Risk and Preventive Factors for SUDI: Need We Adjust the Current Prevention Advice in a Low-Incidence Country

Area of Science:

• Pediatrics
• Public Health
• Epidemiology

Background:

• Sudden Unexpected Death in Infancy (SUDI) has a low incidence in the Netherlands (0.18 per 1,000 live births), potentially leading to decreased attention for prevention.
• Current SUDI risks and preventive factors in Dutch infants are not well-understood, necessitating an examination to update prevention strategies.
• This study aims to assess if current prevention advice for SUDI in the Netherlands needs adaptation based on contemporary risk and protective factors.

Purpose of the Study:

• To investigate current risk and preventive factors for Sudden Unexpected Death in Infancy (SUDI) among Dutch infants.
• To determine if existing SUDI prevention advice requires modification to address current needs in the Netherlands.
• To identify specific risk factors and protective measures relevant to different infant subgroups.

Main Methods:

• A case-control study design was employed, comparing SUDI cases (<12 months, 2014-2020) with a national control group (<12 months, 2017).
• Data included 47 SUDI cases and 1,192 control infants from the Netherlands.
• Statistical analysis utilized adjusted odds ratios (aOR) to assess the association between various factors and SUDI risk.

Main Results:

• Elevated SUDI risks were associated with duvet use (aOR=8.6), maternal smoking during (aOR=9.7) or after pregnancy (aOR=5.4), and prone sleeping (aOR=4.6).
• Reduced SUDI risks were observed with room-sharing (aOR=0.3), sleep sack use (aOR=0.3), breastfeeding (aOR=0.3), and pacifier use (aOR=0.4).
• Specific risks varied by infant age and circumstances, notably higher bed-sharing risks for infants <4 months (aOR=3.3) and increased risks when bed-sharing with mothers who smoked or infants were not breastfed.

Conclusions:

• Internationally recognized SUDI risk factors are also prevalent in the Netherlands.
• Risk factor strengths differ across specific infant groups, highlighting the need for targeted prevention.
• Updated prevention advice is crucial for the Netherlands, with a focus on high-risk groups and low-educated populations.