Exploring contextual risks for infant sleep-related injury deaths in New York city, 2004-2010

Background: Sleep-related infant injuries are the second leading cause of post-neonatal death in New York City (NYC) where death scene investigations are routinely conducted. This study examines contextual circumstances that may have contributed to infants' sleeping on an unsafe sleep surface or bed sharing even though a crib or bassinet was in the home at the time of death.

Methods: Retrospective review of 122 death-scene investigations in NYC from 2004-2010 infants <1 year of age with the ICD-10 codes encompassing asphyxia and undetermined injuries where a crib or bassinet was identified. Analysis of autopsy reports, police reports, and medico-legal investigator notes identified factors that may have contributed to the crib or bassinet not being used.

Results: Known risk factors for infant asphyxia and suffocation were identified; 74% of infants (n=344) were found on an unsafe sleep surface, including adult beds, couches and car seats (n=255). In 48% of these cases (n=122), a crib or bassinet was in the home. Qualitative findings identified environmental threats (e.g., lack of space, vermin infestation, room temperature), and families' knowledge and behavior about suffocation deaths (e.g., parents' fear of cribs as a cause of “crib death”) as reasons why the crib was not being used.

Conclusion: Infants are at risk of death from sleep related infant injuries even when a crib or bassinet is present. Understanding the environmental factors and living conditions that may contribute to infants sleeping on an unsafe surface or bed sharing can help maternal child health professionals develop more appropriate interventions.