Survey of prevalence of protective and risk factors for SIDS in the Netherlands

BACKGROUND: From 1987 on, surveys have been conducted in the Netherlands to monitor babycare habits and target safe sleeping prevention campaigns. The last survey was conducted in 2011. In the Netherlands, the 2016 incidence of SIDS (R95) was 0.075/1000 live births (n=13); taking into account adjacent categories the SUDI incidence was 0.15/1000 (n=26). This low incidence, the lowest in the Western world, may result in decreased parental awareness of SIDS risks and complacency regarding preventive messages. Therefore, a new survey was conducted. OBJECTIVES: 1) To measure the prevalence of protective and risk factors for SIDS in the Netherlands in 2017 including new customs of babycare. 2) To compare 2011 prevalences with 2017. 3) To investigate why parents do not follow recommendations regarding safe sleep position and location. METHODS: A cross-sectional study was conducted using an online questionnaire (52 questions). The study population encompassed parents/caregivers of infants up to 1 year of age living in the Netherlands. Between February 12 – April 30, 2017, invitations with a link to the questionnaire were distributed to 9000 parents visiting 17 child healthcare organizations. In healthcare centers in socially more deprived neighborhoods research assistants helped parents fill out the online questionnaire. In May and June, invitations to participate were also communicated using social media. We used SPSS 24 to calculate prevalence rates and performed a content analysis of answers on open-ended questions on reasons for not following SIDS prevention advice. RESULTS: In total 1289 questionnaires were filled out, of which 80 were excluded, mostly because the child was too old. The study population was comparable to the Dutch population in terms of sex ratio, preterm infants, and parents with a lower education. First-born infants and parents with a higher education were overrepresented, families with a migration background were underrepresented. Sleeping prone increased from 3.1% of infants when 0-2 months old to 13.6% at 9-11 months. Infants aged 0-2 months slept in a separate room in 31.5%, roomshared with parents in 52.3%, slept in an attached bedside sleeper in 9.7% and with their parent(s) in bed in 6.3%. For age 7-8 months this was respectively 71.2%, 15.2%, 4.0% and 8%. Only 4.5% of infants used a duvet. The typical Dutch sleeping sack (wearable blanket) was used for 55.8% of infants. Only 50% of infants 0-2 months and 23.6% of infants 5-6 months were breastfed exclusively. Of all mothers, 4z had smoked during pregnancy; of all infants 21.3% were exposed to parents’ smoking. CONCLUSIONS: The number of infants that sleep prone is comparable to 2011, with still significant room for improvement. Roomsharing with infants 0-2 months has increased significantly since 2011, but so has bedsharing. These data are important for future preventive campaigns.