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Sudden infant death syndrome (SIDS) and the routine otoacoustic emission infant hearing screening test: an epidemiological retrospective case–control study
  1. Peter S Blair1,
  2. Daniel Rubens2,
  3. Anna Pease1,
  4. Diane Mellers3,
  5. Jenny Ingram1,
  6. Andrew K Ewer4,
  7. Marta C Cohen5,
  8. Peter Sidebotham6,
  9. Martin Ward Platt7,
  10. Robert Coombs8,
  11. Adrian Davis9,
  12. Amanda Hall10,
  13. Peter Fleming1
  1. 1Bristol Medical School, University of Bristol, Bristol, UK
  2. 2Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington, USA
  3. 3Department of Research & Development, Birmingham Women’s Hospital, Birmingham, UK
  4. 4Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
  5. 5Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
  6. 6Department of Child Health, University of Warwick Warwick Medical School, Coventry, UK
  7. 7Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
  8. 8Department of Pathology, University of Sheffield, Sheffield, UK
  9. 9Department of Audiology, Imperial College London, London, UK
  10. 10National Institute of Health Research Clinical Research Network: West of England, University of Bristol, Bristol, UK
  1. Correspondence to Dr Peter S Blair; p.s.blair{at}


Objectives To investigate whether decreased otoacoustic emission (OAE) signal recordings in the right ear are associated with an increased risk of sudden infant death syndrome (SIDS) and to monitor any temporal changes in risk factors.

Design Retrospective case–control study.

Setting Telephone interviews with families recruited in England between July 2016 and October 2017 who experienced the unexpected death of a child <4 years old since 2008 and control families recruited from maternity wards in Bristol and Birmingham.

Participants We recruited 91 (89%) of the 102 bereaved families who made initial contact, 64 deaths were under 1 year (sudden unexpected death in infancy) of which 60 remained unexplained (SIDS). Of the 220 control families, 194 (88%) follow-up interviews were conducted. We had analysable hearing data for 24 SIDS infants (40%) and 98 controls (51%).

Results OAE signals were marginally increased rather than decreased among SIDS infants for the right ear, especially at lower frequencies, but not significantly so. The strongest predictors of SIDS were bed-sharing in hazardous (infant sleeping next to a carer who smoked, drank alcohol or slept on a sofa) circumstances (35% vs 3% controls, p<0.0001), infants found prone (33% vs 3% controls, p<0.0001) and infants whose health in the final week was ‘not good’ (53% vs 9% controls, p<0.0001). The prevalence of maternal smoking during pregnancy among both SIDS mothers (20%) and controls (10%) was much lower than previous studies.

Conclusions Hearing data were difficult to obtain; larger numbers would be needed to determine if asymmetrical differences between the right and left ear were a marker for SIDS. A national prospective registry for monitoring and a renewed campaign to a new generation of parents needs to be considered underlining the initial message to place infants on their backs for sleep and the more recent message to avoid bed-sharing in hazardous circumstances.

  • SIDS
  • sudi
  • epidemiology
  • hearing
  • screening

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  • Contributors DR, PF, PSB, AP and JI were responsible for developing the research question. PF, DR, PSB, JI, AP, AH, DM, AKE and AD were responsible for the study design. PF, AP, PS, MCC, MWP and RC were responsible for data collection, death classification and quality assessment of the investigation into the death. AP was responsible for study management. PSB initially drafted the paper. All authors read, commented on and approved the final manuscript.

  • Funding This work was supported by The Lullaby Trust (project number 268) with funding also received from Teddy’s Wish and Seattle Children’s Hospital.

  • Disclaimer These sponsors had no role in the study design; in the collection, analysis and interpretation of the data; in the writing of the report; or in the decision to submit the paper for publication.

  • Competing interests None declared.

  • Ethics approval Ethical approval was sought and gained from the South West Central Bristol Research Ethics Committee; REC (reference: 14/SW/1084). The date of approval was 22 March 2016.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data we have collected are sensitive and include information from bereaved parents and coroner’s reports. We are happy to comply with University of Bristol regulations in this matter although it must be understood that ethical approval would be a prerequisite to access.

  • Patient consent for publication Not required.

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