Rhode Island Child Death Review: sudden infant death and sudden unexpected infant deaths, 2008-2009.

In the United States, in 2006, sudden infant death syndrome (SIDS) was the 3rd leading cause of death in infants under 1 year of age (behind congenital malformations (1) and disorders relating to prematurity/low birth weight (2); and ahead of results of maternal complications of pregnancy (4); and accidents-unintentional (5)). In Rhode Island, during 20082009, SIDS is the 2 leading cause of death for children under 1 year of age. (Figure 1) SIDS is defined as the sudden death of an infant under 1 year of age, which remains unexplained after a thorough case investigation, which includes performing a complete autopsy, examination of the death scene, and review of the clinical history. Improved postmortem examination and testing have resulted in improved cause of death determination in some infants with metabolic or cardiac disorders, but many causes are undetermined. To recognize this trend, the term sudden unexpected infant deaths or deaths in infants (SUID or SUDI) has been introduced. Most recent estimates are that 4,600 SUID deaths occur annually in the US, 50-80% of which can be classified as SIDS.5 Because of the inability to determine actual single cause of some SUID cases, many states report these deaths as “undetermined” or modify death certificates to include environmental findings such as “undetermined – co-sleeping” or “SIDS – co-sleeping”. Because of a resulting code or diagnostic shift, SIDS rates are declining while undetermined/ unspecified/unknown are reported more often.3, 4 The most important risk factors for SIDS/SUID are: prone sleeping position, sleep on a surface not designed for infants, bed-sharing, maternal and/or paternal smoking, excessive environmental temperature, premature birth, and concurrent respiratory illness. 5, 6, 7 The first three are thought to contribute to accidental asphyxia, and the occurrence of strangulation associated with inappropriate sleep surface has resulted in the reporting of some of these deaths as accidental suffocation and strangulation in bed (ASSB). 3 5 Since 2007, the Office of the State Medical Examiner (OSME) has adopted death scene investigation and scene re-enactments in order to more fully understand factors contributing to SUID in R.I. infants. Recent detailed review of deaths in infants under one year of age has revealed a pattern of SUID which lends itself to intervention.