The German case–control scene investigation study on SIDS: epidemiological approach and main results

The present study, which was part of the German SIDS Study (GeSID), enrolled sudden infant death syndrome (SIDS) cases and population controls and obtained objective scene data via specifically trained observers shortly after discovery of each dead infant. Infants who had died suddenly and unexpectedly at ages between 8 and 365 days were enrolled in five regions of Germany between November 1998 and October 2001. Shortly after discovery of each dead infant, a specially trained doctor of legal medicine visited the bereaved family at home. Data were obtained by measurements and observations. Dead infants underwent a standardised autopsy, additional information being obtained by standardised parent interviews. Investigation of the sleep environment and wake-up scene in matched controls followed the same protocol. A total of 52 SIDS cases and 154 controls were enrolled, 58% were boys, and median age of cases vs. controls was 126 vs. 129 days. Risk factors in the sleeping environment were pillow use (adjusted OR 4.3; 95%CI 1.6–11.6), heavy duvets (OR 4.4; 1.5–13.3), soft underlay (OR 3.0; 1.1–8.7), face covered by bedding (OR 15.8; 2.5–102.1) and entire body covered by bedding (OR 35.5; 5.5–228.3). Using a standardised protocol, including objective measurements of the sleep environment and a case–control design, this study was able to confirm many risk factors for SIDS.