1990 i 4,1% w latach 1990-1994, podczas gdy dla niemowląt białych spadki te wynosiły odpowiednio 1,4% i 6,3%¹⁵. Jak pokazują dane wstępne, stosunek czarnych do białych w przypadku SIDS w 1995 roku (2,4) był wyższy niż w jakimkolwiek innym roku od 1983 roku, co wskazuje na pogłębiające się różnice rasowe/etniczne w SIDS¹⁶.

Czynniki demograficzne w epidemiologii SIDS

Najwyższa zachorowalność na SIDS występuje między 2 a 4 miesiącem życia, a 90% przypadków występuje przed ukończeniem 6 miesiąca życia²¹⁷. SIDS jest częstszy u chłopców niż u dziewczynek, w stosunku 3:2¹⁷. Większość zgonów z powodu SIDS (83%) występuje podczas snu nocnego, choć często po północy, a co najmniej cztery zgony SIDS wystąpiły w każdej godzinie dnia¹⁸.

Analiza danych z Wielkiej Brytanii pokazała, że w 2022 roku wskaźnik niewyjaśnionej umieralności niemowląt był najwyższy wśród matek w wieku poniżej 20 lat i wynosił 0,81 zgonów na 1000 żywych urodzeń¹¹. Badania wykazały, że 95% przypadków SIDS wiązało się z co najmniej jednym czynnikiem ryzyka, a 78% przypadków wiązało się z co najmniej dwoma czynnikami ryzyka².

Nadzór i monitorowanie SIDS

Dane dotyczące statystyk życiowych, a w szczególności rejestry żywych urodzeń i zgonów niemowląt, są typowym źródłem informacji o trendach populacyjnych w SIDS i SUID¹. Do kodowania i monitorowania trendów SIDS na całym świecie wykorzystywany jest Międzynarodowy System Klasyfikacji Chorób (ICD). SIDS, po raz pierwszy zdefiniowany w 1969 roku, nie miał przypisanego unikalnego kodu ICD aż do ICD-9 w 1979 roku. Jednak w 1973 roku amerykańskie Narodowe Centrum Statystyk Zdrowia stworzyło odrębny kod ICD-8 dla SIDS (795.0) do stosowania w Stanach Zjednoczonych. SIDS został wprowadzony na całym świecie w ICD-9 jako 798.0. W ICD-10, R95 jest kodem dla SIDS¹.

Ze względu na zmiany preferencji diagnostycznych i wynikające z nich różnice w kodowaniu ICD, obserwuje się dużą zmienność w raportowaniu zgonów w statystykach życiowych⁵. Zmiana diagnostyczna utrudniła nadzór nad SIDS, ponieważ nie można już polegać na pojedynczym kodzie ICD do monitorowania i porównywania trendów, zwłaszcza między jurysdykcjami i krajami⁹.

Systemy nadzoru i monitorowania

W odpowiedzi na problemy z jednolitym kodowaniem i monitorowaniem, badacze zaczęli grupować kody ICD dla SIDS, przypadkowego uduszenia i innych niespecyficznych stanów w celu stworzenia bardziej znaczącego podmiotu do celów nadzoru i badań. Łącznie zgony te są konceptualizowane jako SUID lub SUDI⁵. SUDI jest preferowanym terminem w Europie i Australii, podczas gdy SUID jest częściej używane w Stanach Zjednoczonych⁵.

W Stanach Zjednoczonych Wydział Zdrowia Reprodukcyjnego CDC udostępnia informacje i zalecenia mające na celu zmniejszenie ryzyka SUID i SIDS⁸. W Nowym Meksyku wdrożono projekt CESDI SUDI mający na celu uzyskanie szczegółowych informacji na temat epidemiologii i aktualnych czynników ryzyka związanych z SIDS po kampanii „Back to Sleep” w 1991 roku¹⁹.

Trzeci Międzynarodowy Kongres ds. Niewyjaśnionych Zgonów Niemowląt i Dzieci, który odbył się w listopadzie 2018 roku w Instytucie Radcliffe’a na Uniwersytecie Harvarda, miał na celu dostosowanie obecnego naukowego zrozumienia nagłej nieoczekiwanej śmierci niemowląt/dzieci do nomenklatury certyfikacji i kodowania²⁰. Zalecono cztery kategorie (kategorie MH11, MH12, MH14, PB00-PB0Z Międzynarodowej Klasyfikacji Chorób (ICD)-11) do klasyfikacji i dostarczono wyraźne definicje i wskazówki dla certyfikujących zgony²¹.

Wyzwania w nadzorze i monitorowaniu

W ostatnim dziesięcioleciu nastąpiła zauważalna zmiana w praktyce raportowania zgonów niemowląt, zarówno w Kanadzie, jak i na całym świecie, co utrudnia ocenę częstości występowania SIDS. Od 2012 roku SIDS nie jest już używany do klasyfikacji zgonów niemowląt w większości prowincji/terytoriów w Kanadzie. Zgony te są zamiast tego klasyfikowane jako przyczyna „nieustalona”²².

Wysiłki w zakresie diagnozy, nadzoru, badań i zapobiegania są komplikowane przez znaczne rozbieżności w certyfikacji i kodowaniu tych zgonów²³. W centrum tej rozbieżności znajduje się sama koncepcja SIDS. Chociaż termin SIDS jest popierany przez Światową Organizację Zdrowia (WHO) i jest szeroko stosowany przez lekarzy, badaczy i opinię publiczną, jest on coraz częściej unikany przez patologów sądowych w wielu jurysdykcjach, którzy określają przyczynę i certyfikują nagłe zgony niemowląt²³.

Odsetek zgonów przypisywanych SIDS, które były poprzedzone autopsją, wzrósł z 85,8% w 1983 roku do 93,4% w 1990 roku i do 95,7% w 1994 roku¹⁵, co wskazuje na poprawę w diagnozowaniu i monitorowaniu SIDS.

Czynniki ryzyka i charakterystyka epidemiologiczna SIDS

Liczne badania epidemiologiczne zidentyfikowały szereg czynników ryzyka związanych z SIDS. Wśród najważniejszych wymienia się:²⁴²⁵:

Spanie w pozycji na brzuchu lub na boku
Spanie na miękkich powierzchniach
Spanie z miękkimi przedmiotami
Współspanie z rodzicem/rodzicami
Palenie przez matkę podczas ciąży
Wiek matki poniżej 20 lat
Późna lub brak opieki prenatalnej
Przedwczesny poród
Niska masa urodzeniowa
Brak karmienia piersią
Przegrzanie

Pozycja podczas snu jest jednym z najsilniejszych czynników ryzyka SIDS. Pozycja na brzuchu i na boku jest znacznie bardziej niebezpieczna niż pozycja na plecach²⁶. Niemowlę ułożone do snu na brzuchu jest nawet sześć razy bardziej narażone na SIDS niż niemowlę ułożone na plecach¹¹.

Różnice geograficzne i środowiskowe

Badania wykazały znaczne różnice w związku między temperaturą a SIDS w różnych społecznościach. W Nowej Zelandii i Australii (10 społeczności) związek był konsekwentnie silny; w Europie (siedem społeczności) wahał się od silnego do słabego; a w USA (pięć społeczności) był umiarkowany lub słaby²⁷.

Istnieje hipoteza, że niska temperatura klimatyczna pośrednio zwiększa częstość występowania SIDS, szczególnie w krajach, gdzie temperatura klimatyczna na zewnątrz wpływa na temperaturę wewnątrz i nawyki dotyczące ubrań²⁷. Wiele zgonów SIDS wiąże się również z zanieczyszczeniem powietrza – ryzyko SIDS szacuje się na wzrost o 8% (przedział ufności 95%: 4%-14%) na 10 ppb ekspozycji na NO2 i 9% (przedział ufności 95%: 1%-12%) na 1 ppm ekspozycji na CO²⁸.

Czynniki genetyczne i biologiczne

Rodzeństwo niemowląt, które zmarły na SIDS, ma zwiększone ryzyko śmierci z powodu SIDS. Ryzyko śmierci z powodu SIDS jest 5-6 razy większe niż w populacji ogólnej²⁴. Badania pośmiertne dostarczyły najsilniejszych dowodów na to, że SIDS ma konkretną podstawę biologiczną²⁹.

Badacze z UC San Francisco zidentyfikowali sygnały w systemie metabolicznym niemowląt, które zmarły z powodu SIDS. U niemowląt z niższymi poziomami C-3 i podwyższonymi poziomami C-14OH wydaje się występować wyższe ryzyko śmierci z powodu SIDS³⁰.

Model potrójnego ryzyka w epidemiologii SIDS

Wiodąca teoria poparta literaturą to model potrójnego ryzyka, po raz pierwszy opisany w 1994 roku³¹. Model ten sugeruje, że SIDS jest wynikiem trzech jednoczesnych czynników:

Niemowlę musi mieć podstawową podatność, która predysponuje je do SIDS
Musi wystąpić stres z egzogennego źródła, takiego jak niedotlenienie związane z pozycją spania na brzuchu
Stres ten musi wystąpić w krytycznym okresie rozwoju (pierwsze 12 miesięcy życia)³²³¹

SIDS jest uważany za wynik złożonego modelu, który łączy czynniki genetyczne, środowiskowe i społeczno-kulturowe³³. Uważa się, że SIDS występuje, gdy trzy czynniki ryzyka (wrażliwe niemowlę, krytyczny okres rozwojowy we wczesnych miesiącach życia i stres środowiskowy) występują razem³².

Kampanie prewencyjne i ich wpływ na epidemiologię SIDS

Międzynarodowe wdrożenie kampanii zmniejszania ryzyka, podkreślających spanie na plecach pod koniec lat 80. i na początku lat 90., spowodowało spadek wskaźników SIDS w kilku krajach⁵. W 2000 roku wskaźniki SIDS wahały się od 0,12 zgonów na 1000 żywych urodzeń w Holandii do 1,10 zgonów na 1000 żywych urodzeń w Nowej Zelandii. Procent spadku również różnił się w zależności od kraju; wahał się od 10% spadku w Japonii do 79% spadku w Holandii⁵.

Kampania „Back to Sleep” zorganizowana przez Narodowe Instytuty Zdrowia i Amerykańską Akademię Pediatrii (AAP) spowodowała spadek liczby przypadków SIDS³⁴. Między 1992 a 2001 rokiem wskaźnik SIDS w USA spadł z 1,2 do 0,56 na 1000 żywych urodzeń, podczas gdy odsetek niemowląt śpiących w pozycji na plecach wzrósł z 13% do 72%¹².

W latach 1999-2004 Kanada odnotowała 50% spadek wskaźnika SIDS, co zbiegło się z wprowadzeniem zaleceń dotyczących układania niemowląt na plecach do snu, które zostały wzmocnione przez kampanię „Back to Sleep” w 1999 roku³⁵.

Wskaźnik SIDS w Anglii i Walii zmniejszył się o 80% od czasu wprowadzenia komunikatu „Back to Sleep” w 1991 roku¹¹. Dzielenie pokoju z niemowlęciem może zmniejszyć ryzyko SIDS o połowę¹¹.

Aktualne zalecenia i strategie prewencyjne

Amerykańska Akademia Pediatrii zaleca, aby niemowlęta były układane na plecach na twardej, płaskiej, niepochylonej powierzchni do spania przy każdym śnie, chyba że inne warunki medyczne uniemożliwiają to³⁶. Zaleca się również karmienie piersią, aby pomóc zapobiec infekcjom i jest to związane ze zmniejszonym ryzykiem SIDS³⁶.

Kampania „Safe to Sleep” (wcześniej znana jako „Back to Sleep”) nadal nagłaśnia czynniki ryzyka SIDS i zapewnia, że komunikaty prewencyjne docierają do wszystkich segmentów populacji, zwłaszcza tych o wysokim ryzyku SIDS¹⁶.

Najważniejsze modyfikowalne czynniki, które mogą obniżyć ryzyko, to: układanie niemowląt na plecach do snu przy każdym śnie, ochrona niemowląt przed narażeniem na dym tytoniowy przed i po urodzeniu, zapewnienie bezpiecznego środowiska do spania dla niemowląt oraz karmienie piersią – przez co najmniej 2 miesiące, z większą ochroną zapewnioną przy dłuższym czasie trwania³⁷.

Wyzwania i ograniczenia kampanii prewencyjnych

Mimo ciągłych wysiłków w zakresie zdrowia publicznego koncentrujących się na poprawie warunków snu, ze szczególnym uwzględnieniem grup wysokiego ryzyka, częstość występowania SIDS pozostaje wysoka¹⁷³⁸. SIDS nadal jest częstą przyczyną śmierci niemowląt w Wielkiej Brytanii, z wskaźnikiem 27/100 000 żywych urodzeń i 38/100 000 w Stanach Zjednoczonych¹⁷³⁸.

Badania wykazały, że tylko 10,4% rodzin niemowląt w wieku 0-5 miesięcy i 3,1% rodzin niemowląt w wieku 6-11 miesięcy stosowało się do wszystkich zaleceń dotyczących modyfikowalnych czynników ryzyka SIDS³⁹. Częstość występowania modyfikowalnych czynników ryzyka SIDS w badanej próbie była niedopuszczalnie duża, zwłaszcza w przypadku pozycji snu innych niż leżenie na plecach³⁹.

Po utrzymywaniu się na stałym poziomie przez lata, zgony niemowląt związane ze snem wzrosły o prawie 12% między 2020 a 2022 rokiem. Badacze uważają, że wzrost ten może być związany z tym, że rodzice nie otrzymali informacji na temat bezpiecznego snu podczas pandemii, gdy dostęp do opieki zdrowotnej mógł być bardziej ograniczony⁴⁰.

Nowe kierunki badań nad epidemiologią SIDS

Istnieje pilna potrzeba uzyskania wglądu w wcześniej niezbadane aspekty systemu mózgowego, ze szczególnym uwzględnieniem grup wysokiego ryzyka³³. Postęp w badaniach nad SIDS wydaje się być fundamentalny dla ostatecznego celu, jakim jest wyeliminowanie zgonów z powodu SIDS³³.

Złożony model, który łączy różne dane dotyczące czynników ryzyka z biomarkerów i analizy omicznej, może stanowić narzędzie do identyfikacji profilu ryzyka SIDS w placówkach dla noworodków. Jeśli zostanie wykryte wysokie ryzyko, niemowlę może zostać skierowane do dalszych badań i obserwacji³³.

Nowe badanie opublikowane w JAMA Network Open analizuje wskaźniki SIDS i SUID przed pandemią, w trakcie pandemii i w określonym okresie pandemii, gdy nastąpił wzrost infekcji poza sezonem z powodu złagodzenia ograniczeń pandemicznych (czerwiec-listopad 2021). Badacze odkryli, że wskaźniki SUID wzrosły w tych okresach, co sugeruje, że infekcje układu oddechowego (konkretnie wskazują na RSV) mogą odgrywać rolę w SUID i SIDS⁴¹.

Badanie to wykazało zwiększone wskaźniki zarówno SUID, jak i SIDS podczas pandemii COVID-19, z istotną zmianą w epidemiologii z okresu przed pandemią odnotowaną od czerwca do grudnia 2021 roku. Ustalenia te potwierdzają hipotezę, że powrót endemicznych patogenów zakaźnych poza sezonem może być związany z wskaźnikami SUID, przy czym wskaźniki RSV w USA ściśle przybliżają tę zmianę⁴².

Nowe odkrycia w epidemiologii SIDS

Od najwcześniejszych badań epidemiologicznych na temat śmierci łóżeczkowej lub SIDS, istniały wyraźne wskazania, że infekcja, zwłaszcza wirusowa infekcja dróg oddechowych, była związana z tymi zgonami⁴³. Hipoteza wspólnej toksyny bakteryjnej została opracowana na podstawie tego, że infekcja wirusowa (wraz z położeniem na brzuchu) wywoływała zmiany w górnych drogach oddechowych sprzyjające produkcji toksyn przez bakterie toksynotwórcze, które często kolonizują nosogardło⁴³.

W 50% przypadków toksyny gronkowcowe zostały wykazane w tkankach niemowląt SIDS⁴⁴. Hipoteza sugerowała, że infekcja wirusowa działała jako wyzwalacz dla zdarzeń prowadzących do superantygenowego wstrząsu toksycznego poprzez aktywację komórek T przez enterotoksyny gronkowcowe lub toksynę zespołu wstrząsu toksycznego-1⁴⁴.

Drogi oddechowe w SIDS często wykazują dowody zaangażowania zapalnego dróg oddechowych i płuc. Proces zapalny może obejmować agregację płytek krwi i obturację naczyń włosowatych płuc przez agregaty płytek krwi i leukocyty⁴⁴. Może to dostarczyć wskazówek do patogenezy wewnątrzpiersiowych wybroczyn obserwowanych w 80-90% przypadków SIDS⁴⁴.

Wyzwania i przyszłe kierunki w nadzorze epidemiologicznym SIDS

Rola infekcji w SIDS była w dużej mierze ignorowana przez głównych badaczy⁴⁴. Przekonujące wyjaśnienie czynnika ryzyka, jakim jest pozycja spania na brzuchu, nie zostało osiągnięte przez główny nurt⁴⁴.

Istnieje jednak przekonujące wyjaśnienie zawarte w dwóch dobrze zaprojektowanych i niezależnych, geograficznie odmiennych badaniach epidemiologicznych, które łączą infekcję (z pozycją spania na brzuchu) z SIDS⁴⁵.

SIDS jest w dużej mierze chorobą biedy, złej higieny, przeludnienia, wcześniactwa, narażenia na dym w ciąży i po urodzeniu⁴⁵. Fakty te powinny zwrócić naszą uwagę na możliwość, że czynnik epizootyczny odgrywa rolę, oprócz sezonowych wirusów oddechowych⁴⁵.

Dalsze badania nad czynnikami ryzyka, przyczynami i mechanizmami patofizjologicznymi SIDS i innych zgonów niemowląt związanych ze snem są zachęcane, z ostatecznym celem całkowitego wyeliminowania tych zgonów⁴⁶.

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Materiały źródłowe

#1 The Epidemiology of Sudden Infant Death Syndrome and Sudden Unexpected Infant Deaths: Diagnostic Shift and other Temporal Changes – SIDS Sudden Infant and Early Childhood Death – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK513373/
To provide a detailed review of the changing epidemiology related to sudden infant death syndrome (SIDS) and sudden unexpected infant deaths (SUID), this chapter begins with an overview of the international system used to code and monitor SIDS trends around the world. […] We include a discussion of why using a single code to monitor sudden unexpected and unexplained infant deaths is no longer informative and discuss how new efforts to group codes for surveillance may allow for more consistent monitoring and comparison across jurisdictions and countries. Finally, we provide a description of the epidemiologic profile of SIDS and SUID, including information about current rates and historical trends, and sudden unexpected death in children 1 year old and over. […] Vital statistics data, specifically records from live birth and infant death registration, are the typical source of information on population trends in SIDS and SUID. […] The ICD is currently in its 10th Revision (ICD-10). SIDS, first defined in 1969, did not have a unique ICD code assigned until the ICD-9 in 1979. However, in 1973, the US National Center for Health Statistics (NCHS) created a distinct ICD-8 code for SIDS (795.0) for use in the United States. SIDS was introduced worldwide in ICD-9 as 798.0. In ICD-10, R95 is the code for SIDS. The SIDS code is indexed in the ICD chapter of nonspecific causes of death.
#2 Sudden Infant Death Syndrome – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK560807/
Sudden infant death syndrome (SIDS) is the abrupt and unexplained death of an infant less than 1-year old. SIDS is the leading cause of death in the United States in infants one to twelve months of age. […] According to the Centers for Disease Control and Prevention (CDC), the incidence of SIDS in 2017 was 35.4 per 100,000 live births in the United States. […] In the United States, CDC reports reflect similar variations among non-Hispanic Black Americans, Native Americans, the non-Hispanic white population, Hispanics, and the Asian population. […] The peak incidence occurs between 2 and 4 months, and 90 percent of cases occur before six months of age. […] Studies suggest that 95% of the SIDS cases were associated with at least one risk factor, and 78% of the cases were associated with at least two risk factors.
#3 SIDS – Wikipedia
https://en.wikipedia.org/wiki/SIDS
Sudden infant death syndrome (SIDS), sometimes known as cot death or crib death, is the sudden unexplained death of a child of less than one year of age. Diagnosis requires that the death remain unexplained even after a thorough autopsy and detailed death scene investigation. SIDS usually occurs during sleep. Typically death occurs between the hours of midnight and 9:00 a.m. There is usually no noise or evidence of struggle. SIDS remains the leading cause of infant mortality in Western countries, constituting half of all post-neonatal deaths. […] The exact cause of SIDS is unknown. The requirement of a combination of factors including a specific underlying susceptibility, a specific time in development, and an environmental stressor has been proposed. These environmental stressors may include sleeping on the stomach or side, overheating, and exposure to tobacco smoke. Accidental suffocation from bed sharing (also known as co-sleeping) or soft objects may also play a role. Another risk factor is being born before 37 weeks of gestation. Between 1% and 5% of SIDS cases are estimated to be misidentified infanticides caused by intentional suffocation. SIDS makes up about 80% of sudden and unexpected infant deaths (SUIDs). The other 20% of cases are often caused by infections, genetic disorders, and heart problems.
#4 Sudden Infant Death Syndrome: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/804412-overview
Sudden unexpected infant deaths (SUIDs) are deaths in infants younger than 12 months of age that occur suddenly, unexpectedly, and without obvious cause. Sudden infant death syndrome (SIDS), the leading cause of SUID in the United States, is diagnosed only after a thorough investigation of the scene, interview of caregivers, and a complete forensic autopsy. […] In the United States, approximately 4,500 infants die suddenly of no immediately obvious cause every year; about half of these deaths are due to SIDS, the leading cause of all infant deaths. […] SIDS is defined as the sudden, unexpected death of an infant less than 1 year of age that cannot be explained despite a thorough investigation, including a complete autopsy, examination of the death scene, and review of the clinical and social history. SIDS is the leading cause of death among infants aged 1-12 months, and is the third leading cause overall of infant mortality in the United States. […] Although the overall rate of SIDS in the United States has declined by more
#5 The Epidemiology of Sudden Infant Death Syndrome and Sudden Unexpected Infant Deaths: Diagnostic Shift and other Temporal Changes – SIDS Sudden Infant and Early Childhood Death – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK513373/
Diagnostic preferences, and the resulting ICD coding differences, have led to wide variation in how deaths are represented in vital statistics. […] Consequently, researchers began grouping ICD codes for SIDS, accidental suffocation, and other nonspecific conditions together to comprise a more meaningful entity for surveillance and research purposes. Together, these deaths are conceptualized as SUID or sudden unexpected (or unexplained) death in infancy (SUDI). SUDI is the preferred term in Europe and Australia, whereas SUID is more commonly used in the United States. […] Internationally, the implementation of risk reduction campaigns emphasizing back sleeping in the late 1980s and early 1990s resulted in a decline in SIDS rates in several countries. […] In 2000, SIDS rates ranged from 0.12 deaths per 1,000 live births in the Netherlands to 1.10 deaths per 1,000 live births in New Zealand. The per cent decrease also varied by country; ranging from a 10% decrease in Japan to a 79% decrease in the Netherlands.
#6 Sudden infant death syndrome: Etiology a | Biomedical Research
https://www.currentpediatrics.com/articles/sudden-infant-death-syndrome-etiology-and-epidemiology-17855.html
SIDS has been documented for more than 2000 years. […] In certain countries, including Australia, Canada, England and Wales, Germany, Japan, and the Netherlands, infant mortality from SIDS has steadily decreased over the first decade of this century, while it has stayed stable in others, notably the United States and New Zealand. […] Sudden Infant Death Syndrome (SIDS), unintentional suffocation and strangling in bed, and other ill-defined causes of death are all included in SUID. […] While SIDS mortality has decreased in recent years, mortality from unintentional suffocation and strangling in bed, as well as other ill-defined causes, has increased. […] The „Back to Sleep” initiatives have been credited with a significant decrease in death during the 1990s, particularly with reference to SIDS mortality.
#7 SIDS – Wikipedia
https://en.wikipedia.org/wiki/SIDS
Rates of SIDS vary nearly tenfold in developed countries from one in a thousand to one in ten thousand. Globally, it resulted in about 19,200 deaths in 2015, down from 22,000 deaths in 1990. SIDS was the third leading cause of death in children less than one year old in the United States in 2011. It is the most common cause of death between one month and one year of age. About 90% of cases happen before six months of age, with it being most frequent between two months and four months of age. It is more common in boys than girls. Rates of SIDS have decreased by up to 80% in areas with „Safe to Sleep” campaigns. […] Globally, SIDS resulted in about 22,000 deaths as of 2010, down from 30,000 deaths in 1990. Rates vary significantly by population from 0.05 per 1000 in Hong Kong to 6.7 per 1000 in Native Americans. SIDS was responsible for 0.54 deaths per 1,000 live births in the US in 2005. It is responsible for far fewer deaths than congenital disorders and disorders related to short gestation, though it is the leading cause of death in healthy infants after one month of age. SIDS deaths in the US decreased from 4,895 in 1992 to 2,247 in 2004, a 54% decrease. During a similar time period, 1989 to 2004, SIDS as the cause of death for sudden infant death (SID) decreased from 80% to 55%, a 31% decrease. According to John Kattwinkel, chairman of the Centers for Disease Control and Prevention (CDC) Special Task Force on SIDS „A lot of us are concerned that the rate (of SIDS) isn’t decreasing significantly, but that a lot of it is just code shifting”.
#8 Data and Statistics for SUID and SIDS | SUID and SIDS | CDC
https://www.cdc.gov/sudden-infant-death/data-research/data/index.html
Sudden unexpected infant deaths include: Sudden infant death syndrome (SIDS). […] In 2022, there were about 3,700 sudden unexpected infant deaths (SUID) in the United States. There were: 1,529 deaths from SIDS. […] CDC’s Division of Reproductive Health (DRH) shares information and recommendations to reduce the risk of SUID and SIDS.
#9 The Epidemiology of Sudden Infant Death Syndrome and Sudden Unexpected Infant Deaths: Diagnostic Shift and other Temporal Changes – SIDS Sudden Infant and Early Childhood Death – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK513373/
Studies in Australia, England and Wales, and the United States showed that some of the decline in SIDS rates in the late 1990s was likely due to a diagnostic shift. […] As SIDS rates declined, rates of death attributed to other causes like unintentional injuries (e.g. accidental suffocation), and ill-defined conditions (e.g. undetermined, unknown, and unascertained causes) increased. […] The diagnostic shift has made surveillance of SIDS challenging, as we can no longer rely on a single ICD code to monitor and compare trends, especially across jurisdictions and countries. […] High rates of SIDS and SUID still exist among some racial and ethnic groups, especially among Indigenous populations in high-income countries and among US non-Hispanic black populations.
#10
https://www.alliedacademies.org/articles/sudden-infant-death-syndrome-etiology-and-epidemiology-17855.html
This study reviewed the literature regarding causes and epidemiology of Sudden Infant Death Syndrome (SIDS). […] SIDS is characterized by an unexpected death while sleeping, and it usually occurs in a previously healthy infant during the first 12 months of life. […] SIDS is a subgroup of Sudden Unexpected Infant Deaths (SUID), which accounts for roughly half of all instances. […] In certain countries, including Australia, Canada, England and Wales, Germany, Japan, and the Netherlands, infant mortality from SIDS has steadily decreased over the first decade of this century, while it has stayed stable in others, notably the United States and New Zealand. […] SIDS is more common in Black and Native American newborns, as well as in socioeconomically disadvantaged groups. […] SIDS is most common between the ages of two and four months, with 90 percent of cases occurring before the age of six months.
#11 Statistics on SIDS | The Lullaby Trust
https://www.lullabytrust.org.uk/professionals-hub/statistics-on-sids/
Since parents and carers have been following the risk reduction advice first promoted in the early 1990s, the number of infants dying has fallen significantly. Sudden infant death syndrome (SIDS) is the sudden and unexplained death of an infant where no cause is found after detailed post mortem. 189 babies die from SIDS every year in the UK. 91 % of SIDS happen in the first six months of life. Sharing a room with your baby can halve the risk of SIDS. An infant placed on their front to sleep is up to six times more at risk of SIDS than one placed on their back. The rate of SIDS in England and Wales has reduced by 80% since the Back to Sleep message was launched in 1991. Babies born at low birthweight (2.5kg or 5.5 pounds) are four times more at risk of SIDS than babies born over this weight. In 2022, the unexplained infant mortality rate was highest for mothers aged under 20 years, at 0.81 deaths per 1,000 live births. Sleeping on a sofa or armchair with a baby can increase the chance of SIDS by up to 50 times. Over a third of SIDS deaths could be avoided if no women smoked during pregnancy. Approximately nine babies die suddenly and unexpectedly in England and Wales per week. There were 171 unexplained infant deaths in England and Wales in 2022, a rate of 0.28 deaths per 1,000 live births: a decrease from 0.30 deaths per 1,000 live births in 2021. The peak age for SIDS is 1-2 months, however it’s important that families are encouraged to continue with room-sharing up to six months as 91% of SIDS occur during this period. Our safer sleep advice explains the steps you can take to keep your baby safer, reducing the risk of sudden infant death syndrome (SIDS). Safer sleep advice saves babies lives. Reduce the risk of SIDS by giving our evidence-based safer sleep advice in your practice, and help us empower families.
#12 Preventing Sudden Infant Death Syndrome
https://www.uspharmacist.com/article/preventing-sudden-infant-death-syndrome
Sudden infant death syndrome (SIDS), also called crib or cot death, is the major cause of mortality in infants aged between 1 month and 1 year in the United States. Since the 1990s, however, new studies in pathology and epidemiology have provided the basis for understanding SIDS. […] In the U.S., the incidence of SIDS has declined by more than 50% since the mid-1980s; the greatest reduction occurred after 1992, when the American Academy of Pediatrics (AAP) issued a recommendation to reduce the risk of SIDS by placing infants in a supine position for sleep. Between 1992 and 2001, the SIDS rate in the U.S. fell from 1.2 to 0.56 per 1,000 live births, while the proportion of infants sleeping in the supine position increased from 13% to 72%. […] The rate of SIDS peaks between ages 2 and 4 months, and 90% of cases occur before age 6 months. Approximately 12% of SUIDs occur during the neonatal period and 4% during the first week of the neonates life.
#13 Sudden Infant Death Syndrome — United States, 1983-1994
https://www.cdc.gov/Mmwr/preview/mmwrhtml/00043987.htm
Sudden infant death syndrome (SIDS) is „the sudden death of an infant under 1 year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history.” […] Although SIDS is a diagnosis of exclusion and of unknown etiology, it is the leading cause of postneonatal mortality in the United States, accounting for approximately one-third of all such deaths. […] This report analyzes age-, race-, and region-specific trends for SIDS in the United States during 1983-1994 and indicates that annual rates of SIDS declined more than three times faster during 1990-1994 than during 1983-1989. […] During 1983-1994, SIDS was listed as the underlying cause of death for 61,882 infants. […] During 1983-1990, the rate of SIDS decreased an average of 1.6% per year; during 1990-1994, the rate decreased an average of 5.6% per year.
#14 Whatâs New
https://www.cdph.ca.gov/Programs/CFH/DMCAH/SIDS/Pages/default.aspx
To get SIDS community input, law mandates the appointment of the SIDS Advisory Council, a nine-member council of representatives from parent groups and professionals who provide services to families impacted by SUID. The council advises the California Department of Public Health on training and educational programs, recommends action to address disparities, and helps convene an annual statewide conference. […] Since 2008, SUID rates have declined for all race/ethnic groups. Black infants remain three times more likely to die than Hispanic infants and twice as likely to die than White infants. The Black SUID rate remains more than twice the California SUID rate.
#15 Sudden Infant Death Syndrome — United States, 1983-1994
https://www.cdc.gov/Mmwr/preview/mmwrhtml/00043987.htm
Most SIDS cases occurred during the postneonatal period; 93.7% and 92.4% of SIDS cases occurred in this age group in 1994 and 1983, respectively. […] The postneonatal SIDS rate was 13.9% lower during 1990-1994 than during 1983-1989. […] Rates for SIDS were highest among infants aged 1-3 months at death: in 1994, deaths in this age group accounted for 68.4% of all SIDS cases. […] From 1983-1989 through 1990-1994, the SIDS rate for black infants decreased 10.4% and the rate for white infants decreased 16.7%. […] The average annual decline in the rate of SIDS for black infants was 2.1% during 1983-1990 and 4.1% during 1990-1994. […] For white infants, the decreases for the two periods were 1.4% and 6.3%, respectively. […] The percentage of deaths attributed to SIDS that were followed by an autopsy increased from 85.8% in 1983 to 93.4% in 1990 and to 95.7% in 1994.
#16 Sudden Infant Death Syndrome — United States, 1983-1994
https://www.cdc.gov/Mmwr/preview/mmwrhtml/00043987.htm
The findings in this report indicate that the decline in the rate of SIDS was greater during 1990-1994 than during 1983-1989. […] Based on preliminary data, the black/white ratio for SIDS in 1995 (2.4) was higher than during any other year since 1983, indicating that racial/ethnic disparities in SIDS may be increasing. […] The Back to Sleep campaign should continue to publicize risk factors for SIDS and ensure that prevention messages reach all segments of the population, especially those at high risk for SIDS.
#17 Sudden infant death syndrome: Etiology a | Biomedical Research
https://www.currentpediatrics.com/articles/sudden-infant-death-syndrome-etiology-and-epidemiology-17855.html
Approximately 70% of babies currently sleep in the supine position. […] SIDS is more common in Black and Native American newborns, as well as in socioeconomically disadvantaged groups. […] SIDS is most common between the ages of two and four months, with 90 percent of cases occurring before the age of six months. […] SIDS is more common in boys than in girls, with a 3:2 ratio. […] Despite ongoing public health efforts focusing on improving sleep circumstances, with a particular focus on high-risk groups, the prevalence of SIDS remains high. […] SIDS is still a common cause of infant death in the United Kingdom, with a rate of 27/100,000 live births and 38/100,000 in the United States. […] In the United States, about 3600 infants die each year from Sudden Unexpected Infant Death (SUID).
#18 Sudden Infant Death Syndrome and the time of death: factors associated with night-time and day-time deaths | International Journal of Epidemiology | Oxford Academic
https://academic.oup.com/ije/article/35/6/1563/660060
Objective To investigate the diurnal occurrence of Sudden Infant Death Syndrome (SIDS) and interaction with established risk factors in the infant sleeping environment. […] The majority of SIDS deaths (83%) occurred during night-time sleep, although this was often after midnight and at least four SIDS deaths occurred during every hour of the day. […] SIDS can happen at any time of the day and relatively quickly. Parents need to be made aware that placing infants supine and keeping them under supervision is equally important for day-time sleeps. […] Sudden Infant Death Syndrome (SIDS) predominantly occurs during infant sleep periods and common infant care practices associated with this environment have been established as having an adverse or beneficial effect. […] Recent reports from New Zealand and the Nordic countries suggest that diurnal variations in major risk factors for SIDS may signify different causal mechanisms; prone sleep position was more strongly associated with SIDS occurring during day-light hours, while night-time deaths were more strongly associated with co-sleeping, maternal smoking, alcohol and drug consumption, infant illness, and the non-prone sleeping position.
#19 Sudden Infant Death Syndrome and the time of death: factors associated with night-time and day-time deaths | International Journal of Epidemiology | Oxford Academic
https://academic.oup.com/ije/article/35/6/1563/660060
Characteristically SIDS deaths occur in unobserved infant sleep periods, even for day-time deaths. […] The study of Sudden Unexpected Deaths in Infancy (part of the Confidential Enquiry into Stillbirths and Deaths in Infancy: CESDI SUDI study) was designed to elicit detailed information on the epidemiology and current risk factors associated with SIDS after the âBack to Sleepâ campaign in 1991 and subsequent fall in rates. […] The interaction between the position in which the infant was placed for sleep and whether this was a day-time or night-time sleep was significant, although this was largely due to infants being placed on their side rather than prone. […] Co-sleeping was a significant risk for both night-time and day-time sleep as was infants sleeping in a different room from their parents.
#20
https://link.springer.com/article/10.1007/s12024-019-00156-9
Current classification practices have poor reliability and undermine accounting of progress. […] The international adoption of SIDS terminology in 1969 was intended to identify infants dying from unknown causes in order to investigate their deaths as a distinct but unexplained entity in infancy. […] Ensuing epidemiological research found risks associated with infant sleep environments, which in turn spurred public health efforts and led to a worldwide transformation in infant care practices and the promotion of formal death scene investigations. […] The 3rd International Congress on Sudden Infant and Child Death was convened to align the current scientific understanding of sudden unexpected death in infancy/childhood with certification and coding nomenclature. […] It sought a practical consensus on essential characteristics of this category of mortality and the best nomenclature to reflect this.
#21
https://link.springer.com/article/10.1007/s12024-019-00156-9
This report details the proceedings and conclusions from the 3rd International Congress on Unexplained Deaths in Infants and Children, held November 26-27, 2018 at the Radcliffe Institute at Harvard University. […] The Congress was motivated by the increasing rejection of the diagnosis Sudden Infant Death Syndrome (SIDS) in the medical examiner community, leading to falsely depressed reported SIDS rates and undermining the validity and reliability of the diagnosis, which remains a leading cause of infant and child mortality. […] The Congress was attended by major figures and opinion leaders in this area from countries significantly engaged in this problem. […] Four categories (International Classification of Diseases (ICD)-11 categories of MH11, MH12, MH14, PB00-PB0Z) were recommended for classification, and explicit definitions and guidance were provided for death certifiers.
#22 Joint Statement on Safe Sleep: Reducing Sudden Infant Deaths in Canada – Canada.ca
https://www.canada.ca/en/public-health/services/publications/healthy-living/joint-statement-on-safe-sleep.html
Over the last decade, there has been a notable shift in reporting practice for infant deaths, in Canada as well as globally, making it challenging to assess the prevalence of SIDS. Since 2012, SIDS is no longer being used for the classification of infant deaths in most provinces/territories in Canada. These deaths are instead classified as „undetermined” cause. […] Based on the last available data (pre 2012), the highest rate of SIDS in Canada is in Nunavut, where the SIDS mortality has been found to be over 3 times the Canadian rate. Alarming disparities persist among Canada’s Indigenous population, with a SIDS rate more than seven times higher than the non-Indigenous population. […] Other causes of death that occur while an infant is sleeping include unintentional suffocation or asphyxiation due to overlay or entrapment. These deaths can be difficult to distinguish from SIDS and many of the risk factors are similar.
#23
https://link.springer.com/article/10.1007/s12024-019-00156-9
A distinct category for children over the age of 1 was recommended (MH12). […] As recommended, unexplained sudden death in infancy or SIDS on a death certificate will code a unique, trackable entity, accurately reflecting the inability to determine a definitive explanation, while satisfying surveillance needs and reliable identification for research efforts. […] Efforts in diagnosis, surveillance, research, and prevention are complicated by substantial divergence in certification and coding of these deaths. […] At the center of this divergence is the very concept of SIDS. […] Although the term SIDS is endorsed by the World Health Organization (WHO) and is broadly used by physicians, researchers, and the public, it is increasingly avoided by forensic pathologists in many jurisdictions who determine cause and certify sudden deaths in infants.
#24 Sudden Infant Death Syndrome – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK560807/
Several studies identify the prone sleeping position, sleeping on soft surfaces, sleeping with soft objects, co-sleeping with a parent/parents, maternal smoking during pregnancy, maternal age less than 20 years, late/no prenatal care, preterm birth, low birth weight, lack of breastfeeding, and overheating as risk factors in SIDS deaths. […] Siblings of SIDS infants have an increased risk of dying as a result of SIDS. Siblings are 5-6 times more likely to die from SIDS than the general population. […] Large epidemiologic studies have demonstrated that SIDS is associated with many preventable risk factors, of which the most important is prone sleeping. Many countries started to campaign for sleeping on the back in a safe environment in the 1990s, and the incidence of SIDS has significantly declined in the 2000s.
#25 Preventing Sudden Infant Death Syndrome
https://www.uspharmacist.com/article/preventing-sudden-infant-death-syndrome
A number of risk factors for SIDS have been identified in observational and case-control studies. Those that are consistently identified as independent risk factors include: Young maternal age (younger than 20 years), maternal smoking during pregnancy, and late or no prenatal care. […] More than 95% of SIDS cases are associated with one or more risk factors, and in many cases, the risk factors are modifiable (sleeping position, sleep environment, or parental smoking). […] The following recommendations are made by the AAP. The recommendations apply to infants aged up to 1 year. […] All infants, including those with a history of prematurity, should be placed to sleep on their backs (supine) for every sleep, even if they are able to roll from their backs to the prone position. […] The use of home cardiorespiratory (CR) monitors is not an effective strategy for reducing the risk of SIDS. CR monitors have high rates of false alarms and do not appear to reduce the incidence of SIDS.
#26 Sudden Infant Death Syndrome | AAFP
https://www.aafp.org/pubs/afp/issues/2015/0601/p778.html
Each year in the United States, 4,500 deaths are categorized as sudden unexpected infant death. This includes deaths from SIDS or asphyxiation during sleep, and deaths in which there is insufficient information to categorize the cause. Approximately 2,500 of these deaths are caused by SIDS. There is a marked disparity in the incidence of SIDS among races and ethnicities. The risk is twice as high in Native American, Alaska Native, and black infants compared with non-Hispanic white infants. […] The most important risk factors for SIDS relate to the sleep environment. Sleep position is a strong risk factor for SIDS. The prone and side sleeping positions are significantly more dangerous than the supine position. Bed sharing with a parent is also strongly correlated with an increased risk of SIDS, and is especially dangerous for infants younger than 12 weeks.
#27
https://journals.lww.com/epidem/abstract/1994/05000/the_relation_between_climatic_temperature_and.12.aspx
We examined the negative relation between temperature and the sudden infant death syndrome (SIDS) in 22 communities in seven countries. […] The relation differed substantially among communities. […] In New Zealand and Australia (10 communities), the association was consistently strong; in Europe (seven communities), it varied from strong to weak; and in the USA (five communities), it was moderate or weak. […] We postulate that low climatic temperature indirectly increases the incidence of SIDS, particularly in countries where outdoor climatic temperature modifies the indoor temperature and clothing habits.
#28
https://journals.lww.com/epidem/fulltext/2011/01001/the_role_of_air_pollution_as_a_determinant_of.490.aspx
Our objective was to synthesize the existing evidence and to consider the directions necessary for future research to coherently address the issue of the impact of air pollution on Sudden Infant Death Syndrome (SIDS). […] Nine studies met the inclusion criteria and provided data for meta-analysis. The risk of SIDS was estimated to increase by 8% (95% Confidence Interval: 4%14%) per 10 ppb exposure to NO2 and 9% (95% Confidence Interval: 1%12%) per 1 ppm exposure CO. […] Both short-term exposure to NO2 and CO prior the onset as well as long-term exposure to these pollutants in early infancy or months prior to the onset increase the risk of SIDS. In addition, short-term exposure to SO2 may play a role in the onset of SIDS, but the role of PM10 and PM2.5 remains inconclusive.
#29 Sudden Infant Death Syndrome SIDS | Boston Children’s Hospital
https://www.childrenshospital.org/conditions/sudden-infant-death-syndrome-sids
SIDS is a mysterious syndrome, since by its very definition the cause cannot be determined. […] Childrens researchers have uncovered strong evidence that SIDS has a biological basis, and are continuing to work towards determining the underlying causes and identifying at-risk babies. […] Currently, there is no way to identify living infants at risk of SIDS. But the development of such a test is a major goal of SIDS research at Childrens. […] Recent autopsy data provide the strongest evidence yet that sudden infant death syndrome (SIDS) has a concrete biological basis. […] Dr. Kinney and colleagues are currently working towards a means of identifying those infants who are at increased risk of SIDS, with the ultimate goal of developing a treatment that will protect them from SIDS.
#30 How Newly Identified Biomarkers Could Reveal Risk Factors for SIDS | Epidemiology & Biostatistics
https://epibiostat.ucsf.edu/news/how-newly-identified-biomarkers-could-reveal-risk-factors-sids
Researchers at UC San Francisco are getting closer to being able to predict sudden infant death syndrome, or SIDS. […] In a study that appears Sept. 9 in JAMA Pediatrics, they identified signals in the metabolic system of infants who died of SIDS. […] Each year about 1,300 infants under the age of 1 die from SIDS, and researchers still aren’t sure what causes these unexpected deaths. […] Male babies have a higher rate of SIDS than girls. […] In the 354 infants who died from SIDS, they found that there were some metabolic biomarkers that may be associated with increased risk. […] For example, infants with lower levels of C-3 and elevated levels of C-14OH appear to have a higher risk of dying from SIDS. […] This study is a critical step toward integrating metabolic markers with potential genetic markers and other risk factors to better assess the risk of SIDS in infants, Oltman said.
#31 Sudden Infant Death Syndrome
https://www.uspharmacist.com/article/sudden-infant-death-syndrome-40707
In the 1970s and 1980s, the incidence of SIDS appeared to increase in many developed countries and was especially high in New Zealand. Researchers around the world conducted epidemiological studies to identify risk factors for SIDS. In 1990, a case-control study in the United Kingdom found an estimated 8.8 times greater risk of SIDS in infants in the prone (face-down) sleeping position. In 1991, the New Zealand Cot Death Study Group estimated a 3.53 times greater risk of SIDS in prone infants. […] However, since 2001, the incidence has plateaued, and SIDS currently remains a significant cause of infant mortality in the U.S. and worldwide. […] The leading theory supported by the literature is the triple-risk model, first described in 1994. This model suggests that SIDS is the result of three simultaneous factors. First, the infant must have an underlying vulnerability that predisposes him or her to SIDS. There also must be stress from an exogenous source, such as asphyxia associated with a prone sleeping position. Finally, this stress must occur during a critical period of development (first 12 months of life).
#32 Sudden infant death syndrome: Etiology a | Biomedical Research
https://www.currentpediatrics.com/articles/sudden-infant-death-syndrome-etiology-and-epidemiology-17855.html
The downward trend in SUID that began in the 1990s has stalled, with considerable differences in regional trends between states and even an increase in some. […] SIDS is thought to be caused by a combination of environmental and biological causes. […] SIDS is thought to occur when three risk factors (a fragile newborn, a critical developmental period in the early months of life, and environmental stresses) come together. […] SIDS is more likely in newborns with intrinsic vulnerabilities who are subjected to physical stress during their critical developing period. […] The present study showed that sudden infant death syndrome is still a significant health problem that needs more in-depth investigations to understand its pathogenesis.
#33 Sudden Infant Death Syndrome: Beyond Risk Factors
https://www.mdpi.com/2075-1729/11/3/184
Sudden infant death syndrome (SIDS) is defined as âthe sudden death of an infant under 1 year of age which remains unexplained after thorough investigation including a complete autopsy, death scene investigation, and detailed clinical and pathological reviewâ. A significant decrease of SIDS deaths occurred in the last decades in most countries after the beginning of national campaigns, mainly as a consequence of the implementation of risk reduction action mostly concentrating on the improvement of sleep conditions. Nevertheless, infant mortality from SIDS still remains unacceptably high. There is an urgent need to get insight into previously unexplored aspects of the brain system with a special focus on high-risk groups. SIDS pathogenesis is associated with a multifactorial condition that comprehends genetic, environmental and sociocultural factors. Effective prevention of SIDS requires multiple interventions from different fields. Developing brain susceptibility, intrinsic vulnerability and early identification of infants with high risk of SIDS represents a challenge. Progress in SIDS research appears to be fundamental to the ultimate aim of eradicating SIDS deaths. A complex model that combines different risk factor data from biomarkers and omic analysis may represent a tool to identify a SIDS risk profile in newborn settings. If high risk is detected, the infant may be referred for further investigations and follow ups. This review aims to illustrate the most recent discoveries from different fields, analyzing the neuroanatomical, genetic, metabolic, proteomic, environmental and sociocultural aspects related to SIDS.
#34 Sudden Infant Death Syndrome | AAFP
https://www.aafp.org/pubs/afp/issues/2009/0515/p870.html
Sudden infant death syndrome is the leading cause of death among healthy infants, affecting 0.57 per 1,000 live births. […] In the United States, SIDS affects 0.57 per 1,000 live births, totaling more than 2,200 deaths per year. It is the leading cause of death among healthy infants. […] The relationship between prone sleeping position and SIDS was first noted in 1965, but recommendations supporting supine sleeping were not issued until the early 1990s. […] The Back to Sleep campaign organized by the National Institutes of Health and the American Academy of Pediatrics (AAP) brought about a decrease in SIDS cases. […] Families who have had an infant die from SIDS should be treated with compassion and empathy. They should be supported through the process of the death investigation and guided through problems, such as ending lactation and funeral planning. Grief counseling and referral to a SIDS support group should be offered. Parents should be counseled that the risk of future children dying from SIDS is not increased.
#35 Joint Statement on Safe Sleep: Reducing Sudden Infant Deaths in Canada – Canada.ca
https://www.canada.ca/en/public-health/services/publications/healthy-living/joint-statement-on-safe-sleep.html
Large-scale epidemiological studies over the last two decades have increased our understanding of SIDS and identified certain modifiable risk factors. The most important modifiable risk factors for SIDS are infants sleeping in the prone position, and exposure to tobacco smoke prenatally and after birth. […] The rate of SIDS has declined significantly since the late 1980’s. Between 1999 and 2004, Canada observed a 50% decrease in the rate of SIDS, which coincided with the launch of recommendations to place infants on their back to sleep, a message reinforced by the Back to Sleep campaign in 1999. […] In the years that followed, there was little change in the SIDS rate in Canada. Between 2007 and 2011, 5.8% of all infant deaths (0 to 1 year of age) and 19.6% of postneonatal deaths (28 days to 1 year of age) were attributed to SIDS.
#36 Sudden Unexpected Infant Death (SUID) and Sudden Infant Death Syndrome (SIDS) – Pediatrics – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/pediatrics/miscellaneous-disorders-in-infants-and-children/sudden-unexpected-infant-death-suid-and-sudden-infant-death-syndrome-sids
The cause of SIDS is unknown, although it is most likely due to dysfunction of neural cardiorespiratory control mechanisms. […] The definite association between a prone (on stomach) sleeping position and an increased risk of SUID has been documented strongly. […] Many risk factors for SIDS apply to SUID as well. […] The diagnosis of SIDS, while largely one of exclusion, cannot be made without an adequate autopsy to rule out other causes of sudden, unexpected death. […] The American Academy of Pediatrics recommends that infants be placed on their back on a firm, flat, non-inclined sleep surface for every sleep unless other medical conditions prevent this. […] Breastfeeding is encouraged to help prevent infections and is associated with a reduced risk of SIDS.
#37 Joint Statement on Safe Sleep: Reducing Sudden Infant Deaths in Canada – Canada.ca
https://www.canada.ca/en/public-health/services/publications/healthy-living/joint-statement-on-safe-sleep.html
In Canada, threats to breathing (suffocation, choking, strangulation) were the most common underlying cause of unintentional death for infants under the age of one, representing 69% of accidental deaths. […] There is no evidence connecting BRUE as a risk factor for SIDS. […] The most important modifiable factors that can lower the risk are: Placing infants on their backs to sleep for every sleep. Protecting infants from exposure to tobacco smoke, before and after birth. Providing a safe sleep environment for infants. The safest place for an infant to sleep is in a crib, cradle or bassinet, free of soft loose bedding, placed in the parent’s room for the first 6 months. Breastfeeding – for at least 2 months, with greater protection provided with longer duration. Practicing the principles of safe sleep FOR EVERY SLEEP – at home, in childcare settings and when travelling. […] Although bed sharing is not advised, parents/caregivers should be aware of the factors that put infants at greatest risk when bed sharing so they can take steps to avoid them.
#38
https://www.alliedacademies.org/articles/sudden-infant-death-syndrome-etiology-and-epidemiology-17855.html
SIDS infant mortality has dropped by more than half in most countries, particularly in the first few years after national campaigns began. […] Despite ongoing public health efforts focusing on improving sleep circumstances, with a particular focus on high-risk groups, the prevalence of SIDS remains high. […] SIDS is still a common cause of infant death in the United Kingdom, with a rate of 27/100,000 live births and 38/100,000 in the United States. […] In the United States, about 3600 infants die each year from Sudden Unexpected Infant Death (SUID). […] The downward trend in SUID that began in the 1990s has stalled, with considerable differences in regional trends between states and even an increase in some. […] SIDS was the fourth largest cause of baby mortality in the United States in 2017, accounting for 6% of all newborn fatalities, or 35.5 per 100,000 live births.
#39 Sudden infant death syndrome: Do the parents follow the recommendations? | Anales de PediatrÃa
https://analesdepediatria.org/en-sudden-infant-death-syndrome-do-articulo-S2341287920300223
The aim of our study was to identify the adherence of families to current recommendations in a sample of infants. The primary objective was to analyse the position of the infant during sleep, as it is the most important modifiable risk factor for SIDS. […] We found that only 10.4% of families of infants aged 0-5 months and 3.1% of families of infants aged 6-11 months followed all the recommendations regarding the modifiable risk factors for SIDS included in the analysis. […] The prevalence of modifiable risk factors for SIDS in the sample under study was unacceptably large, especially when it came to sleeping positions other than the supine position. […] More than half of the infants did not sleep in the supine position, which is the position that offers the most protection against SIDS, even though informational campaigns have been promoting this position since the 1990s. […] Our findings evince that there prevalence of modifiable risk factors for SIDS in Spain is still high, and thus that there is ample opportunity for improvement in this regard.
#40 Trump cuts baby 'Safe to Sleep’ team. Here’s what parents should know | NCPR News
https://www.northcountrypublicradio.org/news/npr/nx-s1-5383871/trump-cuts-baby-safe-to-sleep-team-here-s-what-parents-should-know
For decades the NIH has led a public health campaign credited with saving thousands of babies from dying in their sleep. […] The Safe to Sleep campaign has greatly reduced cases of sudden infant death syndrome and other sleep-related deaths. […] Originally called Back to Sleep, the campaign launched in 1994 to bring awareness to Sudden Infant Death Syndrome or SIDS. At the time, more than 4,000 infants a year died from the condition. […] After the campaign launched, those deaths decreased by 50%. […] After holding steady for years, sleep-related infant deaths rose by nearly 12% between 2020 and 2022. Researchers think the rise may be related to parents not getting the information on safe sleep they needed during the pandemic, when access to health care might have been more limited.
#41 Reddit – The heart of the internet
https://www.reddit.com/r/ScienceBasedParenting/comments/1fq05pz/jama_study_finds_rates_of_suid_during_the/
New study is in JAMA Network Open looking at SIDS and SUID rates before the pandemic, during the pandemic and during a specific period in the pandemic when there was a surge of off-season infections due to pandemic restrictions relaxing (June-Nov 2021). Researchers found that SUID rates spiked during those periods, suggesting that respiratory infections (they specifically call out RSV) may play a role in SUID and SIDS. […] Infection surge periods mapping to higher risk of SUID does connect to the leading theory on the cause of SIDS, the triple risk model (a vulnerable infant, e.g., an infant born premature, or male, or to smoking parents, etc), a critical development period and an exogenous stressor combine to create the conditions for a SIDS death). […] Epidemiologic patterns of infection, including respiratory syncytial virus and influenza, were altered during the COVID-19 pandemic. Comparing month-to-month variation in both sudden unexpected infant death (SUID) and SIDS rates before and during the pandemic offers an opportunity to generate and expand existing hypotheses regarding seasonal infections and SUID and SIDS.
#42 Reddit – The heart of the internet
https://www.reddit.com/r/ScienceBasedParenting/comments/1fq05pz/jama_study_finds_rates_of_suid_during_the/
This cross-sectional study found increased rates of both SUID and SIDS during the COVID-19 pandemic, with a significant shift in epidemiology from the prepandemic period noted in June to December 2021. These findings support the hypothesis that off-season resurgences in endemic infectious pathogens may be associated with SUID rates, with RSV rates in the US closely approximating this shift. Further investigation into the role of infection in SUID and SIDS is needed.
#43 Current SIDS research: time to resolve conflicting research hypotheses and collaborate | Pediatric Research
https://www.nature.com/articles/s41390-023-02611-4
The popular research hypothesis explaining sudden infant death syndrome features the triple risk hypothesis with central nervous system homoeostatic mechanisms controlling arousal and cardiorespiratory function. […] Infection-based hypotheses with their strong SIDS risk factor associations are reviewed in a new context. […] From the earliest epidemiological studies on cot death or as it was later defined as SIDS, there were clear indications that infection, especially respiratory viral, was associated with these deaths. […] The common bacterial toxin hypothesis was developed on the basis that a viral infection (along with prone positioning) induced upper respiratory tract changes conducive to toxin production by toxigenic bacteria, all of which were commonly found to colonise the nasopharynx.
#44 Current SIDS research: time to resolve conflicting research hypotheses and collaborate | Pediatric Research
https://www.nature.com/articles/s41390-023-02611-4
In 50% of cases, Staphylococcal toxins were demonstrated in SIDS babies tissues. […] The hypothesis suggested viral infection acted as a trigger for events leading to super antigenic toxic shock through T-cell activation by staphylococcal enterotoxins or toxic shock syndrome toxin-1. […] The respiratory tract in SIDS frequently shows evidence of inflammatory involvement of the airways and lungs. […] The inflammatory process may involve platelet aggregation and obstruction of the lung capillaries by blood platelet aggregates and leucocytes. […] This could provide clues to the pathogenesis of intrathoracic petechial haemorrhages observed in 80-90% of SIDS cases. […] The role of infection in SIDS has been largely ignored by mainstream researchers. […] A convincing explanation of the risk factor of prone sleep position has not been achieved by the mainstream.
#45 Current SIDS research: time to resolve conflicting research hypotheses and collaborate | Pediatric Research
https://www.nature.com/articles/s41390-023-02611-4
There is, however, a compelling explanation provided in two well-designed and independent, geographically disparate epidemiological studies that link infection (with prone sleep position) to SIDS. […] SIDS is largely a disease of poverty, poor hygiene, overcrowding, prematurity, exposure to smoke in pregnancy and postnatally. […] These facts should alert us to the possibility of an epizootic agent playing a role, in addition to seasonal respiratory viruses. […] The apparent lack of progress in determining a cause or causes of SIDS should call for a reappraisal of the fundamental mainstream hypotheses. […] Infection, a key pointer in the SIDS story, has been largely ignored by mainstream research or given minimal attention. […] The overwhelming number of infection-related factors, including risk factors (age, sex, immunity, smoke exposure, seasonality, rural preponderance, etc.), would surely invite serious investigation. […] It is reasonable to ask why the staphylococcal toxin findings in more than 50% of cases have been ignored for so long and that routine testing for these toxins had not been widely applied by those responsible for investigating sudden unexpected infant deaths?
#46 SIDS Infant Death Syndrome Program | Riverside University Health System
https://www.ruhealth.org/sids-infant-death-syndrome-program
SIDS is the sudden unexplained death of an infant under one year of age. […] To diagnose a death as SIDS, three things must happen. The infant must undergo a complete autopsy, a thorough death scene investigation will be done, and a review of the clinical history of the infant will be completed. […] The SIDS Program in Riverside County focuses on providing education about SIDS and safe sleep to professionals and the public. […] The California SIDS Program and Riverside County both follow the risk reduction recommendations provided by the American Academy of Pediatrics. […] Continue research and surveillance on the risk factors, causes, and pathophysiologic mechanisms of SIDS and other sleep-related infant deaths, with the ultimate goal of eliminating these deaths altogether.