Knowledge, attitudes and practice on sudden infant death: study protocol of a scoping review


Sudden infant death has been observed and described since ancient times. Throughout the history of humanity, there has been concern about the health of newborns, especially during sleep, and empirical knowledge has been used to seek the means to protect infants and avoid sudden death. As cited in the journal of the Brazilian Society of Pediatrics,1 between the seventh and eighth centuries BC, the Assyrians used the bronze head of Pazuzu, the king of the wind demons, to protect newborns from attacks by Lamashtu, a female demon, who was believed to be responsible for miscarriages, stillbirths and cot deaths. According to the Brazilian Society of Pediatrics, the first record of sudden infant death syndrome (SIDS) is believed to be in the Bible: “and this woman’s child died in the night; because she overlaid it.” (1,Kings 3:19–22)

With the evolution and dissemination of scientific knowledge, it has become clear that SIDS can be prevented through changes in behaviour. However, the pathophysiology of SIDS is not sufficiently clear, and the established culture of caring for newborns can be a barrier to preventing it.1

SIDS is described as the unexpected death of an infant under 1 year of age, which occurs without presentation of any signs of mortality risk and is not adequately explained after investigation, necropsy and review of the place of death.2 According to Nunes et al, in those regions that implement informative intervention programmes, the incidence of SIDS has decreased as a result of increased provision of guidance to parents, family members and caregivers on the factors associated with its occurrence.3

But still even in developed countries the incidence is high and out of 100 000 live births, at least 1389 died from SIDS with less than 12 months of life.4 In the USA, estimates have shown that SIDS accounts for 90% of mortality in children up to the 6th month of life. These data prompted several other studies on the risk of SIDS and the need of increasing the population’s knowledge about this event.5

Many countries have adopted the United Nations’ Sustainable Development Goals (SDG). Nurses have an essential role in achieving the goals targeting children and families by 2030, especially those related to ending preventable deaths of newborns and children under 5 years of age.6

We intend conducting this research project based on systematic discussions about the links between SDG, preventable death of infants and work strategies to effectively reach the population of caregivers. Considering the relevance of this context, this research project aims to explore the scientific literature about knowledge, attitudes and practice on SIDS.

Methods and analysis


This is a scoping review that involves synthesising research evidence to map the existing literature on the subject in terms of its nature, characteristics and rates.7

The rates of incidence of SIDS are directly related to parents’ and/or caregivers’ prior knowledge—the greater the knowledge of strategies to prevent sudden death of infants, the less likely that such deaths will occur. We used patient, intervention, comparison, outcomes, timing (PICOT)6 criteria to structure the research question (table 1). To achieve our objective, the scoping review will answer the following question based on the PICOT criteria: What is the level of knowledge of professionals and caregivers about SIDS described in the literature?

Table 1

PICOT criteria used in the scoping review18

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Review8 and the guidelines set by the Joanna Briggs Institute9 will be used as a methodological framework and to ensure rigour and allow replicability of this review.

Search strategy and terms

The scientific evidence will be searched for in PubMed, Embase, Scopus, Virtual Health Library, Brazilian Digital Library of Theses and Dissertations of the Brazilian Institute of Information in Science and Technology and Cochrane databases (full details are available in online supplemental file).

Supplemental material

We will also conduct a manual search of recommendations for strategies to prevent SIDS published by recognised health organisations, for example, the WHO, Centers for Disease Control and Prevention and the Brazilian Ministry of Health. The inclusion of heterogeneous sources will be an important strategy to obtain an in-depth understanding of the recommendations available to prevent SIDS.

The references of these selected articles will also be reviewed based on the previously established inclusion criteria to identify new studies not found in previous searches. In the case of the inclusion criteria, a search strategy will be elaborated with the keywords: ‘Sudden Infant Death’, ‘Sudden Infant Death Syndrome’, ‘SIDS’, ‘Cot death’, ‘Crib death’, ‘Risk factors’ ‘Prevention Strategies’, ‘Caregivers’, ‘Health Personnel’, ‘Health Knowledge, Attitudes, Practice’, ‘Family Health Strategy’, ‘Health Education’, ‘Basic Health Services’, ‘Basic Health Care’ and ‘Home Care’. The Boolean operators AND and OR will be used as needed between keywords.

The search terms will include two main concepts:

  1. “Sudden Infant Death” OR “Sudden Infant Death Syndrome” OR “SIDS” AND

  2. “Caregivers” AND “Health personnel” AND “Health Knowledge, Attitudes, Practice” OR “Home Care” OR “Basic health Strategic”.

This strategy will be adapted to the particularities of each database searched. No period will be delimited, and publications found in duplicate will be removed using EndNote.10

Screening process

Eligible quantitative or qualitative primary studies will be included in the review. We will also consider theses, dissertations, books and technical and government documents. There will be no publication time limit for selecting documents. The eligible documents may be in English, Spanish, French or Portuguese. A PRISMA flowchart will be created to illustrate the steps for excluding and including articles.11

The articles found will be read independently by two authors. They will apply the exclusion criteria to titles and abstracts and later to full texts. A third author will be consulted to resolve any discrepancies in the selection process. The third author will also review the studies and materials recommended for exclusion to ensure consistency and rigour in the application of the selection criteria.

The start date for the activities was December 2023. The end date is scheduled for September 2024, what is an approximate projection, subject to possible adjustments.

Data analysis

The articles selected will be subjected to thematic content analysis, which allows data interpretation through a systematic classification process for coding themes or patterns.12 Through a reflexivity process, we will review the codes and analyse their interrelations to identify patterns enabling the construction of categories.

To enable the analysis of quantitative and qualitative studies, meta-aggregation13 will be performed according to the following procedure: high points of qualitative studies will be raised to generate themes which will be coded12 and variables in quantitative studies will be transformed into similar themes and also coded.13 We will employ both quantitative and qualitative data to identify themes, coding all the information into a compatible system for meta-aggregation analysis, ensuring an appropriate transformation and utilisation of both types of data.14–16

Possible variables to be considered for data extraction and analysis from quantitative studies:

  • Tools used to predict the occurrence of the event (SIDS risk classification scales).

  • Maternal characteristics associated with the event (previous illnesses and smoking).

  • Neonatal characteristics associated with the event (extreme prematurity).

  • Environmental characteristics associated with the event (adoption of prone position during sleep and use of blankets).

  • Guidance strategies for SIDS prevention (structured training before discharge, conversation circles, delivery of visual material pamphlets, education for professionals).

The results of the analysis will be synthesised by constructing categories for organisation and presentation of the material subjected to meta-aggregation.13–15 After the literature review, the promotional material for the orientation strategy for families will begin to be developed through Healthcare Network, to be disseminated to the population to sensitise them to the ways to prevent SIDS.17

Given that scoping reviews allow the identification of gaps, as well as synthesis and description of the literature on the topic explored, we will not assess the risk of bias in the empirical studies considered. However, we will map recommendations and factors associated with SIDS that will be useful for elaborating health educational materials to prevent its occurrence.

Data will be extracted on the following categories:

  • General information, for example, author, date, title and country.

  • Objective.

  • Context, for example, level of healthcare, type of publication.

  • Methods.

  • Main findings.

  • Recommendations/conclusions.

Thematic content analysis is appropriate for this review in order to explore and synthesise existing strategies for identifying and preventing SIDS. The analysis will consist of a synthesis of the content of relevant materials, and its findings will be used to develop categories which will be discussed by the authors and validated against the literature. NVIVO V.14 software will be used to organise, code and validate the data analysis.

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