ORIGINAL ARTICLE

Do risk factors differ between explained sudden unexpected death in infancy and sudden infant death syndrome?

M Vennemann¹, T Bajanowski², T Butterfaß-Bahloul³, C Sauerland⁴, G Jorch⁵, B Brinkmann¹, E A Mitchell⁶

¹ Institute for Legal Medicine, University of Münster, Münster, Germany
² Institute for Legal Medicine, University of Duisburg-Essen, Duisburg-Essen, Germany
³ Coordinating Centre for Clinical Trials, University of Münster, Münster, Germany
⁴ Department of Medical Informatics and Biomathematics, University of Münster, Münster, Germany
⁵ Children’s Hospital, University of Magdeburg, Magdeburg, Germany
⁶ Department of Paediatrics, University of Auckland, Auckland, New Zealand

Correspondence to:
Dr Mechtild Vennemann
Institute of Legal Medicine, University of Münster, Münster 48149, Germany; mechtild.vennemann{at}ukmuenster.de

Background: In Germany, 2910 infants died in 2004; for many infants the reason was clear, especially prematurity or congenital abnormalities. However, 394 babies die every year suddenly and unexpectedly. The cause may be immediately clear, but is often not obvious.

Aims: (1) To describe the causes of explained sudden unexpected death in infancy (SUDI) and (2) to compare risk factors for sudden infant death syndrome (SIDS) and explained SUDI.

Methods: A 3-year population-based case–control study in Germany, 1998–2001.

Results: 455 deaths, of which 51 (11.2%) were explained. Most of these deaths were due to respiratory or generalised infections. The risk factors for SIDS and explained SUDI were remarkably similar except for sleep position and breast feeding. Prone sleeping position is a major risk factor for SIDS (adjusted odds ratio (OR) 7.16, 95% confidence interval (CI) 3.85 to 13.31) but not for explained SUDI (adjusted OR 1.71, 95% CI 0.25 to 11.57). Not being breast fed in the first 2 weeks of life is a risk factor for SIDS (adjusted OR 2.37, 95% CI 1.46 to 3.84) but not for explained SUDI (adjusted OR 0.39, 95% CI 0.08 to 1.83).

Conclusions: Prone sleeping position is a unique risk factor for SIDS. Socioeconomic disadvantage and maternal smoking are risk factors for both SIDS and explained SUDI, and provide an opportunity for targeted intervention.

Abbreviations: CESDI, Confidential Inquiry into Stillbirths and Deaths in Infancy; GeSID, German study on sudden infant death; SIDS, sudden infant death syndrome; SUDI, sudden unexpected death in infancy

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