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180124 Evaluating sudden infant death classification and capturing all deaths with sleep-related factors (SRF): Results from NYC

Monday, October 27, 2008: 9:30 AM

Lindsay Senter, MPH , Bureau of Maternal, Infant and Reproductive Health, NYC Department of Health and Mental Hygiene, New York, NY
Judith Sackoff, PhD , Bureau of Maternal, Infant and Reproductive Health, NYC Department of Health and Mental Hygiene, New York, NY
Kristen Landi, MD , Office of Chief Medical Examiner, City of New York, New York, NY
Lorraine Boyd, MD, MPH , Bureau of Maternal, Infant and Reproductive Health, NYC Department of Health and Mental Hygiene, New York, NY
Background: Sudden and unexpected infant deaths are largely preventable and of public health importance. Classifying these deaths is challenging and varies across jurisdictions; with certification including unintentional injury (asphyxia), SIDS or undetermined.

Objective: Investigate sudden infant death certification protocols in NYC; describe how unsafe sleeping environments (bedsharing, sleeping prone) contributed to these deaths; demonstrate how all deaths with sleep-related factors (SRF) were captured.

Methods: To examine the diagnostic shift in classification, death rates for SIDS and injury over 1996-2006 were compared. In-depth analysis of medical examiner data for unintentional injury and undetermined deaths, 2000-2003, was conducted to better understand the role of SRFs. SIDS, no longer certified in NYC if events such as SRFs are present, was excluded.

Results: Between 1996-2006, SIDS mortality rates declined by 84% (50.4 to 8.0/100,000 live births) and increased 93% for injury (26.8 to 51.8/100,000). This shift was due in part to improved death scene investigations and standardized certification definitions in NYC. 71% of the unintentional asphyxia and undetermined deaths, 2000-2003, had SRFs (death rate: 17.9/100,000). By analyzing the undetermined category, and not just asphyxia deaths, the number of SRF deaths increased three-fold. Black infants and infants born to mothers under 20 had higher SRF death rates, 40.7/100,000 and 61.1/100,000, respectively. Bedsharing was the most common SRF (65%); 75% of non-bedsharing infants were found prone.

Conclusions: To advance the study of SRF deaths and promote consistency in the literature, researchers must identify local certification protocols and develop standard criteria for categorizing infant deaths.

Learning Objectives:
1) Present a methodological approach to investigating sudden and unexpected infant deaths in NYC 2) Identify the NYC deaths which occurred in unsafe sleeping environments and describe their demographic and sleep-related factors (SRF). 3)Discuss how the lack of consistency in infant death certification and in the literature has led to unreliable estimates, interfering with a full understanding of deaths with SRF.

Keywords: Infant Mortality, Injury

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Research Scientist trained in Maternal and Child Health Epidemiology and working on local infant mortality research for the NYC Health Department. I have supervised an infant mortality case review of infant deaths in NYC and regularly conduct research using vital records and medical examiner data. I have been in this position for nearly three years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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