Changing infants' sleep position increases risk of sudden infant death syndrome

Objective: To examine whether the prone sleeping position may increase the risk for sudden infant death syndrome (SIDS), particularly in infants unuse d to prone sleep. Design: A 3-year (1987-1990) case-control study. Setting: Nationwide study in New Zealand. Subjects: Four hundred eighty-five infants who died of SIDS and 1800 contro ls. Main Outcome Measures: Infants were classified as unaccustomed to prone if their usual sleep position was nonprone and they were placed prone for the last sleep. Secondary prone was used to describe infants placed nonprone bu t found prone. Results: Infants usually and last placed nonprone were at the lowest risk f or SIDS (odds ratio [OR], 1.0); those usually and last placed prone were at increased risk (adjusted OR, 4.6; 95% confidence interval, 3.4-6.3). Risk was greatly increased among infants unaccustomed to the prone position (adj usted OR, 19.3; 95% confidence interval, 8.2-44.8). These infants accounted for 8% (31/386) of all SIDS deaths. Ninety percent (28/31) of infants in t his group were found prone, and 71% (20/28) of those found prone were found with their faces turned down into bedding-a position in which asphyxia has been implicated as a mechanism of death. In addition, 138 infants who died of SIDS were last placed nonprone. Forty-seven infants (34%) in this group were found prone (secondary prone), and 60% (28/47) of those found prone w ere found with their faces turned down into the bedding. This group account ed for 12% of all SIDS deaths. Most of these infants (91% [43/47]) were usu ally placed nonprone. Conclusions: Infants placed supine to sleep were at the lowest risk of SIDS , which supports the recommendation that this is the preferred sleeping pos ition for healthy infants. Tn New Zealand, 20% of SIDS deaths involved lack of experience with the prone sleeping position. Our findings suggest the p ossibility that an infant's competence in escaping from potentially lethal situations during prone sleep (eg, the face-down position) may be impaired by inexperience in prone sleeping. Great caution should be exercised in pla cing infants unaccustomed to the prone sleeping position in the prone posit ion.