About a year ago I blogged about the concerning trend that sudden unexpected infant death (SUID) rates for non-Hispanic Black babies increased from 2015 to 2020 from 192 to 214 per 100,000 births. In a recently released Pediatrics article titled “Characteristics of Sudden Unexpected Infant Deaths on Shared and Nonshared Sleep Surfaces,” the same author group published more data from the CDC SUID database comparing infant deaths while surface sharing to non–surface sharing deaths (10.1542/peds.2023-061984). The data provides more clarity on the risk factors for SUID deaths in unsafe sleep settings. The authors found that 60% of infants were surface sharing, most in adult beds and couches. The infants who died while surface sharing were significantly more likely to:
- Be younger
- Be non-Hispanic Black
- Be publicly insured
- Be found supine
- Be found in an adult bed or chair/couch
- Have a higher number of unsafe sleep factors present
- Be exposed to maternal cigarette smoking prenatally.
Only 2% of infants who died non–surface sharing had no other SUID risk factors, and fewer than 1% of infants who died surface sharing had no other risk factors.
So what are the take-home messages?
Clearly, surface sharing is a major risk factor for SUID. But the fact that almost every infant who died had multiple risk factors means our messaging cannot be singular. A “one-size-fits-all” single message of placing infants to sleep “Alone, on their Back and in a Crib” is necessary, but clearly not sufficient. As the authors note, we really do need “comprehensive safe sleep counseling for every family at every encounter.”
We also need to better understand how to reach the most vulnerable communities with evidence-based messaging to help families reduce the risk of SUIDs. Perhaps adopting harm-reduction messages highlighting the relative risk of each sleep choice and using motivational interviewing to help families reduce the risk might be an approach, but this needs to be studied.
Even though I may be a broken record, the recommendations I had for pediatricians last year still hold. Anyone who cares for infants in the newborn nursery, NICU, or a pediatric office must provide culturally competent safe sleep counseling and modeling. Pediatricians should be involved in Child Fatality Review in their community and use the AAP Section of Child Death Review and Prevention resources 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 (NICHD) 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.
