Elsevier

Academic Pediatrics

Volume 10, Issue 6, November–December 2010, Pages 376-382
Academic Pediatrics

Prevention
Bed Sharing Among Black Infants and Sudden Infant Death Syndrome: Interactions With Other Known Risk Factors

https://doi.org/10.1016/j.acap.2010.09.001Get rights and content

Abstract

Objective

Bed sharing has been associated with sudden infant death syndrome (SIDS) and may contribute to the racial disparity seen in infant mortality. It is unclear how bed sharing interacts with other factors to impact SIDS risk. We aimed to measure the effects of bed sharing on risk of SIDS in blacks and to determine whether the risk is modified by other characteristics of the sleep environment.

Methods

Characteristics of 195 black infants who died of SIDS were compared with matched controls. The moderating influence of known SIDS risk factors on the effect of bed sharing on risk of SIDS was examined using logistic regression.

Results

Almost half (47.4%) of the study population bed shared during the last/reference sleep (58% cases and 37% controls). Bed sharing was associated with 2 times greater risk of SIDS compared with not bed sharing. The deleterious effect of bed sharing was more pronounced with a soft sleep surface, pillow use, maternal smoking, and younger infant age. However, bed sharing was still associated with an increased risk of SIDS, even when the infant was not using a pillow or sleeping on a firm surface. The strongest predictors of SIDS among bed-sharing infants were soft sleep surface, nonuse of a pacifier, and maternal smoking during pregnancy.

Conclusions

Bed sharing is a common practice among black infants. It is associated with a clear and strong increased risk of SIDS, which is even greater when combined with other known risk factors for SIDS. This practice likely contributes to the excess incidence of SIDS among blacks, and culturally competent education methods must be developed to target this high-risk group.

Section snippets

Subjects and Data Collected

This study involved secondary data analysis from the Chicago Infant Mortality Study (CIMS), which has demonstrated a strong association between bed sharing and SIDS.5, 24 The CIMS methodology has been described in detail previously.5, 20, 24 Briefly, CIMS was a population-based, case-control study designed explicitly to examine the risk factors for SIDS in a largely black population. The study enrolled all Chicago resident infants from birth to 1 year of age who died of SIDS (cases) as

Results

Nearly half of our study population (47.4%) was bed sharing at last/reference sleep. A majority of those infants who died from SIDS (57.9%) were bed sharing as compared with 37% of control infants. After adjustment for maternal marital status, education, and index of prenatal care, bed sharing was associated with a 2 times greater risk of SIDS as compared with sleeping alone (95% CI, 1.2–3.4). As shown in Table 1, mothers in our study were on average aged in their early 20s and were not likely

Discussion

This is the first report of the interaction of bed sharing with other characteristics of the infant and sleep environment on the risk for SIDS among black infants. Because of the ongoing controversy about whether increased SIDS risk is conferred by bed sharing itself or by the circumstances under which bed sharing occurs, it is important to understand if and how bed-sharing risk is modified by other environmental, maternal, and infant factors, especially among black infants who are more likely

Acknowledgment

This study was supported by Health Resources and Services Administration grant 1R40MC08963-01 to Rachel Moon, principal investigator.

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