Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
In their study published in the October issue of Archives, Coleman-Phox et al1 conclude that fan use may be an effective intervention for further decreasing sudden infant death syndrome (SIDS) incidence. They claim that fan use during sleep was associated with a 72% reduction in SIDS risk. Although their results are thought provoking and have drawn major media attention, there are a number of methodological flaws in the article that raise questions about its conclusions.
The poor percentage of recruited cases and controls could have resulted in selection bias. Only 47% of eligible cases were enrolled and only 41% of controls were recruited. Only 6 of the 167 coroner-pronounced SIDS cases used fans, while only 36 of 309 controls used fans. If 20 cases instead of the 6 cases had used fans, for example, the results would no longer be statistically significant, and because 53% of cases were not enrolled, we will never know.
The case and control groups were not similar at the beginning of the study. Differences included lower maternal age, lower education level, increased smoking during pregnancy, late prenatal care, lower birth weight, preterm birth, and illness with a fever in the 48 hours before last sleep in SIDS cases. All of these differences are cited in the American Academy of Pediatrics' policy statement on SIDS as factors that increase SIDS risk.2 Therefore, there is an increased risk of SIDS cases based solely on epidemiologic characteristics of the cases vs the controls.
The conditions of the sleep environment were subject to recall bias. On average, parents of infants with SIDS were interviewed a mean of 3.8 months (range, 1-20 months) after their infant had died. Conversely, controls were interviewed as to the conditions that existed while the infant slept the night before the interview.
In this article, the authors state that they perform a case-control study. However, according to their case presentation, this is a cohort study rather than a case-control study, leading to a lower overall quality of evidence.
Owing to the flaws in this article, including selection and recall bias, low enrollment numbers, and dissimilar study groups, it is difficult to recommend the use of fans as an intervention to prevent SIDS. Although the use of fans is not a harmful intervention, we would be doing a disservice to our families if we suggested, based on this study, that fans indeed provide additional reduction in SIDS risk above and beyond the American Academy of Pediatrics' Back to Sleep recommendations.
Correspondence: Dr Olsson, Brody School of Medicine, East Carolina University, Pediatrics, 600 Moye Blvd, Greenville, NC 27834 (olssonj@ecu.edu).
Author Contributions:Study concept and design: Vanderford and Olsson. Drafting of the manuscript: Vanderford. Critical revision of the manuscript for important intellectual content: Olsson. Administrative, technical, and material support: Vanderford. Study supervision: Olsson.
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Archives of Pediatrics and Adolescent Medicine editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.