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To: ADC Fetal and Neonatal Edition Letters and ADC Education and Practice Letters

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Original articles: Aurore Cote, Aida Bairam, Marianne Deschesne, and George Hatzakis Sudden infant deaths in sitting devices Arch Dis Child 2007; 0: adc.2007.119180v1 [Abstract]

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Electronic letters published:

Sitting devices could protect against sudden infant deaths

Paul Vaucher   (27 July 2007)

Sitting devices could protect against sudden infant deaths 27 July 2007
Paul Vaucher, osteopath LSHTM Student Send letter to journal: Re: Sitting devices could protect against sudden infant deaths paul.vaucher{at}gmail.com Paul Vaucher	Dear Editor, Cote et al [1] concluded that sitting devices increased risk of infant sudden death. The only results supporting this conclusion was done by comparing the relative risk of dying in a sitting device between infants under 1 month and infants over one month adjusted for prematurely born infants (RR=3.8). However this could be explained by the fact that small children sleep more often in the car than older ones. Reading their findings, I would have expected opposite conclusions on associations between the sitting position and sudden death. Of 409 unexplained deaths, 10 (2.4%) were in the sitting position. If risks were equal independently of the sitting position and constant throughout the day, we would expect the same prevalence if infants would spend 35 minutes per day in the sitting position. Callahan et al [2] however revealed that 94% of infants spend more than 30 minutes every day in a sitting device (mean of 5.7 hours). Furthermore, Kinane et al [3] showed that oxygen saturation were not different between infants in a car bed or a car safety seating. I would therefore expect infants in the sitting position to be potentially less at risk than other positions. Could authors explain why the number of cases of sudden deaths in the sitting position were apparently lower than what would have been expected had the risk been equal to other positions? References: [1] Cote A, Bairam A, Deschesne M, Hatzakis G. Sudden infant deaths in sitting devices. Arch Dis Child. 2007 Jul 19; [Epub ahead of print]. [2] Callahan CW, Sisler C. Use of seating devices in infants too young to sit. Arch Pediatr Adolesc Med 1997;151(3):233–5. [3] Kinane TB, Murphy J, Bass JL, Corwin MJ. Comparison of respiratory physiologic features when infants are placed in car safety seats or car beds. Pediatrics. 2006 Aug;118(2):522-7.