Well health care and the sudden infant death syndrome

The aim of this study was to examine whether poor attendance at routine antenatal and postnatal 'well child' health services was associated with a higher risk of sudden infant death syndrome (SIDS, or cot death). A nationwide case-control study of SIDS in New Zealand enrolled 485 postneonatal deaths due to SIDS and 1800 control infants who were selected randomly. The risk for SIDS was found to be higher for infants whose mothers attended their first antenatal check later than 3 months into the pregnancy, made fewer antenatal visits, and did not go to antenatal education classes. However, this increased risk was largely explained by high parity, maternal smoking, the mother not being married, mother being < 20 years old at the birth of her first child, and delivery during the winter months. Infants not attending a 6 week postnatal check had an almost three-fold increased risk of SIDS compared with those who did attend (odds ratio [OR] 2.86; 95% confidence interval [CI] 1.93, 4.24). Similarly, infants not attending well child clinics were at increased risk of SIDS (OR 2.75; 95% CI 2.09, 3.62). These differences persisted when adjusted for likely confounders. This study demonstrates that infants who miss child health nurse clinics are those most at risk for SIDS and are those who warrant increased surveillance.