DefinitionSIDS is the cause ascribed to an infant death that remains unexplained after a thorough assessment that includes a complete autopsy, a death scene investigation, and a review of the clinical history.
ICD-10 code: R95
NumeratorNumber of deaths in the first year of life with Sudden Infant Death Syndrome as the underlying cause of death
DenominatorTotal number of live births in the same year
Why Is This Important?SIDS is the third leading cause of infant death in New Jersey and the U.S. Although rates have declined by over 50% since the start of public health efforts to reduce risk factors associated with SIDS, it still accounted for 1,500 infant deaths in the United States in 2016.
Healthy People Objective: Infant deaths from sudden infant death syndrome (SIDS)U.S. Target: 0.50 infant deaths per 1,000 live births
How Are We Doing?In New Jersey, there has been a 38% decline in the overall SIDS rate from 0.47 in 2000-2002 to 0.29 in 2014-2016. There has been a 50% decline in the SIDS rate for non-Hispanic Black infants from 1.2 in 2000-2002 to 0.6 in 2014-2016, while the rate among non-Hispanic White infants, although lower, has remained between 0.2 and 0.3.
While a rise in the use of safe infant sleep practices recommended by the American Academy of Pediatrics has been associated with declining rates of sudden infant death, compliance with these guidelines does not always predict a lower rate of sudden unexpected infant deaths (SUID).^1^ Social determinants such as poverty and access to healthcare, as well as smoking and preterm birth are examples of important risk factors as well. Racial disparity in these determinants is associated with disparity in the rates of SIDS and other sleep-related infant deaths, independent of safe sleep practices. For example, the preterm birth rate among Black infants in New Jersey is 46% higher than the rate among all other women. Prematurity is a major risk factor. For example, infants born between 24 and 27 weeks of gestation have over three times the risk for SUID compared to full term infants.[https://www.ncbi.nlm.nih.gov/pubmed/28759397 ^2^]
Compensatory behaviors and social determinants may play a role in reducing the impact of some risks. For example, in New Jersey, Asian Indians bed share the most, which is defined as a risk elevating behavior, but they have the lowest rate of sudden unexpected infant death.^3^ This paradoxical finding may reflect compensatory factors in this group such as a high level of supine sleep and less poverty, smoking, or alcohol use. According to the safe infant sleep guidelines, maternal fatigue makes bed sharing especially dangerous. Thus, the cultural practice among Asian Indians of closely involving grandparents in early child care may reduce maternal fatigue in this population. However, even in this low risk population group, reduced bed sharing further reduces risk, underscoring the importance of following safe infant sleep guidelines. It is therefore of note that, in contrast to a national rise in the percentage of infants who usually slept in a shared bed, particularly in families of Black infants[http://jamanetwork.com/journals/jamapediatrics/fullarticle/1746117 ^4^], New Jersey experienced a decline of 31.4%[http://www.nj.gov/health/fhs/maternalchild/outcomes/prams/ ^5^] in the usual use of bed-sharing in this population from 2003 to 2010, the period comparable to the national study.
How Do We Compare With the U.S.?New Jersey's 2014-2016 SIDS rate of 0.29 deaths per 1,000 live births falls below the national rate of 0.39.
What Is Being Done?In 1994, the "[http://pediatrics.aappublications.org/content/98/1/163.2 Back to Sleep]" campaign was enacted encouraging parents to place babies on their backs to sleep. This practice has been termed one of the seven most important research findings in pediatrics in the past 40 years and is associated with a reduction in SIDS and other sleep-related infant deaths such as accidental suffocation. This campaign was based on the evidence-based recommendations the American Academy of Pediatrics (AAP) began issuing in 1992 to reduce the risk of SIDS. Now termed the "[http://www.aappublications.org/content/33/12/18 Safe to Sleep]" campaign, the guidelines have expanded to address other risk factors and apply not only to SIDS but to other sleep-related infant deaths. All fall under the term Sudden Unexpected Infant Death (SUID). The guidelines are described in the Evidence-based Practices section below.
The SIDS Center of New Jersey (SCNJ) is funded in part through a health services grant from the New Jersey Department of Health and carries out the state's mandate to provide bereavement support, to study risk factors associated with SUID, and to provide multilingual and culturally, racially, and ethnically-sensitive risk-reducing education. The SCNJ collaborates with and serves the educational needs of physicians, nurses, social service and child care providers, health care systems, including hospitals and clinics, home visiting programs, maternal and child health consortia, licensing systems, social service organizations, first responders, government agencies, community groups, clergy, and educational institutions with allied public health missions. It identifies barriers to compliance and addresses these and is represented in national initiatives to promote safe sleep. Its 24 hour hotline is noted below. Its programs, materials, and services, also noted below, can be accessed via its website: [http://www.rwjms.rutgers.edu/sids/]
In addition to its long-standing programs and services, noted under Available Services, the SCNJ's newest initiatives include a [https://news.rutgers.edu/news/new-rutgers-app-seeks-reduce-infant-mortality/20180418 mobile phone app for safe sleep] and a public health initiative to address racial and ethnic disparities. The SCNJ has released a free safe sleep mobile phone app for Android and iPhone systems which can be accessed by placing the words "SIDS Info" into the search bar of the appropriate app store. The content is available in English and Spanish and contains voice-over to overcome challenges related to literacy. The SCNJ's app has received a Public Health Innovator Award from the New Jersey Department of Health. The app contains content for providers as well as the public. Hospitals and other provider systems are using the app as an efficient tool for reviewing safe sleep practices with parents. Providers are asked to then help parents download it to review at home and to share with family members and other caregivers.
Disparity in outcomes among racial/ethnic groups is associated in part with disparities in social determinants of health, including economic resources, access to healthcare, access to healthy food, lifespan health, smoking, prematurity, low birth weight, and neighborhood crime, as well as disparities in safe sleep practices. The SCNJ partnered with other public health and healthcare organizations in New Jersey to present a Black Infant Mortality Conference in June 2017 and provided testimony to the NJ State Senate Health Committee to bring greater awareness to the disparities in social determinants that contribute to disparities in infant mortality and to facilitate efforts to address these. In a related project, the SCNJ developed a Student Safe Sleep Ambassador program whereby students in high infant mortality communities learn about safe sleep and educate caregivers in their neighborhoods. The program has proven to be effective in increasing awareness.
Evidence-based PracticesThe most recent safe infant sleep guidelines were published by the American Academy of Pediatrics (AAP) in 2016 and include research conducted by the SIDS Center of New Jersey. The campaign describes the safest sleep environment for infants from birth to 12 months of age. In addition to placing infants on their backs to sleep, the guidelines recommend avoidance of an infant sharing a bed with a sleeping adult or child; avoidance of a sofa or chair for infant sleep; removal of loose bedding, pillows, quilts, soft objects, and bumpers from the infant's sleep area; use of a firm mattress that fits the crib space, is intended for the product, and is covered only with a tightly fitted sheet; avoidance of overheating the infant; and avoidance of exposure to tobacco smoke. In place of bed sharing, room sharing with the baby is advised so that the parent can be close by the infant. Breastfeeding is also recommended. While parents may bring the infant into bed for feeding and comforting, the AAP recommends that the infant be returned to the near-by crib, bassinet, portable crib, or play yard that meets current safety standards, once the parent is ready to sleep. These standards can be obtained from the Consumer Product Safety Commission ([https://www.cpsc.gov/Safety-Education/Safety-Education-Centers/cribs online] or 800-638-2772).
Parents should consider offering a pacifier but should wait one month if breastfeeding and should avoid the use of clips or strings to attach a pacifier to the infant's clothing as these pose a strangulation risk. Tummy time when the infant is awake and supervised is also recommended to facilitate motor development.
The AAP urges all caregivers to discuss these guidelines and any challenges to achieving them with their infant's health care providers. The policy statement can be accessed through the following link provided by the AAP: [http://pediatrics.aappublications.org/content/early/2016/10/20/peds.2016-2938].
Health Program InformationSIDS Center of New Jersey: [http://www.rwjms.rutgers.edu/sids/]
National Institutes of Health "Safe to Sleep" campaign: [http://www.nichd.nih.gov/sids/]
NJDOH SIDS information: [http://www.nj.gov/health/fhs/maternalchild/outcomes/]
NJ Department of Children and Families: [http://njsafesleep.com/main/]