Use of a fan during sleep and the risk of sudden infant death syndrome.

Mary K reported this study after seeing it on Fox 53 late night news (week of Oct. 13, 2008)

She tracked the report to:
Coleman-Phox, K., Odouli, R., & De-Kun, L. (2008). Use of a fan during sleep and the risk of sudden infant death syndroms. Archives of Pediatric & Adolescent Medicine, 162, 963-968.
According to Mary:

• This was a population-based case-control study that took place in 11 counties in California between 1997-2000. The objective was to examine the relationship between room ventilation during sleep and the risk of SIDS.
• Although the incidence of SIDS in the United States has been reduced by 56% over the period of 1992 - 2003, it continues to be the leading cause of post-neonatal mortality in the U.S.
  
• The authors felt that the increased risk of SIDS associated with overheating, a soft sleep surface and soft bedding is widely publicized through the "Back to Sleep" campaign, but that other modifiable risk factors in the enviornment should also be explored.
• Of note is the "pacifier study" of 2006 which supports the theory that re-breathing C02 is a fisk factor and point out that increased air movement may potentially decrease the amount of C02 accumulation around the infant's nose and mouth.
• They obtained SIDS cases from all infant deaths reported in the 11 counties to the CA Dept. of Health and to the Los Angeles County Coroner's Office (SID of an infant <>
• Letters were sent after screening; mothers were contacted by visit or telephone if they agreed to participate.
  
• Of the 396 eligible cases, 25% could not be located, 12.9% refused, 11.6% agreed but never completed interview.
• Eligible controls were identified from birth certificates; matched to county of residence, maternal race/ethnicity, and infant age.
  
• A total of 185 SIDS cases and 312 controls were included in the analysis.
• Mothers of both groups were asked about fan use, open windows, room location, sleep surface, number & types of cover, bedding under the infant and room temperature on the last day of sleep before the infant death for cases and date of interview for controls.
  
• Interviews took place a median of 3.8 months after death for cases.
  
• Unconditional logistic regression was used to examine the room ventilation at last sleep and risk for SIDS relationship.
• Cases and controls were similar for race/ethnicity, age at reference date, region of residence, use of non-use of soft-bedding and room temperature.
• The groups differed in maternal age (SIDS group younger); marital status (SIDS group more likely unmarried), parity (SIDS group more likely to be multiparous), smoking (SIDS more likely to smoke during pregnancy); prenatal care (SIDS less likely), education (SIDS less likely to have completed high school), birthweight (SIDS more like low birth weight), gestational age (SIDS more likely pre-term). SIDS also had increase in infants with fever 48 hr. before death, positioning on side or abdomen, did not use pacifier, found with bedding blankets over heads, slept on soft surface, or shared bed with non-parent.
  
• After adjusting for matching variables, confounders, and known risk factors, having a fan in the room was associated with a 72% reduction in the risk of SIDS.
  
• The authors noted limitations a/w recall bias, selection bias.
• Authors suggest that a fan may be simple and effective in addition to supine positioning. Interestingly, 24.4%of care providers do not regularly place their infants in this position, while counseling their high-risk mothers to do so.