Symptoms, sweating and reactivity of infants who die of SIDS compared with community controls

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Abstract
Objective: To describe the symptoms of illness reported by the parents of infants who have died of sudden infant death syndrome (SIDS) compared with those reported by community controls. Methodology: A nationwide case—control study involving regions of New Zealand with 78% of all births between 1987 and 1990. Home interviews were completed with parents of 393 (81% of total) infants who died from SIDS in the post neonatal age group, and 1592 (88.4% of total) controls who were a representative sample of all hospital births in the study region. Results: Symptoms of infection were common in both cases and controls, but were not significantly different. Infants dying of SIDS, however, were likely to have symptoms suggestive of more severe illness in the 2 days before death (odds ratio [OR] = 3.02, 95% confidence interval [CI] 1.69‐5.38). After adjusting for potential confounding this was still statistically significant (adjusted OR 2.36, 95% Cl 1.14‐4.90). Also, babies dying of SIDS were more likely to have been less reactive to their environment in the 2 weeks before death compared with the controls (univariate OR 0.88, 95% Cl 0.55‐1.39, adjusted OR 0.55, 95% Cl 0.59‐0.88). ‘Drenching’ sweats at least weekly were reported for 15.6% of case infants compared with 5.9% of control infants (adjusted OR 2.12, 95% Cl 1.53‐3.39). Forty per cent of these infants had this symptom in the first 4 weeks of life when it was also associated with a significantly raised risk of SIDS. Apnoea lasting more than 20 s was reported for 13.2% of case infants compared with 5.3% of control infants (adjusted OR 1.93, 95% Cl 1.17‐3.17). Similarly, 71.8% of case infants' faces were reported to never turn red while awake compared to 49.8% of control infants (adjusted OR 2.98, 95% Cl 2.19‐4.07). Conclusions: Only a small number (6.4%) of babies who die of SIDS have symptoms of serious illness in the 2 days before death. There is support for the hypothesis that there is a group of babies dying of SIDS who have subtle abnormalities in autonomic control or arousal ability.