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Examining Trends in Sudden Unexpected Infant Deaths as a Clue to Prevention :

February 12, 2018

Many cases of Sudden Infant Death Syndrome (SIDS) remain a mystery, without a mechanistic explanation.

Many cases of Sudden Infant Death Syndrome (SIDS) remain a mystery, without a mechanistic explanation. Although we do not know why infants die of SIDS, we do know that there are known causes for infant deaths that can be attributed to accidental suffocation and strangulation in bed (ASSB) due to unsafe sleeping conditions.  It is because we want to prevent sudden deaths in all infants regardless of cause, that we have lumped all etiologies of such deaths under the category of “sudden unexpected infant deaths” or SUIDs. How have SUIDs changed over time?  To better understand trends in SUIDs, Erick Lambert et al. (10.1542/peds.2017-3519) decided to look at data compiled from US mortality files.  The authors looked at national and state-specific SUID rates from 1990 to 2015 as well as subtypes, such as SIDS and ASSB.  What makes this study so interesting is that the authors compared states with each other and noted interesting differences by state SUID rates.  in addition, the authors note the overall rate of SUID declining over time from 154.6 per 100,000 live births in 1990 to 92.4 deaths per 100,000 live-births in 2015, with the greatest improvements in the first half of the 16-year time period studied, likely reflecting the back-to-sleep campaign. While the variation in SUID rates between states is concerning, making this article a must-read to see how your state has been doing, one might look more positively at what is shared by focusing on states with the lowest SUID rates and begin to ask if something is being done in those states that we can all learn from.

To shed further light on these findings, we asked specialists in the study of SUID prevention, Drs. Rebecca Carlin and Rachel Moon, to weigh in with an accompanying commentary (10.1542/peds.2017-4083). They look at why SUID rates have plateaued since 1999 as described in the Lambert et al. study, and then offer changes and suggestions for us to implement locally that can continue to move these trends downward.  These suggestions include increased efforts to reduce maternal smoking (found to be higher in the states with the highest SUID rates) and what role the opioid crisis in this country may be playing to contribute to higher SUID rates in some states.  The commentary authors also remind us to be sure to educate families regarding the importance of the safe sleep environment and suggest some tools we may not have thought of that involve the use of smart phones.  What prevention strategies do you use to prevent SUID in your practice as much as possible?  Reading this study and commentary will encourage all of us to do more so we can again move the plateauing in declining SUID rates and do so with more consistency across our country and in turn across all countries.

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