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Sudden infant death syndrome and sleeping position in pre-term and low birth weight infants: an opportunity for targeted intervention
  1. P S Blair1,
  2. M Ward Platt2,
  3. I J Smith3,
  4. P J Fleming1,
  5. and the CESDI SUDI Research Group
  1. 1Institute of Child Life and Health, Department of Clinical Science, South Bristol, University of Bristol, UK
  2. 2Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  3. 3Nuffield Institute for Health, Leeds, UK
  1. Correspondence to:
    Prof. P J Fleming
    Institute of Child Life and Health, UBHT Education Centre, Upper Maudlin St, Bristol BS2 8AE, UK; peter.fleming{at}


Aims: To determine the combined effects of sudden infant death syndrome (SIDS) risk factors in the sleeping environment for infants who were “small at birth” (pre-term (<37 weeks), low birth weight (<2500 g), or both).

Methods: A three year population based, case-control study in five former health regions in England (population 17.7 million) with 325 cases and 1300 controls. Parental interviews were carried out after each death and reference sleep of age matched controls.

Results: Of the SIDS infants, 26% were “small at birth” compared to 8% of the controls. The most common sleeping position was supine, for both controls (69%) and those SIDS infants (48%) born at term or ⩾2500 g, but for “small at birth” SIDS infants the commonest sleeping position was side (48%). The combined effect of the risk associated with being “small at birth” and factors in the infant sleeping environment remained multiplicative despite controlling for possible confounding in the multivariate model. This effect was more than multiplicative for those infants placed to sleep on their side or who shared the bed with parents who habitually smoked, while for those “small at birth” SIDS who slept in a room separate from the parents, the large combined effect showed evidence of a significant interaction. No excess risk was identified from bed sharing with non-smoking parents for infants born at term or birth weight ⩾2500 g.

Conclusion: The combined effects of SIDS risk factors in the sleeping environment and being pre-term or low birth weight generate high risks for these infants. Their longer postnatal stay allows an opportunity to target parents and staff with risk reduction messages.

  • SIDS
  • pre-term
  • low birth weight
  • infant sleeping position
  • co-sleeping

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  • Published Online First 24 May 2005

  • Funding: Grant bodies for this study include funds from (i) the National Advisory Body for the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI), (ii) the Foundation for the Study of Infant Deaths (FSID), and (iii) Babes in Arms. Dr Peter Blair has been funded by all three bodies for work on this project

  • Competing interests: none

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