Pease, AS and Fleming, PJ and Hauck, FR and Moon, RY and Horne, RS and L'Hoir, MP and Ponsonby, AL and Blair, PS, Swaddling and the risk of sudden infant death syndrome: a meta-analysis, Pediatrics, 137, (6) Article e20153275. ISSN 0031-4005 (2016) [Refereed Article]
Copyright 2016 American Academy of Pediatrics
Objective: The goal of this study was to conduct an individual-level meta-analysis of sudden infant death syndrome risk for infants swaddled for sleep.
Data Sources: Additional data on sleeping position and age were provided by authors of included studies.
Study Selection: Observational studies that measured swaddling for the last or reference sleep were included.
Data Extraction: Of 283 articles screened, 4 studies met the inclusion criteria.
Results: There was significant heterogeneity among studies (I2 = 65.5%; P = .03), and a random effects model was therefore used for analysis. The overall age-adjusted pooled odds ratio (OR) for swaddling in all 4 studies was 1.58 (95% confidence interval [CI], 0.97–2.58). Removing the most recent study conducted in the United Kingdom reduced the heterogeneity (I2 = 28.2%; P = .25) and provided a pooled OR (using a fixed effects model) of 1.38 (95% CI, 1.05–1.80). Swaddling risk varied according to position placed for sleep; the risk was highest for prone sleeping (OR, 12.99 [95% CI, 4.14–40.77]), followed by side sleeping (OR, 3.16 [95% CI, 2.08–4.81]) and supine sleeping (OR, 1.93 [95% CI, 1.27–2.93]). Limited evidence suggested swaddling risk increased with infant age and was associated with a twofold risk for infants aged >6 months.
Limitations: Heterogeneity among the few studies available, imprecise definitions of swaddling, and difficulties controlling for further known risks make interpretation difficult.
Conclusions: Current advice to avoid front or side positions for sleep especially applies to infants who are swaddled. Consideration should be given to an age after which swaddling should be discouraged.
|Item Type:||Refereed Article|
|Research Division:||Medical and Health Sciences|
|Research Group:||Paediatrics and Reproductive Medicine|
|Objective Group:||Specific Population Health (excl. Indigenous Health)|
|Objective Field:||Child Health|
|Author:||Ponsonby, AL (Professor Anne Ponsonby)|
|Web of Science® Times Cited:||4|
|Deposited By:||Menzies Institute for Medical Research|
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