A.A.M. Gibson

Case-control study of sudden infant death syndrome in Scotland, 1992-5.

Abstract Objective: To investigate the relation between routine infant care practices and the sudden infant death syndrome in Scotland. Methods: National study of 201 infants dying of the sudden infant death syndrome (cases) and 276 controls by means of home interviews comparing methods of infant care and socioeconomic factors. Results: Sleeping prone (odds ratio 6.96 (95% confidence interval 1.51 to 31.97)) and drug treatment in the previous week (odds ratio 2.33 (1.10 to 4.94)) were more common in the cases than controls on multivariate analysis. Smoking was confirmed as a significant risk factor (odds ratio for mother and father both smoking 5.19 (2.26 to 11.91)). The risk increased with the number of parents smoking (P<0.0001), with the number of cigarettes smoked by mother or father (P=0.0001), and with bed sharing (P<0.005). A new finding was an increased risk of dying of the syndrome for infants who slept at night on a mattress previously used by another infant or adult (odds ratio 2.51 (1.39 to 4.52)). However, this increased risk was not established for mattresses totally covered by polyvinyl chloride. Conclusions: Sleeping prone and parental smoking are confirmed as modifiable risk factors for the sudden infant death syndrome. Sleeping on an old mattress may be important but needs confirmation before recommendations can be made. Key messages Parental smoking is currently the most important modifiable risk factor in the sudden infant death syndrome In this study sleeping prone and, to a lesser extent, sleeping on the side increased the risk of the syndrome, so babies should be put down to sleep only on their back Bed sharing with an infant should be discouraged if the mother smokes Sleeping on an old mattress may carry an increased risk

MATERNAL SERUM α-FETOPROTEIN—A MARKER OF FETAL APLASTIC CRISIS DURING INTRAUTERINE HUMAN PARVOVIRUS INFECTION

In 2 cases of hydrops fetalis and intrauterine death associated with human parvovirus B19 infection that produced very few symptoms during the second trimester of pregnancy, maternal serum alpha-fetoprotein levels were raised, before the ultrasonic detection of hydropic features. Fetal blood sampling in 1 case revealed the features of aplastic crisis. A retrospective study of 3 other affected and 11 unaffected cases of B19 infection during pregnancy showed a correlation between raised maternal serum alpha-fetoprotein level and poor prognosis for the affected pregnancies, with the subsequent development of hydrops fetalis.

Used infant mattresses and sudden infant death syndrome in Scotland: case-control study

Abstract Objective: To examine the proposition that a used infant mattress is associated with an increased risk of sudden infant death syndrome. Design:Case-control study. Setting: Scotland (population 5.1 million, with about 53 000 births a year). Participants: 131 infants who died of sudden infant death syndrome between 1 January 1996 and 31 May 2000 and 278 age, season, and obstetric unit matched control infants. Main outcome measures: Routine use of an infant mattress previously used by another child and place of last sleep. Results: Routine use of an infant mattress previously used by another child was significantly associated with an increased risk of sudden infant death syndrome (multivariate odds ratio 3.07, 95% confidence interval 1.51 to 6.22). Use of a used infant mattress for last sleep was also associated with increased risk (6.10, 2.31 to 16.12). The association was significantly stronger if the mattress was from another home (4.78, 2.08 to 11.0) than if it was from the same home (1.64, 0.64 to 4.2). Conclusion: A valid significant association exists between use of a used infant mattress and an increased risk of sudden infant death syndrome, particularly if the mattress is from another home. Insufficient evidence is available to judge whether this relation is cause and effect. What is already known about this topic The major risk factors for sudden infant death syndrome are sleeping prone and parental smoking One study has suggested that the syndrome is associated with sleeping on an infant mattress previously used by another child What this study adds New case-control data show that the association between a previously used infant mattress and sudden infant death syndrome is valid When source of used mattress is categorised, the association is significant only if the mattress is from another home Insufficient evidence is available to judge whether this is a cause and effect relation

Patent ductus venosus

SummaryA patent ductus venosus has been reported on only two previous occasions. Both involved adults who presented with recurrent bouts of encephalopathy. We present the case of an infant with complex congenital heart disease and multiple other abnormalities, in whom a patent ductus venosus was an incidental finding at necropsy. The etiology of this condition and the options for management are discussed.

POST-PERINATAL INFANT MORTALITY IN GLASGOW 1979-81

Post-perinatal infant mortality (PPIM; deaths from the 8th day to the end of the 1st year of life) was studied in Glasgow over the 3-year period 1979-81. The 244 deaths were divided into three main categories--those determined at birth, those due to accidents and acquired disease, and cot deaths. 50% of deaths were determined at birth, and of these 46% were due to prematurity and 49% to congenital disorder. Cot deaths accounted for 44% of the total (88% of deaths not determined at birth) and a definite cause could be identified in only 10% of these. The PPIM rate was 6.1 per 1000 livebirths, a significant part of the infant mortality rate of 12.6. The significance of these findings is discussed in relation to the possible reduction of these figures.