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Trends in sudden infant death syndrome. The current state of evidence

Ivan Koichev, Emil Ivanov, Silvya Nikolova


Introduction: Sudden infant death syndrome (SIDS) is a term used to describe the sudden and un­identified death of an infant under one year of age. It is among the most common causes of postneo­natal infant deaths in economically advanced countries; yet little is known about SIDS in economi­cally disadvantaged countries, including Bulgaria.

Materials and Methods: A systematic review of the literature for the period 1997-2017 included publi­cations from Medline, Pubmed, and Google Scholar. The initial search selected 79 articles published in English and Bulgarian of which 21 were included for the final review. Eligibility criteria for inclu­sion were year of publication, profile of the family and type of intervention with the goal of evaluat­ing its effectiveness. Effect size [ES] of the interventions measured the statistical significance of the findings.

Results: Studies report that prone sleeping triples the risk of SIDS. Swaddling also showed to be relat­ed to SIDS death with an overall age-adjusted pooled odds ratio (OR) of swaddling of 1.58 (95% CI: 0.97-2.58). Among 22% of the deaths occurred when a parent was sleeping with their child. Econom­ically disadvantaged families and ethnic minority groups had higher prevalence of SIDS. Interven­tions aimed at reducing smoking among pregnant mothers have reduced the risk of SIDS. Addition­ally, hard bedding and pacifier use are found to significantly reduce the risk of SIDS. No evidence of SIDS cases was found for Bulgaria and other economically disadvantaged regions.

Conclusion: Public health measures aimed at early and continuing involvement of expectant mothers in prenatal care are important not just to prevent SIDS, but to improve the health of infants. More re­search and data collection on factors associated to sudden infant deaths in less developing countries are needed to fully comprehend and compare trends in SIDS.


sudden infant death syndrome; effective intervention; prevention; family profile; health of infants



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