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Pacifier (Dummy) Use and Sudden Infant Death

Systematic review
Results
Usual use
Last sleep use
Comment

Sudden infant death rates have fallen substantially over the past few decades, as the importance of sleeping position, parental smoking and other factors have been understood and acted upon through guidance to parents. Sudden infant deaths are unexpected by history, unexplained by a post mortem examination, and after elimination of other causes. What every parent wants is to know that they are doing the right thing, and the use, or not, of pacifiers (called dummies in the UK, soothers elsewhere) when infants sleep is a topic that generates a variety of views. A new meta-analysis of case control studies strongly suggests that their use is associated with a lower incidence of sudden infant death [1].

Systematic review


Medline was searched to mid-2004 for studies relating to pacifier use and sudden infant death syndrome. Evaluation of studies was based on US criteria that included:

Pooled analysis was performed on two outcomes of individual studies, summary statistics of univariate analysis where only pacifier use was assessed, and multivariate analysis, in which confounding factors (and there are many possible confounding factors) were taken into account.

Results


Seven published case-control studies were included in the analysis. The analysis was done on two bases, usual use of pacifiers, and pacifier use during the last sleep.

Usual use


Pacifiers were usually used in 796 of 1568 (51%) of infants dying with sudden infant death syndrome, and in 3,147 of 5,886 (53%) of controls (Figure 1). There was no significant difference in the univariate analysis, with an odds ratio of 0.90 (95% CI 0.79 to 1.03) in five studies. The multivariate analysis used data from four studies, and there was a significantly lower odds ratio for pacifier use in sudden infant death syndrome, with an odds ratio of 0.71 (0.59 to 0.85).


Figure 1: Usual use of pacifiers in SIDS and control






Last sleep use


All of the studies contributed data to the last sleep analysis. Pacifiers were used in the last sleep in 412 of 1,779 (23%) of infants dying with sudden infant death syndrome, and in 2,104 of 5,638 (37%) of controls (Figure 2). In this case both the summary of univariate analyses (odds ratio 0.47; 0.40 to 0.55) and multivariate analysis (odds ratio 0.39; 0.31 to 0.50) showed a significantly reduced use of pacifiers during the last sleep amongst infants with sudden infant death syndrome.


Figure 2: Last sleep use of pacifiers in SIDS and control






Comment


Pacifier use when an infant is placed for sleep might have a significant protective effect against sudden infant death syndrome. The authors calculated that one unexplained sudden infant death syndrome could be prevented for every 2,733 (95% CI 2,416 to 3,334) infants who use a pacifier when placed for sleep. One further study published only as an abstract also supports this result.

Because a large number of factors may impact on the risk of sudden infant death syndrome, the pooled analysis of multivariate analyses is likely to be the more meaningful. This report comes with a thoughtful discussion about possible mechanisms of why pacifiers might have an effect on sudden infant death syndrome, and on other possible consequences of pacifier use, like dental problems, or a slightly increased risk of otitis media in older children. It also has some useful recommendations.

Reference:



  1. FR Hauck et al. Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics 2005 116; 716-723.

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