Infant sleeping position and the sudden infant death syndrome: Systematic review of observational studies and historical review of recommendations from 1940 to 2002

Centre for Evidence-based Child Health, Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
International Journal of Epidemiology (Impact Factor: 9.18). 09/2005; 34(4):874-87. DOI: 10.1093/ije/dyi088
Source: PubMed


Before the early 1990s, parents were advised to place infants to sleep on their front contrary to evidence from clinical research.
We systematically reviewed associations between infant sleeping positions and sudden infant death syndrome (SIDS), explored sources of heterogeneity, and compared findings with published recommendations.
By 1970, there was a statistically significantly increased risk of SIDS for front sleeping compared with back (pooled odds ratio (OR) 2.93; 95% confidence interval (CI) 1.15, 7.47), and by 1986, for front compared with other positions (five studies, pooled OR 3.00; 1.69-5.31). The OR for front vs the back position was reduced as the prevalence of the front position in controls increased. The pooled OR for studies conducted before advice changed to avoid front sleeping was 2.95 (95% CI 1.69-5.15), and after was 6.91 (4.63-10.32). Sleeping on the front was recommended in books between 1943 and 1988 based on extrapolation from untested theory.
Advice to put infants to sleep on the front for nearly a half century was contrary to evidence available from 1970 that this was likely to be harmful. Systematic review of preventable risk factors for SIDS from 1970 would have led to earlier recognition of the risks of sleeping on the front and might have prevented over 10 000 infant deaths in the UK and at least 50 000 in Europe, the USA, and Australasia. Attenuation of the observed harm with increased adoption of the front position probably reflects a "healthy adopter" phenomenon in that families at low risk of SIDS were more likely to adhere to prevailing health advice. This phenomenon is likely to be a general problem in the use of observational studies for assessing the safety of health promotion.

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    • "During the sleeping monitoring, guardian should promptly and effectively discover and deal with some very important events such as the infant's face is covered by clothing or the infant sleeps in the prone, since these events are extremely easy to suffocate infant [2] [3] [4] [5] [6]. Existing infant sleep monitoring is mainly carried out by human monitoring or video surveillance [7] [8] [9]. "
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    ABSTRACT: The sleeping position monitoring of infant is a very important component of baby safe custody. Existing infant sleep monitoring mainly rely on human duty, which is usually easy to cause urgent infant events not to be timely detected and treated, especially when the guardian is sleeping at night. In this paper, we propose an intelligent recognition method of infant sleeping position based on thermal infrared imaging, aiming to overcome the deficiencies of the prior art on infant sleep monitoring. Firstly we capture real-time thermal infrared images on infant sleeping with thermal imager, in a non-touch way. Then we detect the position of infant's nose or mouth as well as the position of infant's head area. Next we discriminate the sleeping position of infant's head according to the relative position of nose or mouth to the detected head area. Finally when the recognized sleeping position is dangerous or with a security risk to infant, we remind the guardian through triggering early warning module to generate alarm. Real data have been used to test the proposed approach and very good results have been achieved, validating it.
    Preview · Article · Jul 2015
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    • "The searching for this review also identified several cumulative meta-analyses in other types of health research, which are not summarised here but have been discussed in brief elsewhere [4]. For example, if epidemiological studies investigating possible aetiological factors in sudden infant death syndrome had taken proper account of the accumulating evidence, the lethal effect of ‘front lying’ would have been recognized at least a decade earlier, and tens of thousands of infant deaths could have been avoided [9]. A cumulative meta-analysis of 55 studies that continued to be conducted over more than two decades showed that for over 17 years there had been ample evidence that never-smoking women who had been exposed to spousal smoking were more likely than controls to develop lung cancer [10]. "
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    ABSTRACT: “Cumulative meta-analysis” describes a statistical procedure to calculate, retrospectively, summary estimates from the results of similar trials every time the results of a further trial in the series had become available. In the early 1990s, comparisons of cumulative meta-analyses of treatments for myocardial infarction with advice promulgated through medical textbooks showed that research had continued long after robust estimates of treatment effects had accumulated, and that medical textbooks had overlooked strong, existing evidence from trials. Cumulative meta-analyses have subsequently been used to assess what could have been known had new studies been informed by systematic reviews of relevant existing evidence and how waste might have been reduced.
    Full-text · Article · Jul 2014 · PLoS ONE
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    • "Modern medical studies have concluded that infants who sleep in the prone position have a seven-fold increased risk of sudden infant death syndrome (SIDS). This has led to “back to sleep” campaigns in Britain (1991) and in the United States (1994).[19] "
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