Re: “Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6,Revision 2019” by Blair et al.

Dear Editor:

The recent article “Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6, Revision 2019” by Blair et al. raises important points about the safety or not of breastfeeding while bedsharing. ¹ Although there has certainly been an awareness of the possibility of accidental suffocation in bedsharing situations for decades,^2,3 the lack of specificity of pathological findings has previously made the identification of such cases difficult. Recent studies have, however, demonstrated significant epidemiological and pathological differences between infants who have died while sleeping alone and infants who died while bedsharing with an adult. ⁴ Specifically, there are more girls among the shared sleepers ⁵ and they have significantly higher number of circulating nucleated red blood cells that suggests that they may have been exposed to an hypoxic environment. ⁶ Conversely, compared with shared sleepers, infants who died while sleeping alone have higher levels of terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling, β-amyloid precursor protein, and glial fibrillary acidic protein.^7–9 These findings are supportive of different lethal mechanisms operating in the two quite distinct environments and suggest that suffocation may be a significant factor in certain of these shared sleeping deaths. Unfortunately, as these markers are not routinely tested for in medicolegal autopsies, the exact number of infants who may have suffocated must remain conjectural.