Risk Factors for Sleep-Related Infant Deaths in In-Home and Out-of-Home Settings.

BACKGROUND AND OBJECTIVE Multiple environmental risk factors are associated with sleep-related infant deaths. Little is known about differences in risk factors for deaths occurring in-home and out-of-home. We sought to compare risk factors for in-home and out-of-home infant deaths. METHODS We conducted a cross-sectional analysis of sleep-related infant deaths from 2004 to 2014 in the National Child Fatality Review and Prevention database. The main exposure was setting (in-home versus out-of-home) at time of death. Primary outcomes were known risk factors: sleep position, sleep location (eg, crib), objects in the environment, and bed sharing. Risk factors for in-home versus out-of-home deaths were compared using the χ2 test and multivariate logistic regressions. RESULTS A total of 11 717 deaths were analyzed. Infants who died out-of-home were more likely to be in a stroller/car seat (adjusted odds ratio, 2.6; 95% confidence interval, 2.1-3.4; P < .001) and other locations (adjusted odds ratio, 1.9; 95% confidence interval, 1.5-2.3; P < .001), and placed prone (adjusted odds ratio, 1.1; 95% confidence interval, 1.02-1.27; P = .02). Bed sharing was less common out-of-home (adjusted odds ratio, 0.7; 95% confidence interval, 0.6-0.7; P < .001). There were no differences in sleeping in an adult bed/on person, on a couch/ chair, or objects in the sleep environment. CONCLUSIONS Sleep-related infant deaths in the out-of-home setting have higher odds of having certain risk factors, such as prone placement for sleep and location in a stroller/car seat, rather than in a crib/bassinet. Caregivers should be educated on the importance of placing infants to sleep supine in cribs/bassinets to protect against sleep-related deaths, both in and out of the home.