Sudden infant death syndrome: risk factors for infants found face down differ from other SIDS cases

OBJECTIVE: To test the hypothesis that infants with sudden infant death syndrome (SIDS) found face down (FD) would have SIDS risk factors different from those found in other positions (non-face-down position, NFD). STUDY DESIGN: We used the New Zealand Cot Death Study data, a 3-year, nationwide (1987 to 1990), case-control study. Odds ratios (univariate and multivariate) for FD (n = 154) and NFD SIDS (n = 239) were estimated separately, and statistical differences between the two groups were assessed. RESULTS: Of 12 risk factors for SIDS, there were 8 with a statistically significant difference between FD and NFD infants. After adjustment for the potential confounders, younger infant age, Maori ethnicity, low birth weight, prone sleep position, use of a sheepskin, and pillow use were all associated with a greater risk of SIDS in the FD than the NFD group. Sleeping during the nighttime, maternal smoking, and bed-sharing were associated with a risk of SIDS only in the NFD group. Pacifier use was associated with a decreased risk for SIDS only in the NFD group, whereas being found with the head covered was associated with a decreased risk for SIDS for the FD group. CONCLUSIONS: Infants with SIDS in the FD position appear to be a distinct subgroup of SIDS. These differences in risk factors provide clues to mechanisms of death in both SIDS subtypes.