Arch Dis Child 2000;82:98-106 ( February )

Article

A clinical comparison of SIDS and explained sudden infant deaths: how healthy and how normal? Martin Ward Platt^c, Peter S Blair^a, Peter J Fleming^a, Iain J Smith^b, Tim J Cole^d, Charlotte E A Leach^a, P J Berry^a, Jean Golding^a, and the CESDI SUDI Research Group

^a FSID Unit, Department of Child Health, Royal Hospital for Children, St Michael's Hill, Bristol BS2 8BJ, UK, ^b Nuffield Institute for Health, 71-75 Clarendon Road, Leeds LS2 9PL, UK, ^c Newcastle Neonatal Service, Ward 35, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK, ^d Department of Epidemiology and Public Health, Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK

Correspondence to: Dr Blair email: p.s.blair{at}bris.ac.uk

Accepted 23 September 1999

OBJECTIVESTo compare the clinical characteristics associated with sudden infant death syndrome (SIDS) and explained sudden unexpected deaths in infancy (SUDI).
DESIGNThree year population based, case control study with parental interviews for each death and four age matched controls.
SETTINGFive regions in England (population, > 17 million; live births, > 470 000).
SUBJECTSSIDS: 325 infants; explained SUDI: 72 infants; controls: 1588 infants.
RESULTSIn the univariate analysis, all the clinical features and health markers at birth, after discharge from hospital, during life, and shortly before death, significant among the infants with SIDS were in the same direction among the infants who died of explained SUDI. In the multivariate analysis, at least one apparent life threatening event had been experienced by more of the infants who died than in controls (SIDS: 12% v 3% controls; odds ratio (OR) = 2.55; 95% confidence interval (CI), 1.02 to 6.41; explained SUDI: 15% v 4% controls; OR = 16.81; 95% CI, 2.52 to 112.30). Using a retrospective illness scoring system based on "Baby Check", both index groups showed significant markers of illness in the last 24 hours (SIDS: 22% v 8% controls; OR = 4.17; 95% CI, 1.88 to 9.24; explained SUDI: 49% v 8% controls; OR = 31.20; 95% CI, 6.93 to 140.5).
CONCLUSIONSThe clinical characteristics of SIDS and explained SUDI are similar. Baby Check might help identify seriously ill babies at risk of sudden death, particularly in high risk infants.

Key messages There are clinical features and health markers characterising increased vulnerability of infants who die suddenly and unexpectedly that are evident at birth, during life, and just before death These features, important among the infants with sudden infant death syndrome, are in the same direction among the explained sudden unexpected deaths Clinical features common to both groups of explained and unexplained deaths after controlling for possible confounders included a higher prevalence of an apparent life threatening event and ill health in the 24 hours before death "Baby Check" might help identify seriously ill babies at risk of sudden death, particularly in high risk infants

Keywords: signs of illness in infants; sudden unexpected death in infancy; sudden infant death syndrome; Baby Check

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© 2000 by Archives of Disease in Childhood
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