New Sleep Environment Risk Factors for SIDS Identified

From Medscape Medical News

News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd

April 17, 2009 — Novel risk factors for sudden infant death syndrome (SIDS) include sleeping outside the parental home, in the living room, or prone on a sheepskin, according to the results of a population-based, case-control study reported in the April issue of Pediatrics.

"A number of case-control studies in the late 1980s and early 1990s identified prone sleeping as a major risk factor for SIDS," write Mechtild M. Vennemann, MD, PD, MPH, from the University of Münster in Münster, Germany, and colleagues from the German Sudden Infant Death Syndrome Study Group.
"Following advice to put infants only on their back for sleeping, the rates in all developed countries for SIDS have decreased dramatically."

The purpose of this study, which took place from 1998 to 2001 in Germany, was to identify risk factors for SIDS in the sleep environment for a population in which few infants sleep prone because of widespread education campaigns.

During the study period, there were 333 SIDS cases and 998 matched controls. Only 4.1% of the infants were placed in a prone position to sleep, but the risk for SIDS was increased in those infants. The risk was very high in those infants who were unaccustomed to sleeping prone or who were turned to prone.

Factors associated with an increased risk for SIDS were bed sharing, particularly for infants younger than 13 weeks; use of duvets; sleeping prone on a sheepskin; sleeping in the house of a friend or a relative vs sleeping in the parental home; and sleeping in the living room vs in the parental bedroom.

Pacifier use during the last sleep was associated with a significantly decreased risk for SIDS.
Limitations of this study include small numbers of cases in groups with some of the novel risk factors.


Pediatrics. 2009;123:1162-1170.

Clinical Context

SIDS is the leading cause of death in infants younger than 1 year in developed countries. Sleeping in a prone position has been identified as a significant risk, leading to the Back to Sleep campaign, which resulted in a reduction in SIDS mortality rates in many countries. Since that campaign was initiated, other risk factors such as sleep environment have not been fully examined.

This is a population-based case-control study conducted in a part of Germany with more than 50% of its live births to determine risk factors associated with SIDS during a 3-year period (1998-2001).