University of Virginia School of Medicine, Charlottesville, VA.
Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA.
J Pediatr. 2018 Jun;197:57-62.e36. doi: 10.1016/j.jpeds.2018.01.051. Epub 2018 Apr 2.
To compare risk factors for infant sleep-related deaths under the supervision of parents and nonparents.
We conducted a secondary analysis of sleep-related infant deaths from 2004 to 2014 in the National Center for Fatality Review and Prevention Child Death Review Case Reporting System. The main exposure was supervisor at time of death. Primary outcomes included sleep position, location, and objects in the environment. Risk factors for parental vs nonparental supervisor were compared using χ and multivariable logistic regression models. Risk factors associated with different nonparental supervisors were analyzed using χ.
Of the 10 490 deaths, 1375 (13.1%) occurred under nonparental supervision. Infants who died under nonparental supervision had higher adjusted odds of dying outside the home (OR 12.87, 95% CI 11.31-14.65), being placed prone (OR 1.61, 95% CI 1.39-1.86) or on their side (OR 1.35, 95% CI 1.12-1.62), or being found prone (OR 1.74, 95% CI 1.50-2.02). Among infants who died under nonparental supervision, those supervised by relatives or friends were more often placed on an adult bed or couch for sleep and bed sharing (P < .0001), and to have objects in the sleep environment (P = .01).
Infants who died of sleep-related causes under nonparental supervision were more likely to have been placed nonsupine. Among nonparental supervisors, relatives and friends were more likely to use unsafe sleep environments, such as locations other than a crib or bassinet and bed sharing. Pediatricians should educate parents that all caregivers must always follow safe sleep practices.
比较在父母和非父母监督下婴儿睡眠相关死亡的危险因素。
我们对 2004 年至 2014 年期间国家死亡审查和预防儿童死亡审查报告系统中的与睡眠相关的婴儿死亡进行了二次分析。主要暴露因素为死亡时的监护者。主要结局包括睡眠姿势、位置和环境中的物体。使用 χ2 和多变量逻辑回归模型比较父母与非父母监督者的危险因素。使用 χ2 分析与不同非父母监督者相关的危险因素。
在 10490 例死亡中，有 1375 例（13.1%）发生在非父母监督下。非父母监督下死亡的婴儿，其在家外死亡的调整后优势比（OR）为 12.87（95%CI，11.31-14.65），俯卧位（OR 1.61，95%CI，1.39-1.86）或侧卧位（OR 1.35，95%CI，1.12-1.62）的调整后优势比更高，或被发现俯卧位（OR 1.74，95%CI，1.50-2.02）。在非父母监督下死亡的婴儿中，由亲戚或朋友监督的婴儿更常被放置在成人床或沙发上睡觉和同床（P<0.0001），并且环境中有物体（P=0.01）。
在非父母监督下死于与睡眠相关原因的婴儿更有可能被放置在非仰卧位。在非父母监督者中，亲戚和朋友更有可能使用不安全的睡眠环境，如婴儿床或摇篮以外的位置和同床。儿科医生应教育父母，所有照顾者都必须始终遵守安全睡眠习惯。
