Skip to main content
Log in

German study on sudden infant death (GeSID): design, epidemiological and pathological profile

  • Original Article
  • Published:
International Journal of Legal Medicine Aims and scope Submit manuscript

Abstract

The German study on sudden infant death (GeSID) is a multi-centre case-control study aiming at the assessment of etiological factors and risk factors of SIDS. This report describes the study design and the methods applied and presents some general findings. Between 1998 and 2001, 455 cases of sudden and unexpected death of infants aged between 8 and 365 days were recruited into the study. The study comprised at least 11 out of the 16 German states with 18 centres involved. In 1999 and 2000, 75% of all SIDS cases registered with the Federal Office of Statistics (ICD 10/R95, n=384) in the study area were recruited into the study (n=286). A standardised autopsy including extended histology, microbiology, virology, toxicology and neuropathology investigations was carried out. Of the parents 82% (n=373) agreed to fill in an extensive questionnaire containing 120 questions reflecting all important aspects of the infant’s development. For each SIDS case, the parents of three living control infants were interviewed. These controls were matched for age, gender and region (n=1,118). The response rate of the controls was 58.7%. Data were linked with medical records obtained from obstetrics departments, the children’s hospitals, and general practitioners. Death scene investigation was performed in 4 study areas (cases: n=64, controls: n=191). All cases were classified into one of 4 categories using defined criteria: 7.3% of the children were assigned to category 1 (no pathological findings: SIDS), 61.1% to category 2 (minor findings: SIDS+), 20.4% to category 3 (severe findings: SIDS+) and 11.2% to category 4 (findings which explained the death: non-SIDS). In case conferences the previous history and circumstantial factors were included and an extended category (E-cat.) was defined. The consideration of these factors for the final classification is of great importance in the causal explanation of some cases. An analysis of 18 main variables in cases of categories 1–3 (SIDS) compared to the cases of category 4 (non-SIDS) showed significant differences for the sleeping position, coughing the day before death and breast-feeding indicating that the cases of both groups should be separated for further analyses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Statistisches Bundesamt Deutschland (2001) http://www.statistik-bund.de

  2. Dutch Central Bureau of Statistics (CBS) (1997) Death by cause, age and sex in the years 1980–1997, Series A1 (in Dutch). Vorburg, The Netherlands

  3. Jorch G, Findeisen M, Brinkmann B et al. (1991) Bauchlage und plötzlicher Säuglingstod. Dtsch Arztebl 48:4266–4272

    Google Scholar 

  4. Findeisen M, Jorch G (1991) Plötzlicher Säuglingstod: Epidemiologische Daten. Dokumentationsband Expertenhearing. MAGS-NRW, Düsseldorf

  5. Mitchell EA, Scragg R, Stewart AW et al. (1991) Cot death supplement: results from the first year of the New Zealand cot death study. NZ Med J:71–76

    Google Scholar 

  6. De Jonge GA, Engelberts AC, Koomen-Liefting AJM, Kostense PJ (1989) Cot death and prone sleeping position in The Netherlands. BMJ 298:722

    PubMed  Google Scholar 

  7. Fleming PJ, Gilbert R, Azaz Y et al. (1990) Interaction between bedding and sleeping position in the sudden infant death syndrome: a population based case control study. BMJ 301:85–89

    CAS  PubMed  Google Scholar 

  8. Beal S (1989) Sleeping position and SIDS. Lancet ii:512

    Google Scholar 

  9. Schlaud M, Kleemann WJ, Poets CF, Sens B (1996) Smoking during pregnancy and poor antenatal care: two major preventable risk factors for sudden infant death syndrome (SIDS). Int J Epidemiol 25:959–965

    CAS  PubMed  Google Scholar 

  10. Leach CEA, Blair PS, Fleming PJ et al. (1999) Sudden unexpected deaths in infancy: similarities and differences in the epidemiology of SIDS and explained deaths. Pediatrics 104:e43

    CAS  PubMed  Google Scholar 

  11. L’Hoir MP, Engelberts AC, van Well GTJ et al. (1998) Case control study of current validity of previously described risk factors for SIDS in The Netherlands. Arch Dis Child 79:386–393

    CAS  PubMed  Google Scholar 

  12. Wennergren G, Alm B, Øyen N et al. (1997) The decline in the incidence of SIDS in Scandinavia and its relation to risk-reduction campaigns. Acta Paediatr 86:963–968

    CAS  PubMed  Google Scholar 

  13. Keil U (1985) MONICA Project Region Augsburg. Manual of Operations. GSF, Munich

  14. Winkler J (1998) Die Messung des sozialen Status mit Hilfe eines Index in den Gesundheitssurveys der DHP. RKI-Schriften 1:69–74

    Google Scholar 

  15. Brinkmann B (1999) Harmonisation of medico-legal autopsy rules. Int J Legal Med 113:1–14

    Article  CAS  PubMed  Google Scholar 

  16. Krous H (1996) Instruction and reference manual for the international standardised autopsy protocol for sudden unexpected infant death. J SIDS Infant Mortal 1:203–246

    Google Scholar 

  17. L’Hoir MP, Engelberts AC, van Well GTJ, Bajanowski T, Helweg-Larsen K, Huber J (1998) Sudden unexpected death in infancy; epidemiology determined risk factors related to a pathology classification. Acta Paediatr 87:1279–1287

    Article  CAS  PubMed  Google Scholar 

  18. Bajanowski T, Fürst P, Wilmers K, Beike J, Köhler H, Karger B, Brinkmann B (2001) Dioxin concentrations in infant tissue and sudden infant death. Int J Legal Med 116:27–32

    Article  Google Scholar 

  19. Schütz H, Machbert G (1988) Photometrische Bestimmung von Carboxy-Hämoglobin (CO-Hb) im Blut. Mitteilung VIII der Senatskommission für klinisch-toxikologische Analytik. VCH Verlagsgesellschaft, Weinheim

  20. Käferstein H, Sticht G, Staak M (1989) Vergleich verschiedener immunologischer Methoden mit einer Gc-MS Analyse. Beitr Gerichtl Med 47:115–122

    PubMed  Google Scholar 

  21. Pavlic M, Haidekker A, Grubwieser P, Rabl W (2002) Fatal intoxication with omethoate. Int J Legal Med 116:238–241

    CAS  PubMed  Google Scholar 

  22. Taylor EM, Emery JL (1990) Categories of preventable unexpected infant deaths. Arch Dis Child 65:535–539

    CAS  PubMed  Google Scholar 

  23. Slattery ML, Edwards SL, Caan BJ, Kerber RA, Potter JD (1995) Response rates among control subjects in case-control studies. Ann Epidemiol 5:245–249

    Article  CAS  PubMed  Google Scholar 

  24. Fleiss J (1981) Statistical methods for rates and proportions. Series in probability and mathematical statistics. Wiley, New York, pp 216–236

  25. Becroft DMO, Thompson JMD, Mitchell EA (1998) Epidemiology of intrathoracic petechial hemorrhages in sudden infant death syndrome. Pediatr Dev Pathol 1:200–209

    Article  CAS  PubMed  Google Scholar 

  26. Gibbons LE, Ponsonby A-L, Dwyer TA (1993) A comparison of prospective and retrospective responses on sudden infant death syndrome by case and control mothers. Am J Epidemiol 137:654–659

    CAS  PubMed  Google Scholar 

  27. Drews CD, Kraus JF, Greenland S (1990) Recall bias in a case-control study on SIDS. Int J Epidemiol 19:405–411

    CAS  PubMed  Google Scholar 

  28. Stang A, Ahrens W, Jöckel K-H (1999) Control response proportions in population-based case-control studies in Germany. Epidemiology 10:181–183

    CAS  PubMed  Google Scholar 

  29. Ärztekammer Westfalen-Lippe (2001) Jahresauswertung 2001 Geburtshilfe

  30. Gregersen M, Rajs J, Laurensen H et al. (1995) Pathological criteria for the Nordic study of SIDS. In: Rognum TO (ed) Sudden infant death syndrome. New trends in the nineties. Scandinavian University Press, Oslo, pp 50–58

  31. Gilbert R, Rudd P, Berry PJ et al. (1992) Combined effect of infection and heavy wrapping on the risk of sudden unexpected infant death. Arch Dis Child 67:171–177

    CAS  PubMed  Google Scholar 

  32. Jorch G, Schmidt-Troschke S, Bajanowski T (1994) Epidemiologische Risikofaktoren des plötzlichen Kindstodes. Ergebnisse der westfälischen Kindstodsstudie 1990–1992. Monatsschr Kinderheilkd 142:45–51

    Google Scholar 

Download references

Acknowledgements

The study is supported by the Federal German Ministry for Science and Education (01 ED 9401/8). We thank H. Hansen and E.A. Mitchell for acting as consultants as well as E. Müller and T. Butterfaß-Bahloul who worked as recorders. We thank the physicians of the health offices and the doctors of the children’s hospitals and the obstetric departments for sending us the clinical documents and all paediatricians and general practitioners for filling in the questionnaire. We also thank the 32 interviewers who undertook interviews during the 3 years of the study and Schwertner Field Research, Augsburg, for performing the fieldwork. We thank the police for supporting the parents and the study. We thank all the local registry offices for sending us the addresses of control families. Most importantly, the authors are indebted to the parents who participated in this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to B. Brinkmann.

Additional information

A list of the collaborating authors and institutes is given in the appendix.

Electronic Supplementary Material

Appendix

Appendix

The following collaborating authors were from Institutes for Legal Medicine:

  • P. Bach, State of Brandenburg, Potsdam

  • B. Bockholt, Free University, Berlin (West)

  • M. Bohnert, Albert-Ludwigs-University, Freiburg im Breisgau

  • U. Cremer, Rheinisch-Westfälische Technische Hochschule, Aachen

  • U. Deml, Friedrich-Alexander-University, Erlangen

  • A. Freislederer, Universität-Gesamthochschule, Essen

  • S. Heide, Martin-Luther-University, Halle

  • W. Huckenbeck, Heinrich-Heine-University, Düsseldorf

  • K. Jahau, Otto-von-Guericke-University, Magdeburg

  • H-J. Kaatsch, Christian-Albrechts-University, Kiel

  • A. Klein, Friedrich-Schiller University, Jena

  • W.J. Kleemann, Hannover Medical School, now University of Leipzig

  • K.-P. Larsch, A. Fiegut, Hannover Medical School

  • H.W. Leukel, Johann-Wolfgang-Goethe-University, Frankfurt am Main

  • E. Rauch, R. Penning, Ludwig-Maximilians-University, München

  • F. Rublack, Humboldt-University, Berlin (East)

  • J. Sperhake, University of Hamburg

  • G. Zimmer, Ruprecht-Karls-University, Heidelberg

  • R. Zweihoff, City of Dortmund

The following collaborating authors were from Institutes for Epidemiology and Social Medicine:

  • K. Berger, University of Münster

  • D. Fischer, Children’s Hospital, Otto-von-Guericke-University, Magdeburg

  • W. Paulus, Institute of Neuropathology, University of Münster

  • C. Sauerland, Department of Medical Informatics and Biomathematics, University of Münster

  • M. Schlaud, MH Hannover Medical School

  • B. Schmidt, Institute for Virology, Friedrich-Alexander-University, Erlangen

Rights and permissions

Reprints and permissions

About this article

Cite this article

Findeisen, M., Vennemann, M., Brinkmann, B. et al. German study on sudden infant death (GeSID): design, epidemiological and pathological profile. Int J Legal Med 118, 163–169 (2004). https://doi.org/10.1007/s00414-004-0433-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00414-004-0433-8

Keywords

Navigation