Risk factors for early sudden deaths and severe apparent life-threatening events

Abstract

Objective: To identify potential risk factors for unexpected sudden infant deaths (SID) and severe apparent life-threatening events (S-ALTE) within 24 h of birth. Design: Case-control study embedded in an epidemiological survey over a 2-year period. Patients and methods: Throughout 2009, every paediatric department in Germany was asked to report cases of unexplained SID or S-ALTE in term infants with a 10-min Apgar score ≥8 to the Surveillance Unit for Rare Pediatric Conditions. Throughout 2010, the inclusion criteria were extended to infants ≥35 week gestational age and those where an explanation for the deterioration had been found. For each unexplained case, hospitals were asked to fi ll in a questionnaire for 3 (near-)term controls with good postnatal adaptation at the age (in minutes) when the event had occurred in the case under study. Results: Of the 85 cases reported, 34 fulfi lled the entry criteria; of these, two were near-term newborns and, in three cases, a cause had been identifi ed for the event. For the 31 cases with unknown cause for the event (13 males; mean (SD) gestational age 38.9 (1.7) week), the authors gathered 93 controls (51 male infants; 38.9 (1.4) week). As signifi cant risk factors for S-ALTE and SID, the authors could identify primipara (OR 6.22; 95% CI 2.11 to 18.32) and potentially asphyxiating position (OR 6.45; 95% CI 1.22 to 34.10). Conclusions: Close observation of newborns seems necessary, particularly in primipara; a potentially asphyxiating position should be avoided.