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:

Last sleep in SIDS: a bad indicator?

In our opinion methodological reasons should advise against giving
any value to comparisons based on “last sleep” in studies about SIDS. The
last sleep is an exclusive feature of a dead baby. Who doesn’t die cannot
experience the “last sleep before dying”! It seems incorrect to surrogate
the absence of last sleep in the control group with a “reference sleep”
(that is only one particular sleep among many, and, therefore, should be
considered "usual sleep").

It would be more reasonable to make comparisons based on common
exposures (e.g. parent’s smoking, usual sleeping position, bed sharing,
pacifier during usual sleep, etc).

In a recently published meta-analysis, which focuses on the
relationship between the use of a pacifier and SIDS(1), the effect of
pacifier in the usual sleep, measured in terms of odds ratio, is smaller
than that observed for the last sleep, thus suggesting caution when taking
last sleep as an indicator.

In the absence of clear and strong evidence in support of pacifiers
(which could have some adverse effects on breast feeding), we think it
would be more appropriate not to provide any recommendations.

Best regards

Roberto Buzzetti, MD

Roberto D Amico

University of Modena and Reggio Emilia,
Policlinico di Modena, via del Pozzo 71,
41100 Modena, Italy

(1) Hauck FR, Omojokun OO, Siadaty MS. Do Pacifiers Reduce the Risk of
Sudden Infant Death Syndrome? A Meta-analysis. PEDIATRICS Vol. 116 No. 5
November 2005, pp. e716-e723 (doi:10.1542/peds.2004-2631).

Competing interests:
None declared

Competing interests: No competing interests

16 December 2005
Roberto Buzzetti
Roberto D Amico
41100 MODENA (Italy)