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Sudden infant death syndrome A medical mystery

Fahad Hassan Shaikh, Muhammad Shariq Usman, Syed Ammar Salman  ( Dow Medical College, Karachi )

Madam, by definition, sudden infant death syndrome (SIDS) is the medically unexplained death of a seemingly healthy newborn. Although the pathophysiology of SIDS has not been established, studies have identified several risk factors. The incidence of SIDS peaks between the ages of two to four months and declines thereafter.1 It is more common in infants with low birth weight, males, and in babies born in financially deprived families.2 The prone sleeping position is another factor which is strongly associated with this syndrome.3 The 'Back to sleep' campaign was started in the Unites States to educate parents on the proper sleeping position for infants and this initiative eventually led to a fall of 44% in the incidence of SIDS.4 However, a 2015 study by Auger et al. led to the identification of a new risk factor: ambient heat.5 Auger and colleagues studied the link between outdoor temperatures and incidence of SIDS over the previous 30 years. They discovered that high temperatures caused a statistically significant increase in the number of SIDS cases.

The results of this study raise serious concerns in temperate countries such as Pakistan. Recently Pakistan has seen extraordinarily high temperatures, especially in summer, and air conditioners are a luxury owned by few. Pakistan also has a high poverty rate which, as stated before, is another risk factor for SIDS. We carried out a thorough online literature search on PubMed and PakMediNet and found no researches studying the incidence of SIDS in Pakistan. This is indicative of the lack of attention this syndrome is given in the country. However, the infant-rearing practices of Asian parents living in the United Kingdom have been studied, and the results can give some idea about the occurrence and risk factors of SIDS in the Indian subcontinent.6 It is the duty of physicians to educate new parents on the proper nurturing of their baby. This includes making sure the infant is placed on its back or side while sleeping, and that the room is properly cooled. The baby should not be swaddled tightly or in multiple layers, especially in summer. It is ideal for the baby to sleep in the same room as the parents, but not on the same bed. One must bear in mind that superstition is endemic in Pakistan and many causes of SIDS are probably attributed to supernatural causes and remain unreported. As proven by the 'back to sleep' campaign, awareness drives have the potential to save hundreds of lives and could play a vital role in informing the Pakistani public of this dreadful problem.

Disclaimer: None to declare.
Conflict of Interest: None to declare.
Funding Sources: None to declare.


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2. Blair PS, Sidebotham P, Berry PJ, Evans M, Fleming PJ. Major epidemiological changes in sudden infant death syndrome: a 20-year population-based study in the UK. Lancet 2006; 367: 314-9.

3. Willinger M, Hoffman HJ, Hartford RB. Infant sleep position and risk for sudden infant death syndrome: report of meeting held January 13 and 14, 1994, National Institutes of Health, Bethesda, MD. Pediatrics 1994; 93: 814-9.

4. Li DK, Petitti DB, Willinger M, McMahon R, Odouli R, Vu H, Hoffman HJ. Infant sleeping position and the risk of sudden infant death syndrome in California, 1997-2000. Am J Epidemiol 2003; 5: 446-55.

5. Auger N, Fraser WD, Smargiassi A, Kosatsky T. Ambient Heat and Sudden Infant Death: A Case-Crossover Study Spanning 30 Years in Montreal, Canada. Environ Health Perspect 2015; 123: 712-6.

6. Farooqi S, Perry IJ, Beevers DG. Ethnic differences in infant-rearing practices and their possible relationship to the incidence of sudden infant death syndrome (SIDS). Paediatr Perinat Epidemiol 1993; 3: 245-52.



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