Jump to comment:

• Critical review of approaches to SIDS research
  Paul N. Goldwater
  Published on: 23 January 2004
• SIDS rates and risk campaigns
  Roger W. Byard
  Published on: 9 January 2004

• Published on: 23 January 2004

  Critical review of approaches to SIDS research

  • Paul N. Goldwater, Snior Consultant Clinical Microbiologist

  Dear Editor

  It is gratifying that Professor Byard agrees in principal over the need for SIDS research to be continually re-assessed in regard to the ‘diagnosis’ of SIDS, and the problems associated with understanding its pathogenesis.[1] We clearly differ in our views of the epidemiology of SIDS.

  From the outset, there is no argument about prone sleep position being a proven risk factor for SIDS, and for...

  Show More

  Dear Editor

  It is gratifying that Professor Byard agrees in principal over the need for SIDS research to be continually re-assessed in regard to the ‘diagnosis’ of SIDS, and the problems associated with understanding its pathogenesis.[1] We clearly differ in our views of the epidemiology of SIDS.

  From the outset, there is no argument about prone sleep position being a proven risk factor for SIDS, and for this reason parents should be encouraged to continue to avoid putting their baby to bed prone. However, until the underlying mechanism(s) by which prone position increases the risk of SIDS is clarified, it remains a subject of much conjecture, it therefore remains a risk factor and cannot be construed as being a cause. Whilst acknowledging the apparent success of the Reducing the Risk (RTR) campaign, and the hard work by all involved, the degree to which the campaign has influenced the incidence of SIDS remains open to question. It is probable that in 1970 many more babies were sleeping prone than in 2004, yet in 1970 the incidence of SIDS was as low as it is today. This is a paradox that has not been addressed by Professor Byard. If the observed decrease was entirely due to the RTR campaign, with no role of natural variation, then, using the same criteria, we are forced to ask this question… Was the increase in incidence of SIDS observed in many countries in the 1980s solely attributable to an increase in prone sleeping? I think not. Only thorough pathological & epidemiological investigation of SIDS cases and controls could have answered such a question.

  There have been a vast number of social, life style, technological, dietary, agricultural, and environmental changes in developed countries over the last four decades. Few of these potential influences have been examined in the context of the epidemiology of SIDS. My review discussed the defects in approaches to research resulting from a lack of attention to very consistent pathological clues. The review showed how the epidemiology of SIDS connects in useful ways with the pathological findings and demonstrates that while prone sleep position is indeed a risk factor, the evidence to support a connection with asphyxia is lacking and should guide researchers away from spending valuable research funds and time on this seemingly fruitless approach. Avoidance of the prone risk factor does not necessarily prevent SIDS. Regrettably SIDS also occurs in the supine and lateral positions. Further attention to the possible mechanisms by which prone sleeping increases the risk (as alluded to in my review) will hopefully shed more light on the pathogenesis of SIDS.

  Reference

  (1) Byard et al. SIDS rates and risk campaigns [electronic response to Goldwater PN; Sudden infant death syndrome: a critical review of approaches to research] archdischild 2004http://adc.bmjjournals.com/cgi/eletters/archdischild;88/12/1095#593

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top
• Published on: 9 January 2004

  SIDS rates and risk campaigns

  • Roger W. Byard, Forensic Pathologist
  • Other Contributors:
    • Henry F. Krous, and Torleiv O. Rognum

  Dear Editor

  We were interested in the paper by Goldwater calling for a critical review of approaches to research in sudden infant death syndrome (SIDS).[1]

  We would agree that SIDS research needs to be continually re-assessed due both to difficulties in establishing this ‘diagnosis’, and to problems associated with understanding aetiological mechanisms. However, the suggestion that the fall in SIDS rates has...

  Show More

  Dear Editor

  We were interested in the paper by Goldwater calling for a critical review of approaches to research in sudden infant death syndrome (SIDS).[1]

  We would agree that SIDS research needs to be continually re-assessed due both to difficulties in establishing this ‘diagnosis’, and to problems associated with understanding aetiological mechanisms. However, the suggestion that the fall in SIDS rates has not been due to ‘reducing the risks’ (RTR) campaigns but instead is merely ‘a reflection of natural variation’ is of great concern. Although data from Sweden and Australia are used to support this contentious proposition, examination of the data is not confirmatory.

  While SIDS rates in Sweden have been less pronounced than in certain other Scandinavian countries, (at 0.3/1000 live births in 1970), by the time the Swedish back to sleep campaign was launched in 1991 the rate had risen to 1.2; it subsequently dropped to 0.4 in 1994 and has remained low ever since.[2,3] SIDS rates in Finland were lower than in Sweden, but even there the trends are similar.[2] Examination of Australian Bureau of Statistics data also does not support Goldwater’s contention. These data clearly show continued and consistent falls in SIDS rates in all parts of Australia since information become available on risk factors (in the late 1980s). Any increases in rates have been temporary, minimal, not sustained and not statistically significant. Similar falls have been shown in many other countries.[3] Thus, there can be no doubt that the marked decline in SIDS rates has been due to the RTR campaigns, sponsored by extremely hard working and well-motivated SIDS organisations, and not to random variation. To question the effectiveness of the RTR campaign has the potential to encourage parents to ignore well-established safety messages about infant sleeping, and thus to put their infants lives needlessly at risk.

  References

  1. Goldwater PN. Sudden infant death syndrome: a critical review of approaches to research. Arch Dis Child 2003;88:1095-1100.

  2. Sudden infant death in the Nordic countries. Results of the Nordic Study of Sudden Infant Death Syndrome, 1990-1996. TemaNord, Nordic Council of Ministers, Copenhagen, Denmark. 1997:600.

  3. Hauck FR. Changing epidemiology. Ch 3. In: Sudden Infant Death Syndrome: Problems, Progress & Possibilities Eds. Byard RW, Krous HF. London, Arnold. 2001; 31-57.

  Address for correspondence:
  Prof Roger W. Byard
  Forensic Science Centre
  21 Divett Place
  Adelaide 5000, Australi

  Phone: (618) 8226 7700
  Fax: (618) 8226 7777
  Email: byard.roger@saugov.sa.gov.au

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top