Interventions for Perinatal Hypoxic-Ischemic Encephalopathy

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To the Editor. McKenna, Mosko, and Richard compare nocturnal breastfeeding patterns of 35 infants while both sleeping with their mothers and while sleeping alone in a laboratory setting.1 Although the results of the study are interesting and it is difficult to argue with the desirability of enhancing breastfeeding in relation to a number of infant outcomes, the authors draw conclusions about the possible protective effect of bedsharing against sudden infant death syndrome (SIDS) that have no foundation, based either on their own study or the work of numerous other researchers. The literature on breastfeeding and SIDS is inconsistent. Gilbert and coauthors summarized the results of 17 case-control and 1 cohort study that analyzed feeding methods in relation to SIDS.2 Eleven showed an increased risk of SIDS in bottle-fed babies and 7 showed no relationship. Inconsistent findings were related to different ways of measuring feeding and different ways of considering potential confounding factors, such as socioeconomic variables. Gilbert et al found in their own study of SIDS in England that breastfeeding was not protective after taking into account maternal smoking, parental employment, preterm gestation, and sleep position. In Chicago, where a case-control study of SIDS risk factors has recently concluded, preliminary analysis of the relationship between never breastfeeding and SIDS, based on 250 SIDS cases and 250 matched living controls, showed an odds ratio of 2.8 (95% confidence interval, 1.7–4.6), adjusting for socioeconomic status.4 However, after adjusting for additional factors, such as maternal smoking, bed softness, and sleep position, it was no longer significant. Rates of SIDS have declined dramatically in a number of countries, including England, New Zealand, and Australia, following education campaigns focusing on sleep position and other recommendations.5 The single most important factor accounting for the declining rates was reduced prevalence of prone sleep …