Overlaying, co-sleeping, suffocation, and sudden infant death syndrome: the elephant in the room
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Overlaying, co-sleeping, suffocation, and sudden infant death syndrome: the elephant in the room Roger W. Byard
Accepted: 30 July 2014 Ó Springer Science+Business Media New York 2014
Despite numerous publications over decades on the issues surrounding shared sleeping of infants with adults [1, 2], it appears that there is still no clarification or consensus on how deaths in these circumstances should be classified. In particular, the possibility of accidental suffocation is often overlooked, with, for example, two recent meta-analyses and reviews classifying all infant deaths in shared sleeping situations as SIDS [3, 4]. This included deaths that occurred with shared sleeping on the narrow, soft and often sloped surfaces of sofas, and in beds with intoxicated parents. In fact, it has even been asserted that an intoxicated or drugged adult sleeping with an infant increases the risk of SIDS, rather than suffocation [4, 5]. This seems a rather odd conclusion, as intoxication or a reduced conscious state due to drugs in a parent would surely be more likely to impair parental, rather than infant, arousal [6]? Templeman in 1892 had no doubt that parental intoxication increased the number of deaths due to overlaying [7] but, over a century later, his observation is still being ignored. Thus, despite situations such as sofa sleeping and breast feeding being clearly associated with a risk of infant suffocation [8–11], these deaths are still being attributed to SIDS. We know that certain factors may predispose an infant to accidental suffocation in a situation where a sleeping surface is shared with adults and/or siblings and these include prematurity, small infant size and young age, beds with soft surfaces, heavy covers and multiple bed sharers,
R. W. Byard (&) Discipline of Anatomy and Pathology, Level 3 Medical School North Building, The University of Adelaide, Frome Road, Adelaide, SA 5005, Australia e-mail: [email protected]
and obese, tired, sedated, or intoxicated parents [12]. Certain infants are also very vulnerable to the effects of airway obstruction after only very short periods of time [13]. A problem that has perhaps complicated this issue is the lack of diagnostic findings in most cases of infant asphyxia and SIDS, resulting in the autopsy findings usually being identical in these two circumstances [14]. However, the lack of pathognomonic features after death does not exclude an entity’s existence. Examples of this situation are found throughout forensic pathology and include many inherited metabolic and cardiac conduction system disorders, epilepsy, and drowning, to name but a few. The socalled ‘‘negative autopsy’’ is well recognized. Two recent studies have been published which support the hypothesis that infants who die in a shared sleeping situation are different from those who die alone. In the first, a simple retrospective study was performed which demonstrated that the sex ratio of infants who were sleeping alone was 2:1 (males to females), which was quite different to the ratio
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