Intended for healthcare professionals

Rapid response to:


Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome (SIDS): population based case-control study

BMJ 2006; 332 doi: (Published 05 January 2006) Cite this as: BMJ 2006;332:18

Rapid Response:

Comments onn SIDS and pacifiers Study

There is a body of evidence to suggest that Sudden Infant Death
Syndrome commonly referred to as cot death is linked to a mild diffuse
brain injury acquired by the foetus in utero or during the birth procedure
linked to trauma.

Untreated viral and bacterial infection during pregnancy, smoking and
drinking alcohol, all increase the risk of early miscarriage and increases
the risk of trauma during birth procedure. The ultimate pathology of brain
injury is death of he foetus or newly born.

Organisations linked to Sudden Infant Death Syndrome, agree on the
links to Smoking and Alcohol intake during pregnancy, to increase risk of
cot death.

After reading the published article, I find no evidence of the
research team making reference to these links and inferences.

Should the following questions have been posed to the parents of the
study and control groups?
1] Were you aware of an infection during pregnancy especially in the first
2] Did you risk miscarriage in the first trimester?
3] Did you experience birth intervention i.e. C-section or mechanical aid
4] Was the birth less than 2 hours or longer than 12 hours?
5] Was the birth preterm?
6] Were you aware of the newborn acquiring an infection during he first

On the basis that the study group may have been affected by the
above, then the control group should be free of the above influences.

Other facts gleaned from the study should undergo further
The discussion of sleeping position of, on back, versus prone, or on side,
may not be a clear cut situation, as 51 studied children succumbed to cot
death in spite of being placed to sleep on their backs. Should the
researchers have considered the sleeping position in which they were
found, or when they were laid down to sleep before death?
Researchers in the US have reported increased maternal age, i.e. over 35
years of age, to increased risks of problematic pregnancies and births. In
this study more than half of the study group were born to mothers of
maternal age over 25 (it would be interesting to look at over 35 years of
age, numbers)
Finally the study group individuals had a birth weight of less than 2500
grammes five times greater than the control group.

Competing interests:
None declared

Competing interests: No competing interests

14 December 2005
Robin Burn
Burry Port SA16 0DX