Williams S M, Taylor B J, Mitchell E A
Department of Preventive and Social Medicine, University of Otago Medical School, Dunedin, New Zealand.
Int J Epidemiol. 1996 Apr;25(2):366-75. doi: 10.1093/ije/25.2.366.
Thermal stress related to excessive insulation from bedding and clothing has been postulated to be associated with sudden infant death syndrome (SIDS).
The parents of 393 (81%) of the infants who died of SIDS in the post neonatal period were interviewed at home. Interviews were also completed with the parents of 1592 (88.4% of total) controls, a representative sample of all hospital births. The study was conducted in regions of the North and South Island of New Zealand in which 78% of all New Zealand births occurred in 1987-1990. Temperatures for the infant's bedroom estimated from the outside temperature and a model were used to predict the appropriate insulation for lower critical temperature (temperature below which the metabolic rate is likely to increase).
Sudden infant death syndrome was associated with extra thermal insulation of > 2 tog above the lower critical value, the odds ratio (OR) was 1.70 (95% confidence interval [Cl] : 1.3-2.20) after adjusting for season. After adjusting for a number of confounding factors the CR was reduced to 1.35 (95% Cl: 0.97-1.87). Also associated with SIDS was too little thermal insulation OR = 1.67(95% Cl: 1.13-2.48; and 2.63 (95% Cl: 1.61-4.30) when adjustments were made for the confounding factors. The interaction effect between infants sleeping prone and >2 tog extra thermal insulation was significant (OR = 6.07, 95% Cl: 3.83-9.60). Infants with too little thermal insulation were at increased risk if they were not tightly wrapped (OR = 3.81, 95% Cl: 2.04-7.09). There were also small additive interaction effects if the mother smoked and the infants had > 2 tog extra thermal insulation, or they were ill and had > 4 tog extra insulation. Interaction effects between thermal insulation and other factors were not significant.
More thermal insulation than was necessary to maintain the lower critical temperature increased the risk of SIDS primarily among infants in the prone sleep position, and to a lesser degree in infants whose mothers smoked and in infants who were unwell.
据推测，与床上用品和衣物过度保暖相关的热应激与婴儿猝死综合征（SIDS）有关。
对393名（81%）在新生儿后期死于SIDS的婴儿的父母进行了家访。还对1592名对照婴儿（占所有医院出生婴儿总数的88.4%）的父母进行了访谈，这些对照婴儿是所有医院出生婴儿的代表性样本。该研究在新西兰北岛和南岛的部分地区进行，1987 - 1990年期间，新西兰78%的婴儿在这些地区出生。根据室外温度和一个模型估算婴儿卧室的温度，以预测适合较低临界温度（低于该温度代谢率可能会增加）的保暖程度。
婴儿猝死综合征与比较低临界值高>2托格的额外保暖有关，调整季节因素后，比值比（OR）为1.70（95%置信区间[Cl]：1.3 - 2.20）。在调整了一些混杂因素后，比值比降至1.35（95% Cl：0.97 - 1.87）。与SIDS相关的还有保暖不足，未调整混杂因素时OR = 1.67（95% Cl：1.13 - 2.48）；调整混杂因素后为2.63（95% Cl：1.61 - 4.30）。婴儿俯卧睡眠与额外保暖>2托格之间的交互作用显著（OR = 6.07，95% Cl：3.83 - 9.60）。保暖不足的婴儿如果包裹不紧，风险会增加（OR = 3.81，95% Cl：2.04 - 7.09）。如果母亲吸烟且婴儿额外保暖>2托格，或者婴儿生病且额外保暖>4托格，也存在较小的相加交互作用。保暖与其他因素之间的交互作用不显著。
维持较低临界温度所需的保暖程度以上的更多保暖措施，主要增加了俯卧睡眠婴儿患SIDS的风险，对母亲吸烟的婴儿和身体不适的婴儿影响较小。
