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Reducing Sudden Infant Deaths For All Babies

March 13, 2023

When it comes to reduction infant mortality, we are not making progress across the board. Healthy babies, especially non-Hispanic Black, continue to die suddenly and unexpectedly in the US. The data from Shapiro et al published in this month’s Pediatrics (10.1542/peds.2022-058820) could not be more stark; sudden unexpected infant death (SUID) rates for non-Hispanic Black babies increased from 192 per 100,000 births in 2015 to 214 per 100,000 births in 2020, the only racial group to see an increase after experiencing decreasing rates of infant mortality since the 1990s. And this is data from before the pandemic began. As noted in an accompanying commentary by Drs. Carlin and Moon (10.1542/peds.2022-060798), the COVID-19 pandemic has more than ever before highlighted many health system disparities in the US. They note that the increase in deaths is likely not related to COVID-19 disease, but is likely a result of other factors like “poverty levels, lack of access to prenatal and well-child care, and education regarding safe sleep and other practices, including the feeding of human milk.”

Unfortunately, I am expecting the 2021 and 2022 data to be even worse. The structural challenges noted above that non-Hispanic Black infants face have not improved. Additionally, the fall of 2022 brought widespread respiratory viral illnesses to infants across the country in numbers we have not seen since the influenza H1N1 outbreak of 2008. Locally in Maryland, we have historically had large disparities of SUID deaths, and this past month providers received alerts from local health departments about a dramatic increase in SUID deaths since December 2022 associated with unsafe sleep positions and many with concomitant respiratory infections. Similar to the data from Shapiro, these deaths have occurred disparately in non-Hispanic Black infants. It appears that we are continuing to go in the wrong direction.

What can be done? While it can be overwhelming to try to tackle systemic issues, we can start locally. Anyone who cares for infants in the newborn nursery, NICU, or a pediatric office must provide culturally competent safe sleep counseling and modeling. Creating a culture of sleep safety in the nursery has been shown to reduce SUID rates. If you aren’t involved in Child Fatality Review in your community, I would encourage all pediatricians to either become involved or make sure their local team has a pediatric representative. The AAP Section of Child Death Review and Prevention has resources for pediatricians to help turn tragedies of deaths into prevention efforts. Additionally, we need to make sure that the Safe to Sleep campaign by the National Institute of Child Health and Human Development gets more widespread dissemination and becomes the “cultural norm” like car seats and reducing tobacco exposure for children. Finally, we all have to begin the hard work of dismantling the longstanding structural racism policies and biases that underpin the majority of all health disparities in our country, including infant mortality.

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