The U.S. has seen only small declines in the rate of sudden unexpected infant death (SUID) in recent years.
The rates vary widely among states and often do not meet federal Health People 2020 targets, researchers from the Centers for Disease Control and Prevention (CDC) found.
“States that have been successful in significantly reducing their SUID rate might serve as models for other states in terms of SUID risk reduction,” authors wrote in the study “National and state trends in sudden unexpected infant death: 1990-2015” (Erck Lambert AB, et al. Pediatrics. Feb. 12, 2018, http://pediatrics.aappublications.org/content/early/2018/02/09/peds.2017-3519).
Each year, about 3,500 U.S. infants die of SUID, which includes sudden infant death syndrome (SIDS) and accidental suffocation and strangulation in bed. To protect infants, AAP policy calls for infants to sleep on their backs on a firm surface with no toys or soft bedding. They should share their parents’ room but not their bed. The Academy also recommends breastfeeding, routine immunization and avoiding smoke exposure.
In 1990, 154.6 of every 100,000 infants died of SUID, according to the CDC’s analysis of mortality data. By 1998, following the Back to Sleep campaign (now known as Safe to Sleep), the rate declined 44.6%. However, from 1999 to 2015 rates declined only 7% to 92.4 deaths per 100,000 live births. The Healthy People 2020 goal is 84 per 100,000.
From 2013-’15, SUID rates among states ranged from 33.2 to 202.2 per 100,000. During those years, 18 states met the federal target, and California, Colorado, Florida, Kansas, Missouri, New York, Oregon, Washington, Washington, D.C., and Wisconsin saw significant declines in SUID rates compared to 2000-’02.
SUID rates in Alabama, Alaska, Arkansas, Kentucky and Louisiana increased significantly since 2000-’02, and each had rates above 150 per 100,000 births.
Authors said more research is needed on the impact of each state’s SUID reduction programs, demographic changes and emerging issues like opioid use.
“Increased understanding about the factors that have influenced these state-specific trends is needed in order to leverage successful interventions for adaptation by other states,” authors wrote.
In a related commentary, Rebecca Carlin, M.D., FAAP, and Rachel Y. Moon, M.D., FAAP, lead author of the Academy’s SIDS policy and chair of the AAP Task Force on Sudden Infant Death Syndrome, note the U.S. has a higher SUID rate than other developed countries. It also is the only one that lacks universal health care, universal paid maternity leave and neonatal home visiting, which are associated with decreased infant mortality.
As such programs do not appear to be on the horizon, they called for more effective strategies to discourage maternal smoking and substance use and better communication of safe sleep practices to combat misinformation.
“In the absence of a dramatic change in our healthcare delivery system that would enable more emphasis on public safety and prevention,” they wrote, “in order to improve infant mortality rates, we must commit to learning from local successes and applying them more broadly.”
