Abstract â–¡ 47

The nationwide prevention of cot death in the Netherlands started with the 'back to sleep' campaign in October 1987. Thereafter other advices on baby care followed: the advice not to lay down to sleep infants on a side after the age of two weeks (October 1992), the advice not to use duvets and head bouncers before the age of two years (October 1994) and the advice to pay more attention to infants while they are asleep. Together with these advices other advices in relation to hazardous influence of substances like tobacco smoke and sedatives were complied into a national consensus text on the prevention in 1996. From the beginning of the prevention of cot death the effects were monitored in nationwide surveys, carried out every two years in the month of November. (1988 - 1996). Additional information was obtained from several case control studies of SIDS-victims. The results of this research show clearly a beneficial effect. In general baby care practices became a lot more safe between 1987 and 1997 and in the same period a striking decrease of the incidence of SIDS from 1.0 to 0.2 per 1,000 live births could be demonstrated, presently is the lowest incidence in the estern world. However, since 1994 the prevalence of the prone position decreased only slightly. In 1996 8% of the infants sometimes or always, at daytime or at night, were still laid down to sleep on their belly. There is still the misunderstanding that the prone sleep position is less hazardous in daytime than at night. Striking is also the observation that parents pay most attention to the first child when it comes to the prevention of SIDS. Second, third etc. children seem to be relatively neglected. This is the case for sleeping position as for the use of duvets. So it is not surprising that relatively few first children die from SIDS. Still ununderstood is the phenomenon that more boys than girls are laid to sleep in the prone position and this is partly the explanation of the fact that more boys than girls die from SIDS. Between 1987 and 1997 the difference between infants of normal birth weight and infants of low birthweight has disappeared. In 1987 37% of all children below 2,500 grams were laid to sleep prone, often because the paediatrician in hospital adviced the parents to do so. In 1997 almost every hospital did infants get used to the supine sleep position before discharge. Due to the advice to lay infants on their back, the side position increased tremendously from 43% in 1987 to 66% in 1996 (at the age of 1 month). Even two years after the advice (1994) not to put down infants on a side after they have reached the age of two weeks, still 25% of the parents did so, exposing their child to the danger of secondary prone sleep position. The use of duvets decreased from 74% in 1992 to 43% in 1996. A further decrease can be expected after one of the biggest chains of retailers of baby goods (Prénatal) has attached a warning on the duvets in their shops. Because most risk factors are reduced in the past ten years, (passive) smoking has become the most important risk factor for SIDS. However, health education on this point seems not to be very effective in the Netherlands. Our task for the future is to find effective strategies for altering smoking habits of parents. In combination with never lasting health education on sleeping position, use of duvets and other preventive measures, we expect that we can reach a further decrease of the SIDS-incidence as low as 0.1 per 1,000 live births.