In spite of violent fall in 1994 among cot death (MSN), with the campaign  I sleep
on the back  , 350 babies die even every year in an unexplained way. This figure remains stable, but it is possible to improve prevention, underlined the participants in a debate organised as part of the Discussions of Bichat (summer, 2004)
THE DEFINITION of the cot death is the violent, unexpected decease, of a new-born baby of less than 1 years old, obviously in good health, during its sleep. As since for a long time, MSN is listed by Inserm since 1970. Reference centres were set up in regions in 1986. Made responsible for taking a census of MSN, for performing complete balance sheets (clinical, biological, genetic, radiological), autopsies, they assure the psychological taking care of the parents and the long-term monitoring, notably during the following pregnancy, which awakens concerns. They play an informative and preventive role. Key date 1990. The role of the conditions of sleeping arrangements, notably the noxiousness of the ventral sleeping arrangements of the baby, is highlighted. The campaign I sleep on the back brought down in a spectacular way, 75 % in less than 1 year, the number of MSN (350 deceases instead of 1500). But, since the number of 350 MSN a year stable rest. He could again be lowered if the young parents are sensitised.
The cot death is fact  of a multifactorial accident  , term accident underlining the randomness of drama. The "peak" of mortality is between 2 and 3 months. The boys are more affected than the girls (two thirds, a third) and the winter period is the most formidable, indeed by the conjunction of factors favorisants and virus.

MSN implicates the presence of several factors p rinataux favorisants of very various nature. Among these factors, it is possible to name the hypotrophie, an impairment of the ripening of the control of vital functions (respiratory, cardiac, neurovegetative functions, immunity) very variable according to subjects and prematurity. Factors to which d clenchantes reasons belonging to the habitual domain of the pathologies of this age group can be added (infections, hyperthermies, pathologies because
diaques, Low tide, pilepsie, metabolic diseases). Other favorisants factors linked to the environment of the baby were identified the bad conditions of sleeping arrangements (on the belly or aside, the presence of covers, pillows, gave, spacious fuzz, mattresses not adapted to the bed), high surrounding temperature, co-sleeping car (between the parents), passive tobacco addiction, (more and more rare) self-medication.
Basic Councils. To lower still the number of deceases by MSN, action must be orientated to last named factors, environmental factors, such tobacco addiction during the pregnancy and afterwards, the hyperthermie, risks of suffocation led by the bedclothes. All basic advice must be reminded bedclothes  of security  , without pillow, without cover, with a never "knocked up " adapted mattress, a temperature of the room from 18 to 20 , the ban of the co-sleeping car and finally make sleep the child on the back. Forty for hundred babies hit last year by MSN in region Midi-Pyr n es gave in ventral position.
For other factors, underlines the Dr Ann-France Bongrand, the means of action are weak and research tracks remain huge (research on the augmented sensitivity by these babies in infections, genetic researches, on the ripening of the nervous system).