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Health Indicator Report of Sudden Unexpected Infant Death (SUID)

Even after a thorough investigation, it can be difficult to distinguish SIDS from other sleep-related infant deaths such as suffocation by soft bedding. This is because these deaths are often unwitnessed, and there are no tests to tell SIDS apart from suffocation. To complicate matters, people who investigate SUIDs may report cause of death in different ways and may not include enough information about the circumstances of the event from the death scene.[https://www.cdc.gov/sids/AboutSUIDandSIDS.htm ^1^]

Notes

Confidence limits are not available for the U.S. data.

Data Sources

  • Birth Certificate Database, Office of Vital Statistics and Registry, New Jersey Department of Health
  • Centers for Disease Control and Prevention, National Center for Health Statistics. Linked Birth/Infant Death Records, CDC WONDER On-line Database accessed at [http://wonder.cdc.gov/lbd.html]
  • Linked Infant Death-Birth Database, Center for Health Statistics, New Jersey Department of Health

Definition

Sudden unexpected infant deaths are those involving an infant less than 1 year of age that occur suddenly and unexpectedly, and whose cause of death is not immediately obvious before investigation. Following a thorough investigation by autopsy, death scene investigation, and review of medical history, a small portion of these deaths turn out to be due to an undetected medical cause. However, the majority of these deaths are finalized with one of the following '''ICD-10 codes: R95''' (Sudden Infant Death Syndrome or SIDS), '''R99''' (unknown cause), or '''W75''' (accidental suffocation and strangulation in bed). By definition, SIDS is a sudden and unexpected infant death for which no cause has been found following a thorough investigation. SIDS and the other sleep-related infant deaths are grouped under the term Sudden Unexpected Infant Death (SUID) and share common risk factors. They are the focus of the evidence-based safe sleep guidelines of the American Academy of Pediatrics and its goal of reducing all sleep-related infant deaths.

Numerator

Number of deaths in the first year of life with Sudden Unexpected Infant Death as the underlying cause of death

Denominator

Total number of live births in the same year

Healthy People Objective: Sudden unexpected infant deaths (includes SIDS, Unknown Cause, and Accidental Suffocation and Strangulation in Bed)

U.S. Target: 0.84 infant deaths per 1,000 live births

How Are We Doing?

In New Jersey, there was a 29% decline in the SUID rate from 0.68 in 2000-2002 to 0.48 in 2012-2014, however the rate rose in 2013-2015 and again in 2014-2016. An increase in national rates was also noted in this period. Through the state-mandated work of the [http://www.rwjms.rutgers.edu/sids/ SIDS Center of New Jersey] (SCNJ), New Jersey began disseminating safe sleep information in 1992 based on the publication of the first American Academy of Pediatrics guidelines in advance of the 1994 onset of the National Institute of Child Health and Human Development's "[http://pediatrics.aappublications.org/content/98/1/163.2 Back to Sleep]" campaign. Thus, by 1998, New Jersey's rate had already fallen to one the lowest in the U.S. 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).^2^ 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 ^3^] 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.^4^ 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 ^5^], New Jersey experienced a decline of 31.4%[http://www.nj.gov/health/fhs/maternalchild/outcomes/prams/ ^6^] 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 SUID rate of 0.6 deaths per 1,000 live births falls well below the national rate of 0.9 in 2014-2016. Based on the most recently available national data, New Jersey's SUID rates for infants of White, Black, or Hispanic mothers also are among the lowest in the U.S. However, as with infant deaths from any cause, the rate of SUID among infants of Black mothers is higher than for other racial/ethnic groups both nationally and in New Jersey. In 2014-2016, the New Jersey SUID rate among Blacks (1.6 per 1,000 live births) was more than triple the rate among Whites and Hispanics (0.5). The most recent year with national and state data available from the Centers for Disease Control (CDC WONDER) for the linked birth/infant death file is 2015. For 2013-2015, the SUID rate of 0.61 per 1,000 live births for New Jersey fell well below the national rate of 0.87 and placed it among the five states with the lowest rate. New Jersey's SUID rate of 0.49 per 1,000 live births among Whites was the second lowest reported in the U.S for this group. The SUID rate of 1.59 per 1,000 live births among Blacks was the sixth lowest of the 28 states with sufficient population for this group for calculation of a statistically reliable rate. New Jersey's SUID rate of 0.44 per 1,000 live births among Hispanics placed it among the three states with the second lowest rate for this population group, based on the 17 states with sufficient population for the calculation of a statistically reliable rate. The SUID count among Asians in New Jersey is too low for a reliable rate calculation for the 2013-2015 period. However, for the 2000-2015 period, its rate of 0.2 per 1,000 live birth was the lowest compared to the rates for White, Black, and Hispanic infants in that time period.

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 Practices

The 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].

Available Services

Sudden Infant Death Syndrome Center of New Jersey (SCNJ) Hotline: 800-545-7437[[br]] Mission: *Risk reduction and preventive education *Research *Bereavement support [[br]] Visit [http://www.rwjms.rutgers.edu/sids/] or call the hotline to obtain additional bereavement services; hospital Safe Sleep Tool Kits; the American Academy of Pediatrics safe infant sleep guidelines; and SIDS Center safe sleep flyers, videos, information on its free mobile phone app, and related material. Examples of SCNJ's educational programs are *Free mobile app *Nurses LEAD the Way, which is presented at birthing hospitals and has resulted in improvements in knowledge about safe sleep and in education policies and procedures related to the provision of this information to families, *Neighborhoods LEAD the Way, which reaches into communities at highest risk to address the challenges of racial disparity often in collaboration with local clergy, and *Presentations to the New Jersey [https://www.nj.gov/dcf/about/divisions/dcpp/ Division of Child Protection and Permanency]. [[br]] The SCNJ provides educational materials in English, Spanish, Arabic, Haitian Creole, and Hindi with other languages available as requested. Educational videos, hospital tool kits, webinars, and other message facilitating material are distributed and also available on the SCNJ website. In addressing the major risk of household smoke exposure, the SCNJ collaborated with [http://momsquit.com/ Mom's Quit Connection] to extend the penetration of knowledge and interventions. The SCNJ also targets specific groups of caregivers, such as grandparents, and works with faith-based communities to reach caregivers at community levels. The free SIDS Center of New Jersey [https://news.rutgers.edu/news/new-rutgers-app-seeks-reduce-infant-mortality/20180418#.W3WoAc5KiUm safe sleep mobile phone app] can be accessed through the app stores for Android and iPhones by typing "SIDS Info" into the search bar. To arrange an education program, call the hotline: 800-545-7437

Health Program Information

SIDS 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/]
Page Content Updated On 08/24/2018, Published on 08/24/2018
The information provided above is from the Department of Health's NJSHAD web site (https://nj.gov/health/shad). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Mon, 19 August 2019 0:37:38 from Department of Health, New Jersey State Health Assessment Data Web site: https://nj.gov/health/shad ".

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