Published online March 30, 2009
PEDIATRICS Vol. 123 No. 4 April 2009, pp. 1162-1170 (doi:10.1542/peds.2008-0505)

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ARTICLE

Sleep Environment Risk Factors for Sudden Infant Death Syndrome: The German Sudden Infant Death Syndrome Study

Mechtild M. Vennemann, MD, PD, MPH^a, Thomas Bajanowski, MD, PD^b, Bernd Brinkmann, MD, PD^a, Gerhard Jorch, MD, PD^c, Cristina Sauerland, MSc^d, Edwin A. Mitchell, FRACP, DSc^e the GeSID Study Group

^a Institute of Legal Medicine and Institute of Epidemiology and Social Medicine
^d Department of Medical Informatics and Biomathematics, University of Münster, Münster, Germany
^b Institute of Legal Medicine, University of Duisburg-Essen, Essen, Germany
^c Department of Pediatrics, University of Magdeburg, Magdeburg, Germany
^e Department of Paediatrics, University of Auckland, Auckland, New Zealand

OBJECTIVE. Our goal was to investigate the risk factors for sudden infant death syndrome in the infants' sleep environment for a population in which few infants sleep prone as a result of education campaigns.

METHODS. This was a population-based sudden infant death syndrome case-control study over 3 years (1998–2001) in Germany.

RESULTS. There were 333 sudden infant death syndrome cases and 998 matched controls. Although only 4.1% of the infants were placed prone to sleep, those infants were at a high risk of sudden infant death syndrome. Those who were unaccustomed to sleeping prone were at very high risk, as were those who turned to prone. Bed sharing (especially for infants younger than 13 weeks); duvets; sleeping prone on a sheepskin; sleeping in the house of a friend or a relative (compared with sleeping in the parental home); and sleeping in the living room (compared with sleeping in the parental bedroom) increased the risk for sudden infant death syndrome; pacifier use during the last sleep was associated with a significantly reduced risk of sudden infant death syndrome.

CONCLUSIONS. This study has clarified the risk factors for sudden infant death syndrome in a population where few infants sleep prone. This study supports the current recommendations of the American Academy of Pediatrics. This study has identified several novel risk factors for sudden infant death syndrome: an increased risk if the infants sleeps outside the parental home, death in the living room, and the high risk when sleeping prone on a sheepskin; however, because the numbers of cases in these groups are small, additional studies are needed to confirm these findings.

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Key Words: bed sharing • environmental factors • SIDS • sleep position

Abbreviations: SIDS—sudden infant death syndrome • GeSID—German SIDS Study • SES—socioeconomic status • OR—odds ratio • CI—confidence interval • aOR—adjusted odds ratio • df—degree(s) of freedom

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Accepted Jul 30, 2008.

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