Kiechl-Kohlendorfer U, Peglow U P, Kiechl S, Oberaigner W, Sperl W
Department of Paediatrics, University of Innsbruck, Austria.
Wien Klin Wochenschr. 2001 Jan 15;113(1-2):27-32.
We investigated the epidemiology of sudden infant death syndrome (SIDS) in the Tyrol before and after an intervention campaign.
Descriptive characteristics and risk factors of SIDS before the campaign were assessed in a retrospective case-control study (1984 to 1994). In April 1994 a country-wide information campaign on modifiable risk behaviours was initiated. Thereafter we prospectively collected data on child care practices four to six weeks after birth for all infants born in the Tyrol (participation rate 72%; n = 28,361) and evaluated new SIDS cases (1994 to 1998). For this purpose two questionnaires were used, one with 96 items for the evaluation of all SIDS cases and assessment of child care practices before 1994, and the other with 24 items for prospective data collection.
The incidence of SIDS decreased from 1.83 (mean incidence, 1984-1994) to 0.4/1000 live births immediately after the campaign and remained low until 1998. The frequency of maternal smoking during pregnancy declined (22.9% vs. 14.5%, p < 0.01), as did the prevalence of the prone sleeping position (53.7% vs. 5.4%, p < 0.001) and of non-breastfeeding (21.3% vs. 6.7%, p < 0.001). All these variables were prominent risk factors for SIDS before the campaign and remained significant thereafter. On account of the markedly reduced prevalence of the prone sleeping position, smoking became the most common SIDS risk factor. The prevalence of sleeping on the side significantly increased (5.1% vs. 36.4%, p < 0.001) and the social status of mothers of SIDS infants tended to be lower than that before the campaign. The clear winter preponderance of SIDS which was evident before the campaign disappeared, or was even reversed.
Our study documents the long-term efficacy of a low-cost intervention campaign by way of health education. Further efforts must be directed toward lower social classes, thereby focusing on maternal smoking and avoidance of the side sleeping position.
我们调查了蒂罗尔州在开展一项干预活动前后婴儿猝死综合征（SIDS）的流行病学情况。
在一项回顾性病例对照研究（1984年至1994年）中评估了活动开展前SIDS的描述性特征和危险因素。1994年4月发起了一场关于可改变风险行为的全国性宣传活动。此后，我们前瞻性地收集了蒂罗尔州所有出生婴儿出生后四至六周的育儿习惯数据（参与率72%；n = 28361），并评估了新的SIDS病例（1994年至1998年）。为此使用了两份问卷，一份有96个项目，用于评估所有SIDS病例及1994年前的育儿习惯，另一份有24个项目，用于前瞻性数据收集。
活动开展后，SIDS的发病率立即从1.83（1984 - 1994年平均发病率）降至0.4/1000活产，并一直保持在低水平直至1998年。孕期母亲吸烟的频率下降（22.9%对14.5%，p < 0.01），俯卧睡眠姿势的患病率下降（53.7%对5.4%，p < 0.001），非母乳喂养的患病率下降（21.3%对6.7%，p < 0.001）。所有这些变量在活动开展前都是SIDS的显著危险因素，此后依然如此。由于俯卧睡眠姿势的患病率显著降低，吸烟成为最常见的SIDS危险因素。侧卧睡眠的患病率显著增加（5.1%对36.4%，p < 0.001），SIDS婴儿母亲的社会地位往往低于活动开展前。活动开展前明显的冬季SIDS高发情况消失了，甚至出现了反转。
我们的研究证明了通过健康教育开展低成本干预活动的长期效果。必须进一步针对社会阶层较低的群体开展工作，重点关注母亲吸烟和避免侧卧睡眠姿势。
