Sleep Environment Risks for Younger and Older Infants

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Sudden infant death syndrome and other sleep-related causes of infant mortality have several known risk factors. Less is known about the association of those risk factors at different times during infancy.WHAT THIS STUDY ADDS: Risk factors for sleep-related infant deaths may be different for different age groups. The predominant risk factor for younger infants is bed-sharing, whereas rolling to prone, with objects in the sleep area, is the predominant risk factor for older infants. abstract OBJECTIVE: Sudden infant death syndrome and other sleep-related causes of infant mortality have several known risk factors. Less is known about the association of those risk factors at different times during infancy. Our objective was to determine any associations between risk factors for sleeprelated deaths at different ages. METHODS:A cross-sectional study of sleep-related infant deaths from 24 states during 2004-2012 contained in the National Center for the Review and Prevention of Child Deaths Case Reporting System, a database of death reports from state child death review teams. The main exposure was age, divided into younger (0-3 months) and older (4 months to 364 days) infants. The primary outcomes were bed-sharing, objects in the sleep environment, location (eg, adult bed), and position (eg, prone). RESULTS:A total of 8207 deaths were analyzed. Younger victims were more likely bed-sharing (73.8% vs 58.9%, P , .001) and sleeping in an adult bed/on a person (51.6% vs 43.8%, P , .001). A higher percentage of older victims had an object in the sleep environment (39.4% vs 33.5%, P , .001) and changed position from side/back to prone (18.4% vs 13.8%, P , .001). Multivariable regression confirmed these associations. CONCLUSIONS:Risk factors for sleep-related infant deaths may be different for different age groups. The predominant risk factor for younger infants is bed-sharing, whereas rolling into objects in the sleep area is the predominant risk factor for older infants. Parents should be warned about the dangers of these specific risk factors appropriate to their infant' s age. Pediatrics 2014;134:e406-e412 AUTHORS:

Nocturnal Video Assessment of Infant Sleep Environments

“…These findings are more consistent with 4 data from Child Death Review teams, which reported that in sleep-related deaths, 38% of infants were found on their stomach, and only 28% of infants were found in a crib, bassinet, or playpen. 15 We also found higher rates of bed-sharing and loose bedding in the environment than studies relying on parental report have noted. The most recent report from NISP demonstrated that 13.5% of families usually shared a bed.…”

“…However, soft bedding in the sleep environment is the most common risk factor seen in sudden and unexpected infant deaths that occur in infants aged ≥4 months. 15 There are 2 likely reasons that utilization of nocturnal videos resulted in the finding of higher rates of unsafe sleep environments than have been previously reported. First, objective video observations eliminate the bias inherent in self-reporting.…”

“…Importantly, <10% at each time point were observed sharing a surface at the beginning of the night, but this scenario increased overnight. Interestingly, Colvin et al 15 reported that 69% of infant deaths reviewed by Child Death Review teams occurred while the infant was sharing a sleep surface. Similarly, NISP reported a lower rate (55%) of soft or loose bedding use, 8 compared with ∼75% in our observations.…”

Sofas and Infant Mortality

“…Multiple imputation has been previously used for analyses of the CDR-CRS database. 20,23 Multiple imputation predicts values for incomplete variables by using regression equations from complete variables. This minimizes assumptions that the subset of cases with complete data are representative of the entire sample population.…”

In Reply to the Letter From Dr Cutz

“…Although we provided the proportion of deaths that were attributed to specific causes of death, we analyzed the associated factors for the group as a whole. 1 Because the modifiable risk factors for the 3 most common causes of sleep-related infant death are remarkably similar, we felt that it was important to identify these risk factors across categories of sleep-related infant deaths, regardless of the specific "official" diagnosis. Second, we did adjust for known health problems, including genetic and metabolic disorders, in the cohort.…”