Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea.
Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea.
World J Pediatr. 2024 May;20(5):451-460. doi: 10.1007/s12519-024-00806-1. Epub 2024 Apr 29.
Comprehensive quantitative evidence on the risk and protective factors for sudden infant death syndrome (SIDS) effects is lacking. We investigated the risk and protective factors related to SIDS.
We conducted an umbrella review of meta-analyses of observational and interventional studies assessing SIDS-related factors. PubMed/MEDLINE, Embase, EBSCO, and Google Scholar were searched from inception until January 18, 2023. Data extraction, quality assessment, and certainty of evidence were assessed by using A Measurement Tool Assessment Systematic Reviews 2 following PRISMA guidelines. According to observational evidence, credibility was graded and classified by class and quality of evidence (CE; convincing, highly suggestive, suggestive, weak, or not significant). Our study protocol was registered with PROSPERO (CRD42023458696). The risk and protective factors related to SIDS are presented as equivalent odds ratios (eORs).
We identified eight original meta-analyses, including 152 original articles, covering 12 unique risk and protective factors for SIDS across 21 countries/regions and five continents. Several risk factors, including prenatal drug exposure [eOR = 7.84 (95% CI = 4.81-12.79), CE = highly suggestive], prenatal opioid exposure [9.55 (95% CI = 4.87-18.72), CE = suggestive], prenatal methadone exposure [9.52 (95% CI = 3.34-27.10), CE = weak], prenatal cocaine exposure [4.38 (95% CI = 1.95-9.86), CE = weak], prenatal maternal smoking [2.25 (95% CI = 1.95-2.60), CE = highly suggestive], postnatal maternal smoking [1.97 (95% CI = 1.75-2.22), CE = weak], bed sharing [2.89 (95% CI = 1.81-4.60), CE = weak], and infants found with heads covered by bedclothes after last sleep [11.01 (95% CI = 5.40-22.45), CE = suggestive], were identified. On the other hand, three protective factors, namely, breastfeeding [0.57 (95% CI = 0.39-0.83), CE = non-significant], supine sleeping position [0.48 (95% CI = 0.37-0.63), CE = suggestive], and pacifier use [0.44 (95% CI = 0.30-0.65), CE = weak], were also identified.
Based on the evidence, we propose several risk and protective factors for SIDS. This study suggests the need for further studies on SIDS-related factors supported by weak credibility, no association, or a lack of adequate research.
关于婴儿猝死综合征 (SIDS) 风险和保护因素的综合定量证据尚缺乏。我们调查了与 SIDS 相关的风险和保护因素。
我们对观察性和干预性研究的荟萃分析进行了伞式综述，评估了与 SIDS 相关的因素。从建库到 2023 年 1 月 18 日，我们在 PubMed/MEDLINE、Embase、EBSCO 和 Google Scholar 进行了检索。使用 A Measurement Tool Assessment Systematic Reviews 2 按照 PRISMA 指南进行数据提取、质量评估和证据确定性评估。根据观察性证据，根据可信度对风险和保护因素进行分级和分类，并按照类别和证据质量 (CE; 有说服力、高度提示、提示、弱或无显著意义) 进行分类。我们的研究方案已在 PROSPERO（CRD42023458696）上注册。与 SIDS 相关的风险和保护因素以等效比值比 (eOR) 表示。
我们确定了八项原始荟萃分析，包括来自 21 个国家/地区和五个大陆的 152 篇原始文章，涵盖了 12 个独特的与 SIDS 相关的风险和保护因素。一些风险因素，包括产前药物暴露 [eOR=7.84 (95% CI=4.81-12.79)，CE=高度提示]、产前阿片类药物暴露 [9.55 (95% CI=4.87-18.72)，CE=提示]、产前美沙酮暴露 [9.52 (95% CI=3.34-27.10)，CE=弱]、产前可卡因暴露 [4.38 (95% CI=1.95-9.86)，CE=弱]、产前母亲吸烟 [2.25 (95% CI=1.95-2.60)，CE=高度提示]、产后母亲吸烟 [1.97 (95% CI=1.75-2.22)，CE=弱]、同床睡 [2.89 (95% CI=1.81-4.60)，CE=弱]、以及最后一次睡眠后发现婴儿头部被被褥覆盖 [11.01 (95% CI=5.40-22.45)，CE=提示]，这些因素被识别出来。另一方面，三个保护因素，即母乳喂养 [0.57 (95% CI=0.39-0.83)，CE=非显著]、仰卧位睡眠 [0.48 (95% CI=0.37-0.63)，CE=提示]和使用安抚奶嘴 [0.44 (95% CI=0.30-0.65)，CE=弱]，也被识别出来。
基于证据，我们提出了几个与 SIDS 相关的风险和保护因素。本研究表明，需要进一步研究与 SIDS 相关的因素，这些因素的可信度较弱，没有关联或缺乏足够的研究。
