{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T00:22:02Z","timestamp":1792887722368,"version":"4.5.0"},"reference-count":30,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T00:00:00Z","timestamp":1697155200000},"content-version":"unspecified","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NHS England","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"National Clinical Audit and Patient Outcomes Programme","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["NIHR300820"],"award-info":[{"award-number":["NIHR300820"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,9,27]]},"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Using the National Child Mortality Database, this work aims to investigate background characteristics and risk factors in the sleeping environment associated with sudden infant death syndrome (SIDS) and compare the prevalence with previous English SIDS case\u2013control studies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Cohort of SIDS in 2020 compared with a combined analysis of two case\u2013control studies conducted in 1993\u20131996 and 2003\u20132006.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>England, UK<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>138 SIDS deaths in 2020 compared with 402 SIDS deaths and 1387 age-equivalent surviving controls, combined from previous studies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The increased vulnerability of SIDS infants identified in previous studies has become more marked. The infants who died in 2020 were younger (median=66\u2009days (IQR: 34\u2013118) vs 86 days (IQR: 52\u2013148), p=0.003) with an increased prevalence of low birth weight (30.5% vs 21.6%, p=0.04) and preterm births (29.6% vs 19.3%, p=0.012). The excess of socioeconomically deprived families, male infants and high levels of maternal smoking during pregnancy were still evident. Among recent deaths, fewer infants were put down or found on their side; however, there was no significant change in the proportion of infants who were put down (15.6% vs 14.6%, p=0.81) and found prone (40.4% vs 35.3%, p=0.37), despite population wide risk reduction advice over three decades. The proportional increase observed in 2003\u20132006 of half the deaths occurring while sleeping next to an adult was maintained in 2020, and for the vast majority (90%), this was in hazardous circumstances (adult had consumed alcohol, smoked, slept on a sofa, or the infant was premature or low birth weight and less than 3 months old). More deaths also occurred when there was a disruption in infant care routine compared with previous observations (52.6% vs 20.7%, p&lt;0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A more targeted approach is needed with vulnerable families emphasising the importance of sleeping infants on their back and proactive planning infant sleep when there are disruptions to the normal routine, in particular to avoid hazardous co-sleeping.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-076751","type":"journal-article","created":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T10:36:59Z","timestamp":1697193419000},"page":"e076751","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Changes in background characteristics and risk factors among SIDS infants in England: cohort comparisons from 1993 to 2020"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3472-1047","authenticated-orcid":false,"given":"Anna","family":"Pease","sequence":"first","affiliation":[{"name":"Population Health Sciences, University of Bristol Medical School, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1591-6997","authenticated-orcid":false,"given":"Nicholas","family":"Turner","sequence":"additional","affiliation":[{"name":"Population Health Sciences, University of Bristol Medical School, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2366-008X","authenticated-orcid":false,"given":"Jenny","family":"Ingram","sequence":"additional","affiliation":[{"name":"Population Health Sciences, University of Bristol Medical School, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Fleming","sequence":"additional","affiliation":[{"name":"Population Health Sciences, University of Bristol Medical School, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Patrick","sequence":"additional","affiliation":[{"name":"Research and Development, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Williams","sequence":"additional","affiliation":[{"name":"Translational Health Sciences, University of Bristol Medical School, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicky","family":"Sleap","sequence":"additional","affiliation":[{"name":"Translational Health Sciences, University of Bristol Medical School, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0927-7677","authenticated-orcid":false,"given":"Kieren","family":"Pitts","sequence":"additional","affiliation":[{"name":"Research IT, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9806-1092","authenticated-orcid":false,"given":"Karen","family":"Luyt","sequence":"additional","affiliation":[{"name":"Translational Health Sciences, University of Bristol Medical School, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8991-9616","authenticated-orcid":false,"given":"Becky","family":"Ali","sequence":"additional","affiliation":[{"name":"Population Health Sciences, University of Bristol Medical School, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7832-8087","authenticated-orcid":false,"given":"Peter","family":"Blair","sequence":"additional","affiliation":[{"name":"Population Health Sciences, University of Bristol Medical School, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,10,13]]},"reference":[{"key":"2025101811482518000_13.10.e076751.1","unstructured":"Beckwith JB . Proc 2ND INT Congress on causes of sudden death in infants. In: Discussion of terminology and definition of the sudden infant death syndrome. Washington Univ: Washington Press, 1969."},{"key":"2025101811482518000_13.10.e076751.2","unstructured":"Office for National Statistics (ONS) . Unexplained deaths in infancy England and Wales:2020. ONS Statistical Bulletin September 8, 2022. Available: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/deaths\/bulletins\/unexplaineddeathsininfancyenglandandwales\/2020"},{"key":"2025101811482518000_13.10.e076751.3","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-3016.2003.00465.x"},{"key":"2025101811482518000_13.10.e076751.4","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.b3666","article-title":"Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in South West England","volume":"339","author":"Blair","year":"2009","journal-title":"BMJ"},{"key":"2025101811482518000_13.10.e076751.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.313.7051.191"},{"key":"2025101811482518000_13.10.e076751.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.319.7223.1457"},{"key":"2025101811482518000_13.10.e076751.7","first-page":"52","article-title":"The combination of Bedsharing and maternal smoking leads to a greatly increased risk of sudden unexpected death in infancy: the New Zealand nationwide SUDI case control study","volume":"130","author":"Mitchell","year":"2017","journal-title":"N Z Med J"},{"key":"2025101811482518000_13.10.e076751.8","unstructured":"Government UK . Working together to safeguard children. Department for Education, 2010."},{"key":"2025101811482518000_13.10.e076751.9","unstructured":"Government HM . Child death review: statutory and operational guidance (England). In: HM Government (UK). London, 2018."},{"key":"2025101811482518000_13.10.e076751.10","unstructured":"Department of health and social care. child death reviews: forms for reporting child deaths. 2014."},{"key":"2025101811482518000_13.10.e076751.11","doi-asserted-by":"publisher","DOI":"10.1590\/S0034-89102010000300021"},{"key":"2025101811482518000_13.10.e076751.12","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0107799","article-title":"Bed-sharing in the absence of hazardous circumstances: is there a risk of sudden infant death syndrome? An analysis from two case-control studies conducted in the UK","volume":"9","author":"Blair","year":"2014","journal-title":"PLoS One"},{"key":"2025101811482518000_13.10.e076751.13","unstructured":"National Institute for Health and Care Excellence . Postnatal care: quality standard [Qs37]; Published:16 July 2013"},{"key":"2025101811482518000_13.10.e076751.14","unstructured":"Pease A , Ali B , Ingram J , et al . Baby Sleep Research 2023. Available: https:\/\/babysleepresearch.co.uk\/"},{"key":"2025101811482518000_13.10.e076751.15","unstructured":"Royal college of Paediatrics and child health.State of child health: smoking during pregnancy. 2020."},{"key":"2025101811482518000_13.10.e076751.16","unstructured":"Office for National Statistics (ONS) . Birth characteristics in England and Wales: 2021. January 19, 2023. Available: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/livebirths\/bulletins\/birthcharacteristicsinenglandandwales\/2021"},{"key":"2025101811482518000_13.10.e076751.17","doi-asserted-by":"publisher","DOI":"10.1111\/apa.13354"},{"key":"2025101811482518000_13.10.e076751.18","unstructured":"The Lullaby Trust . Co-sleeping with your baby. 2022. Available: https:\/\/www.lullabytrust.org.uk\/safer-sleep-advice\/co-sleeping\/"},{"key":"2025101811482518000_13.10.e076751.19","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)67968-3"},{"key":"2025101811482518000_13.10.e076751.20","unstructured":"Odd D , Stoianova S , Sleap V , et al . Child mortality and social deprivation: national child mortality database programme thematic report. National Child Mortality Database 2021."},{"key":"2025101811482518000_13.10.e076751.21","doi-asserted-by":"crossref","unstructured":"Kanits F , L\u2019Hoir MP , Boere-Boonekamp MM , et al . Renewed attention needed for prevention of sudden unexpected death in infancy in the Netherlands. Front Pediatr 2021;1421. doi:10.3389\/fped.2021.757530","DOI":"10.3389\/fped.2021.757530"},{"key":"2025101811482518000_13.10.e076751.22","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.anpedi.2019.06.011","article-title":"Sudden infant death syndrome: do the parents follow the recommendations?","volume":"92","author":"Ruiz Botia","year":"2020","journal-title":"An Pediatr (Engl Ed)"},{"key":"2025101811482518000_13.10.e076751.23","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-023-28008-1","article-title":"Implementation of safe infant sleep recommendations during night-time sleep in the first year of life in a German birth cohort","volume":"13","author":"Gaertner","year":"2023","journal-title":"Sci Rep"},{"key":"2025101811482518000_13.10.e076751.24","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2019-317000"},{"key":"2025101811482518000_13.10.e076751.25","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.1111\/apa.15797","article-title":"Norwegian parents avoid placing infants in prone sleeping positions but frequently share beds in hazardous ways","volume":"110","author":"Osberg","year":"2021","journal-title":"Acta Paediatr"},{"key":"2025101811482518000_13.10.e076751.26","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.jpeds.2022.01.044","article-title":"Infant sleep hazards and the risk of sudden unexpected death in infancy","volume":"245","author":"MacFarlane","year":"2022","journal-title":"J Pediatr"},{"key":"2025101811482518000_13.10.e076751.27","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2004.070391"},{"key":"2025101811482518000_13.10.e076751.28","doi-asserted-by":"crossref","first-page":"226","DOI":"10.12968\/johv.2019.7.5.226","article-title":"Conversations with families about reducing the risk of sudden infant death syndrome","volume":"7","author":"Pease","year":"2019","journal-title":"Journal of Health Visiting"},{"key":"2025101811482518000_13.10.e076751.29","doi-asserted-by":"crossref","DOI":"10.1136\/bmjpo-2020-000983","article-title":"Decision-making for the infant sleep environment among families with children considered to be at risk of sudden unexpected death in infancy: a systematic review and qualitative Metasynthesis","volume":"5","author":"Pease","year":"2021","journal-title":"BMJ Paediatr Open"},{"key":"2025101811482518000_13.10.e076751.30","doi-asserted-by":"crossref","DOI":"10.1136\/bmjpo-2017-000133","article-title":"Factors influencing maternal decision-making for the infant sleep environment in families at higher risk of SIDS: a qualitative study","volume":"1","author":"Pease","year":"2017","journal-title":"BMJ Paediatr Open"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-076751","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T18:48:35Z","timestamp":1760813315000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-076751"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10]]},"references-count":30,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10,13]]},"published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1136\/bmjopen-2023-076751"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-076751","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10]]}}}