DEFINITION & HISTORY

INCIDENCE & DISTRIBUTION

The number of babies dying from cot deaths each year is on the gradual increase and since doctors are unsure of the exact cause of death, it is difficult to prevent it from occurring.
Until recently the incidence of SIDS in the UK was about 2 per 1000 live births per year, however in the period 1989 to 1993 the incidence has fallen by two thirds. In Scotland This is largely attributed to the “Back to Sleep“ campaign which started in 1991.

• White = 1.2
  
• Black = 5.1
  
• Oriental = 0.5
  
• Native American = 7.0
  
  The incidence also varies in different countries: (per 1000 live births per year)
  
  
• Hong Kong = 0.3
  
• Sweden = 0.4
  
• USA = 2.0-2.5
  
• New Zealand = 4.9-6.3
  
• UK = 0.35-0.7
  

  SIDS is rare after 1 year of age and is the most common mode of death among babies under 1 year old; it peaks between 4 and 24 weeks of age and 80% of deaths occur in the 1st 6 months.

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  CAUSES & RISK FACTORS OF SIDS

  
  

  By 1892, the causes were defined (by a medical forensic police officer from Dundee, Templeman) to be:

  1. Ignorance and carelessness of mothers.
  2. Drunkness.
  3. Overcrowding.
  4. According to some observers, “illegitimacy and the (life) insurance of infants”.
     

     A thorough post mortem examination will reveal a specific cause of death in less than half of all cot deaths. Causes may include accidents, infection, congenital abnormality or metabolic disorder. For the cases that remain unexplained (SIDS), researchers think there are likely to be undiscovered causes. For many it is likely that a combination of factors affect a baby at a vulnerable stage of development.
     

     • Obstetric factors:
       1. low birth weight
       2. preterm delivery
       3. multiple births
       4. infection
     • Cultural: -feeding method ( breast feeding/bottle )
     • Environmental:
       1. Parental smoking.
       2. Bad sleeping position.
       3. Sleeping on the side.
       4. Amount of bedding and clothing.
       5. Covers over the head.
       6. Sleeping on polystyrene- filled beanbags.
       7. Parental alcohol and drug abuse.
     • Maternal:
       1. Young mother.
       2. High parity and birth order.
       3. Smoking/ drinking during pregnancy.
     • Social & General:
       1. Low income.
       2. Illegitimate child.
       3. Poor health care.
       4. History (previous siblings)
       5. Infection.
       6. Season. (Higher risk in autumn and winter)
       7. Sex. (Male to female ratio of 3:2)
       8. Age. (80% of deaths occur in the 1st 6 months of life and the peak incidence is around 3d and 4th months of age)

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     DIFFERENT MODES OF DEATH (& Causes)

     
     

     SIDS has been known to occur and have different modes and ways of striking. Some of these are:

     • Death Instananeous and Observed: where the cause could be apparent (e.g. accident or trauma) or non apparent (e.g. cardiac malformations).
     • Found Dead in Cot - Death Unexpected and Unobserved : 90% of SIDS cases are unexplained.
     • Rapid Death Following Significant Illness ( infection, inborn error of metabolism, Reye’s syndrome, etc).
     
     

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     CURRENT THEORIES AS TO THE CAUSE OF SIDS

     
     
     • Sleeping Position: in counties with a high incidence of SIDS, babies tend to be put to bed lying on their front (prone position). The “Back to Sleep” campaign resulted in a reduction in the number of SIDS cases
     • Overheating and Thermoregulation: Newborn babies have poor temperature regulation. Many SIDS babies are found wrapped in numerous layers of clothing and bedding, are soaked in sweat when found and have a raised body temperature.
     • Delayed maturation of the central nervous system: Some SIDS babies have delayed myelination of sites in the brain. Various abnormalities have been described in the brain stem which contains the nerve cells that control respiration.
     • Increased susceptibility to infection.
     • Abnormal colonisation by micro organisms.
     • Metabolic disorders: A small number of cases of SIDS are found to have inborn metabolic errors.
     • Arousal: There is some evidence that parent-infant co-sleeping (ie sleeping in the same room or bed ) decreases the risk of SIDS.
     • Toxic gas generation from plastic mattresses: a theory that suggests that the fungus, Scopulariopsis brevicaulis lives in mattresses and that the incubation of infected materials generated a toxic gas.
     • Long QT interval Syndrome: The long QT interval syndrome is a cardiac disorder characterised by fainting episodes, seizures and sudden death. It is caused by defects in ion transport in and out of cells resulting in defects in the conduction of electrical impulses in the heart.

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     WHAT RESEARCH IS CURRENTLY TAKING PLACE

     
     

     Most of the research into cot death in England and Wales has been funded by FSID. Since it was founded in 1971, FSID has spent over £8 million on research. It is currently looking at:
     

     • How babies cope living in difficult circumstances
     • Whether genes have a part to play in sudden infant deaths
     • Interactions between parents and their babies when room sharing or bed sharing
     • How physiological control mechanisms are influenced by age, sleep, position, passive smoking and other risk factors
     • What influences parents in making baby care decisions
     • Antenatal and postnatal physiological development of babies born to mothers living in difficult circumstances and how this affects mother/infant interaction
     • Ways to reduce babies’ exposure to passive smoke.

     The full reduce the risk of cot death advice is:
     

     • Place your baby on the back to sleep
     • Cut smoking in pregnancy - fathers too!
     • Do not let anyone smoke in the same room as your baby
     • Do not let your baby get too hot
     • Keep your baby's head uncovered
     • place your baby with feet to the foot of the cot, to prevent wriggling down under the covers
     • If your baby is unwell, seek medical advice promptly
     • Avoid falling asleep with your baby on a sofa
     • Sleep your baby in a cot in your room for the first six months
     • Do not share a bed with your baby if you or your partner are smokers,have been drinking alcohol, take drugs or medication that makes you drowsy or are excessively tired
       
       Case of Sally clark Trial
       
       See Dr Sprott's study Here
       
       
       

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       CHEMICALS & DRUGS

       
       

       If alcohol gets into the system of children under 12 years of age, it drops the glucose level in their blood dramatically and, a tiny drop of insulin given to a baby could kill instantly. Infants born to mothers on methadone maintenance for their heroin addiction are at higher risk for problems in the neonatal period( prematurity, low birth weight, decreased head circumference and length) and for neurobehavioral problems in infancy and early childhood. There is also a speculation about arsnic ( from mattresses and sheep skin) having a connection to SIDS.

       FAMILIES & RELATIVES

       
       

       Families and Relatives must be taken into consideration in cases of SIDS in terms of:

       • Feeling of Guilt
       • Effects (future/ on family and relatives)
       • Counselling and Help.
       
       

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       SIDS, AN EASY EXCUSE

       
       

       An unknown small percentage of cot deaths are due to deliberate asphyxia (chocking); however smothering by a soft pillow often leaves no marks and the postmortem findings may be identical to those of SIDS. About 1% of apparent cot deaths are due to frank child battering - this is usually obvious at autopsy.

       INTERNATIONAL SCALE OF THE PROBLEM

       
       

       Cot death rates vary considerably from country to another, hence it is recognised internationally, and the international conference for sudden infant deaths has a meeting every few years to discuss and spread new findings among all countries.

       SSIDS(simultaneous SIDS)

       
       

       This unfortunate but rare condition occurs when twins die within a brief period of each other with each infant meeting the criteria for the Sudden Infant Death Syndrome (SIDS).( Koehler et al.)

       
       

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       >>> REFERENCES
       >>> MEDIA RELEASES
       
       ********** Pay your tributes & see tributes made to babies that have died as Cot Death **********
       
       Useful Resources
       Useful Organisations and Contacts
       Facts, Numbers, Tables
       Figures & Charts

       
       
       A few surveys of how well known & published is SIDS are soon to be added Here.
       Readers are invited to call FSID’s Helpline on 0870 787 0554 with their questions about safer sleeping for their baby.
       
       

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