Student Tulane Univeristy New Orleans, Louisiana, United States
Background: In the US, Sudden Unexpected Infant Death (SUID) is a leading cause of death in healthy infants. SUID rates, however, have plateaued, as many caregivers do not adhere to recommendations for a safe infant sleep environment (supine positioning, separate uncluttered sleep spaces, and approved sleep surfaces). Infant night awakenings may make a caregiver move an infant from a safe (first sleep) to a less safe sleep position (second sleep). However, the role of positioning for first and second infant sleep in actual SUID cases is unclear and needs to be clarified. Objective: To describe the circumstances of the first and second sleep environments in cases of SUID where a scene re-enactment was done as part of the death investigation by the medical examiner. Design/Methods: We retrospectively reviewed records of scene re-enactments of cases of SUID that were reported to the Connecticut Office of the Chief Medical Examiner (OCME) from January 2018 to August 2023. The following data was abstracted: demographic characteristics of infants (age, sex, race/ethnicity, gestational age); maternal characteristics (prenatal care, breastfeeding); usual caregiver; caregiver at the time infant was found unresponsive; prenatal exposure to maternal substances; first sleep environment; and if the infant was moved, the second sleep environment. Results: To date, we have reviewed 30/100 cases of SUID with scene re-enactments. Demographic characteristics of infants, mothers, and caregivers are in Table 1. The majority (26/30) of the cases were found unresponsive in an unapproved infant sleep environment; 23/30 were supine. Additionally, 13/30 had evidence of airway obstruction from the sleep environment; of these, 6/23 found supine. For 23/30, this was the first sleep environment, and 7/30 were in a second sleep environment. Only 3/30 were found in a safe sleep environment (supine, alone in a separate approved infant sleep environment) at either the first or second sleep environment. While mothers were predominantly the usual caregiver, in 17/30 cases someone other than the mother (father, grandmother, babysitter) was responsible for the last sleep environment.
Conclusion(s): In this first study to use scene re-enactment data to describe cases of SUID, we found that most cases of SUID involved unsafe first infant sleep environments; airway obstruction was documented in nearly half of these cases. Strategies should be explored to include fathers, grandparents, and babysitters in safe sleep education, especially for first infant sleep. Image 10-30-23 at 2.54 PM.jpeg
