Influence of increased survival in very low birth weight, low birth weight, and normal birth weight infants on the incidence of sudden infant death syndrome in the United States: 1985-1991,☆☆,,★★

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Abstract

Objective: To examine the relationship between infant survival and the rates of sudden infant death syndrome (SIDS) in very low birth weight (VLBW), low birth weight (LBW), and normal birth weight (NBW) infants from 1985 to 1991.

Methods: The National Center for Health Statistics Birth Cohort Linked Birth/Infant Death Data Sets were used to determine birth weight, age at death, and cause of death for US-born singleton infants with birth weights of 500 g or more.

Results: Increasing infant and postneonatal survival rates were greatest in VLBW infants. In contrast, SIDS rates did not change in VLBW infants (3.66 to 3.69; P = .70) but declined in both LBW (3.51 to 3.32; P = .041) and NBW (1.07 to 1.03; P = .008) infants. Postneonatal SIDS rates (per 1000 neonatal survivors) did not change in VLBW (4.93 to 4.58; P = .58) or LBW (3.36 to 3.22; P = .07) infants but declined in NBW infants (1.00 to 0.97; P = .018). Although there were differences among the slopes of survival rates, there was no statistical evidence of differences in the slope of SIDS rates among the three groups.

Conclusions: The marked increase in survival of VLBW infants increased the pool of babies at potential risk for SIDS. VLBW infants’ SIDS rates have not changed while they have declined in NBW and LBW infants. (J Pediatr 1998;133:73-8)

Section snippets

Data Source

The source of data was the National Center for Health Statistics Birth Cohort Linked Birth/Infant Death Data Sets9, 10, 11, 12, 13, 14, 15 for each year from 1985 through 1991. These data sets are composed of birth and death certificate information on all infants born, as well as those who died, in the United States and its territories. Birth and death certificate linkage was performed at both the state and national levels to confirm accuracy. All infant data were recorded in the year of birth,

Live Births

The study population was made up of 26,866,694 singleton live-born infants with a recorded birth weight of at least 500 g who were born to US residents. They represented 97.4% of the total population born during this period in the United States (Table I).

. Comparison of study population with total US population of live-born infants by selected criteria: 1985–1991

Selection criteriaCumulative No. (%) of population meeting selection criteria
Live births27,578,316
 Live births to US residents27,547,686

Discussion

The relationship of SIDS rates to concurrent increases in infant survival stratified by birth weight has not been reported previously. This study of a discrete data set (identified to eliminate potentially confounding variables) confirms the presence of a significant increase in singleton infant and postneonatal survival (VLBW > LBW > NBW) for the period from 1985 to 1991 in the United States. In contrast to our hypotheses, these data indicate an overall declining trend in SIDS rates (infant

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    From the Departments of Pediatrics and Neurosurgery (Biostatistics Unit) at Rush Children’s Hospital, Rush–Presbyterian–St. Luke’s Medical Center, Chicago, Illinois.

    ☆☆

    Supported by the Justin Carl Suth SIDS Research Fund.

    Reprint requests: Harold R. Bigger, MD, Rush–Presbyterian–St. Luke’s Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612.

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