A comparison of apparent life-threatening events before and after the back to sleep campaign

Objectives. The incidence of the Sudden Infant Death Syndrome (SIDS) has decreased significantly in the United States since the 1992 recommendation that healthy term infants be placed on their backs or sides during sleep. However, little is known regarding the effect that this recommendation has had on the incidence and epidemiology of apparent life-threatening events (ALTEs) in this country. Methods. To examine this, we completed a retrospective chart review study of all infants admitted to the Children's Hospital of Wisconsin with the diagnosis of an ALTE during two study periods before and after the back to sleep initiative: January 1, 1991 to December 31, 1992 and January 1, 1996 to December 31, 1997. Results. There were 81 ALTEs in 1991-1992 vs. 102 in 1996-1997. Infants in both groups were similar with respect to gender, race, and age, with approximately 80% in each group < 4 months of age. ALTEs occurred equally throughout the year during both time periods. The majority of episodes occurred during sleep; 74% of the 1991-1992 cohort and 59% of the 1996-1997 infants did not have information in the medical record describing their position during the ALTE. Three infants (2 during 1991-1992) died during the hospitalization and were subsequently diagnosed with SIDS or probable SIDS. Conclusions. In a large midwestern city, the epidemiology surrounding ALTEs has not bee appreciably affected by the Back to Sleep Campaign. In addition, historical data for infants with ALTEs is frequently lacking. These data also suggest that ALTEs and SIDS are influenced by different factors.