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Association between use of a quilt and sudden infant death syndrome: case-control study

BMJ 1998; 316 doi: (Published 17 January 1998) Cite this as: BMJ 1998;316:195
  1. Anne-Louise Ponsonby, deputy director of research (,
  2. Terence Dwyer, directora,
  3. David Couper, biostatisticiana,
  4. Jennifer Cochrane, research officera
  1. aMenzies Centre for Population Health Research, University of Tasmania, GPO Box 252-23, Hobart, Australia 7001
  1. Correspondence to: Dr Ponsonby
  • Accepted 11 June 1997


The relation between an infant's sleeping environment and development of the sudden infant death syndrome depends on the infant's sleep position.1 We report how the association between the use of a quilt and the syndrome depends on sleep position.

Subjects, methods, and results

Between 1 October 1988 and 31 December 1995 in Tasmania 107 infants <1 year old died of the sudden infant death syndrome. Of the families affected, 100 (93%) participated in this study and were compared directly with 196 age matched controls. Methods are described elsewhere.1 A quilt is a coverlet made by stitching two thicknesses of fabric together with a filling (usually synthetic) enclosed between the layers. Conditional multiple logistic regression2 was used to evaluate interaction effects; egret 0.26.6 software (Cytel Software, Cambridge, MA, USA) provided matched odds ratios with logit-based 95% confidence intervals.

An adverse effect of quilt use was evident in infants who did not sleep prone but not in infants who slept prone (1). This interaction was not altered by adjustment for sleeping on sheepskin; the interaction between sleeping on sheepskin and sleeping prone; mattress liner; mattress type; use of a quilt under the infant; use of a pillow; infant illness; heating …

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