RISK AND PREVENTIVE FACTORS FOR COT DEATH IN THE NETHERLANDS, A LOW-INCIDENCE COUNTRY

In the Netherlands an 18 months case control study into cot death was undertaken as part of the European Concerted Action (ECAS) on sudden i nfant death syndrome to determine the relative risk of prone sleeping and other sleep practices. Physicians in the Netherlands were asked to report to the study centre all sudden and unexpected deaths of childr en between 1 week and 2 years of age. Non cot death cases were deleted from further analysis after a consensus was reached by three patholog ists, not primarily involved in the post mortem diagnosis. A positive response of families was achieved in 91% of cases registered in the Ce ntral Bureau of Statistics. The study comprised 73 cot deaths and 146 controls, two for each case and matched for date of birth. All familie s were visited at home for completion of a questionnaire. The cot deat h rate has dropped considerably over the past 10 years after the recom mendations on supine sleeping to a low of 0.26 per 1000 live born infa nts. In addition to the ECAS objective, we wanted to establish whether previously found risk factors are still valid in the present situatio n or that new factors might have emerged, some of them possibly protec tive. Conclusion Placing an infant prone or on side on last occasion, secondary prone position (not placed prone but turned to prone), unexp erienced prone sleeping and use of a duvet, leading to head and body b eing covered, were shown to be risk factors. Preventive factors were u sing a cotton sleeping-sack and a dummy. Even in a low incidence count ry, such as the Netherlands, there are indications that further preven tion is possible.