Abstract □ 63

Slovakia on its 49.000 km2 area has of 5,6 million inhabitants. Annually there is born about 50.000 newborns. Besides others, well developed pediatric prevention includes also a compulsory immunisation and preventive care from newborn period up to 16 year of age. The method of prevention is very well organized. System of dispensarisation of children has a high standard and all statistic informations are centralizely followed and collected beginning from the level of head of pediatric departments of regional and district hospitals to the Ministry of health. At all children died until 18 years of age the autopsy has to be done. On the base of this reality we started to built up a system of prevention of SIDS. The steps were followed: * Epidemiological follow up (from regional level in 1977 to the whole country level from 1991 till today). * Identification of risk factors (smoking, social factors, ethnicity etc.). * Centralization of SIDS autopsy to forensic medicine departments (since 1991 approximately 90%). * Information medical campaign on TV, radio, family magazines, newspapers - from 1991. * Information campaign for physicians and health staff (publishing articles in medical journals, lectures of congresses, lectures at postgradual meetings and for medical students and for nurses. * Cooperation with head of pediatric departments of regional and district hospitals. * International cooperation with others SIDS Foundations and training abroad in a different hospitals and institutes (Graz, Hamburg, Stoke-on-Trent, Providence, Basel, Atlanta, Philadelphia). * Lending of apnoe monitors to families with SIDS-risk babies. * Founding of sleep laboratory and the examination of all siblings of SIDS victims and consequently an unclear ALTE cases under the support of TEMPUS project. * Detection of gene A985G for MCAD in all SIDS family members and some ALTE cases. * Founding of the Slovak SIDS Foundation (in 1992).

At present we register all SIDS cases who have died in Slovakia and all siblings of SIDS victim have got an apnoe monitor from birth-time until one year of age. The polysomnographic examination is done to all of them minimaly once. These babies are hospitalised for a few days and the base metabolic and clinical screening together with cardiological, neurological and ENT examination is done. These children are dispensarisated and their parents are trained in resuscitation. They are in contact with pediatricians educated in SIDS problems.

By now the complex project has been benefitial. The incidence of SIDS in 1977-1985 (registered in some regions of Slovakia) was 1,05 - 1,4 - 2,4 - 3,05/1000 live newborns. From 1991 the SIDS rate was 0.89 (which represent 23,1 % from post-neonatal mortality). In 1992 it was 0,71 (18 % from PNM), in 1993 - 0,61 (18 % from PNM), in 1994 it was 0,55 (15% from PNM) and in 1995 - 0,47 which represent 18,3% from PNM. In 1996 a dramatic decrease of SIDS incidence in Slovakia has started. It was only 0,16 (5,8% from PNM) and in 1997 continue decreasing of SIDS incidence with 0,14 which represent only 4,8% from PNM.