Most of 4,000 sudden infant deaths a year are preventable, studies show

WASHINGTON - No matter whether they classify them as Sudden Infant Death Syndrome, suffocation or unexplained, investigators are increasingly convinced that most of about 4,000 sudden infant deaths that occur nationwide each year can be called one thing --- preventable.

Three new reports in the past two weeks suggesting most such deaths of babies under a year old happen in unsafe sleeping conditions.

The largest analysis of sudden unexplained infant deaths done to date was published online Thursday by the American Journal of Public Health, which found that only 25 percent of more than 3,100 infants who died were sleeping in a crib or on their back, as recommended.

Child-death review records from nine states between 2005-08 showed that 70 percent of the fatalities occurred somewhere not intended for babies to sleep, like an adult bed or a couch. Sixty-four percent of the deaths occurred when the babies were sharing a sleep surface with someone else, nearly half of those with an adult.

While bed sharing is a known risk, "We were surprised by the large proportion of infants in this analysis that were sleeping in an adult bed and with an adult," said Patricia Schnitzer, an associate professor of nursing at the University of Missouri and lead author of the report.

The study is the largest and most detailed look ever taken of conditions surrounding unexplained infant deaths. It is based on a registry built from reports by state and local child death-review boards. Most previous major studies of infant deaths have relied on much less detailed death certificate data.

Another report on childhood injuries released Tuesday by the Centers for Disease Control and Prevention noted infant deaths from suffocation increased by 54 percent between 2000 and 2009, mainly in sleep settings.

Dr. Julie Gilchrist, an injury prevention epidemiologist, said some of those deaths may once have been misclassified as SIDS but, with the growing awareness of the dangers of unsafe sleeping, are now designated as suffocations.

"But it's still almost 1,000 infants a year that are suffocating in their beds and in environments that we know aren't safe and that can be prevented,'' Gilchrist said during a conference call with reporters.

The third study, published in the April issue of Pediatrics, looked at risk factors present in 568 San Diego County SIDS cases between 1991 and 2008, particularly noting differences before a 1994-95 national campaign encouraging parents to put infants on their backs to sleep, and afterward.

Infant deaths attributed to SIDS went down by about 10 percent from 1996 on, and stomach sleeping among those fatalities declined to 30 percent, according to research led by Dr. Henry Krous of the San Diego SIDS Research Project at Rady Children's Hospital.XXXX.

But the proportion of babies found sharing a bed with someone else when they died went from 19 percent to 38 percent, and the share found in an adult bed nearly doubled to 45 percent.

Beyond the studies, evidence of bed sharing dangers is also in daily headlines. This year so far, South Carolina authorities in Anderson, Greenville and Spartan counties say nearly a dozen infants have been smothered when sleeping with their parents. Most recently, a 1-month old boy suffocated against his father's back.

In Lufkin, Texas, a mother was recently convicted of child endangerment for sharing a bed with her husband and a 2-month old who suffocated in 2010. Charges were filed only when prosecutors realized her one-month-old son had died in similar fashion in 2009, and the couple had received extensive counseling and warnings against co-sleeping with a baby.

About half of U.S. sudden infant deaths are now classified as SIDS, down from 80 percent or more in the 1990s; the other half are attributed to accidental suffocation or from unknown causes. But as Scripps Howard News Service showed in a 2007 investigation, classification of the deaths is erratic, with many medical examiners and coroners calling virtually all mysterious baby deaths SIDS, while others never use the term.

SIDS is supposed to be diagnosed only after an autopsy and death-scene investigation, that includes in-depth interviews and doll re-enactments of the scene, rule out any apparent cause.

Infant-death prevention advocates say child death-review programs and a pilot CDC registry of the reports now underway in seven states should help bring better understanding of the threats facing babies as they sleep -- and better ways to educate adults in how to avoid them.

Theresa Covington, director of the National Center for Child Death Review in Ann Arbor, Mich., and a co-author of the Public Health report, noted in a survey last year that of 37 states presenting infant safe sleep messages

to new parents, all mention back sleeping, but only about half cautioned against bed-sharing.

Updated sleep guidelines issued by the American Academy of Pediatrics last fall for the first time explicitly discourage bed-sharing, ending a long impasse over concern about impeding breastfeeding.

The AAP guidelines: http://pediatrics.aappublications.org/content/128/5/1030.full

(Contact Lee Bowman at Bowmanl@shns.com)

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