Unexplained Infant Deaths Often Linked to Bed Sharing

Emma Hitt, PhD

April 20, 2012

April 20, 2012 — Among infants who have died suddenly and unexpectedly, most were sharing a sleep surface with another child or adult, and only one fourth were sleeping in a crib or on their back when found, according to a new report.

Results were published in the American Journal of Public Health online April 19. The study was conducted by Patricia G. Schnitzer, PhD, from the Sinclair School of Nursing, University of Missouri, Columbia, and colleagues.

According to the researchers, more than 4000 infants without prior known illness or injury die suddenly and unexpectedly each year in the United States.

Sudden unexpected infant deaths (SUIDs) may result from a variety of causes, including previously undiagnosed metabolic disorders and homicides. However, over half of SUIDs cases are attributed to sudden infant death syndrome (SIDS), which is defined as a death that remains unexplained after investigation (including autopsy, death scene investigation, and a review of the infant's clinical history).

The current study investigated similarities and differences in SUID risk factors among infants whose deaths are ultimately classified as resulting from SIDS, suffocation, or undetermined causes.

The authors used data collected from 2005 to 2008 from 9 states in the United States to assess 3136 sleep-related cases of SUIDs. The cases were classified into 3 categories: SIDS (n = 960 [30.6%]), suffocation (n = 939 [29.9%]), and undetermined cause (n = 1237 [39.5%]).

The researchers found that only about one fourth of infants were sleeping in a crib or on their back when found, but 70% were on a surface not intended for infant sleep, such as an adult bed. Of note, 64% of infants were sharing a sleep surface, and of those, nearly half were sleeping with an adult.

One study limitation, among others, is the possible lack of generalizability because the data were as drawn from only 9 states.

"Infants whose deaths were classified as suffocation or undetermined cause were significantly more likely than were infants whose deaths were classified as SIDS to be found on a surface not intended for infant sleep and to be sharing that sleep surface," Dr. Schnitzer and colleagues note.

"Our findings are largely consistent with those of other studies that have described the sleep environment and other characteristics of SUIDs," they note.

According to the researchers, their findings, along with those of other studies, indicate that "a large proportion of SUIDs involve hazards in the sleep environment such as non-supine sleep position, use of surfaces not intended for infant sleep, and the presence of people (bed sharing) or objects (bedding) in the sleep environment."

The authors suggest that “[f]uture research should focus on development of novel interventions that facilitate behavior change and result in a safe infant sleep environment.”

The study was supported by the Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services. The researchers have disclosed no relevant financial relationships.

Am J Public Health. Published online April 19, 2012. Abstract

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