Maternal and Child Health and Epidemiology Conference 2004
Synopsis of SIDS Related Sessions

Presentation Sessions

Presentation: Are Declines in Rates of Sudden Infant Death Syndrome due to a Shift in Diagnosis? By Carrie Florez, California Department of Health Services. cflorez@dhs.ca.gov

The aim of this study was to determine whether the decline in SIDS in California from 1999-2002 was due to a shift in diagnosis. The authors used California birth and death files from 1999-2002 to calculate cause-specific infant mortality rates. They compared rates of SIDS to deaths coded as:
• Other Ill-defined and Unspecified Causes of Mortality (R99)
• Unspecified Threat to Breathing (W84)
• Accidental Suffocation and Strangulation in Bed (W75)
• Hanging, Strangulation and Suffocation, Undetermined Intent (Y20)
• Unspecified Event, Undetermined Intent (Y34)

They concluded that SIDS rates declined between 1999 and 2002, but that deaths diagnosed as “undetermined (Y34)” have increased since 1999.

Combined rates of SIDS and undetermined cause-of-death showed a slight increase after 1999 and then a slow decline beginning in 2001. So, if one assumed all “undetermined” deaths were really SIDS, the rate would be decreasing, but at a slower rate. They concluded that the continued decline in the SIDS rate from 1999-2002, is in part due to a shift in diagnosis. The authors also interviewed county coroners/medical examiners to determine what may be causing a shift in diagnosis. They found that there was considerable variability in the criteria used for diagnosing SIDS and recommended that experts work with counties to improve the diagnosis of SIDS. They also felt that the impact of not receiving reimbursements for the death scene investigations and autopsies should be investigated.

Finally, they felt that the issue of entitlement to special services be addressed since families with an infant death due to SIDS receive these services while families experiencing an infant death not due to SIDS are not given these services.

The California results are similar to our results (CDC- Shapiro-Mendoza CK, Tomashek K, Anderson RN) that we presented this June at the Seventeenth Annual Meeting of the Society for Pediatric and Perinatal Epidemiologic Research (SPER), Salt Lake City, Utah. Using national data of birth linked files from 1989-2001, we found that the greatest decline in SIDS occurred after the initiation of the Back to Sleep Campaign from 1995-1998, but that the decline from 1999-2001 was offset by increasing rates of unknown cause-of death and accidental suffocation and strangulation in bed.

Presentation: Health Departments Do It Better: Prenatal Care Site and Prone Infant Sleep Position by Martin Lahr, MD, Oregon Department of Health Services martin.b.lahr@state.or.us

The authors used PRAMS data from Oregon 1998-1999 to determine the association between prone sleeping and place prenatal care received. The authors found that in Oregon, women who received prenatal care from private physicians or HMOs were less likely to place their babies on their backs for sleeping than those who received prenatal care/advice from their health department clinic. They concluded that health departments communicate the back-to-sleep message better than private prenatal care providers. Women receiving prenatal care from private physicians or HMOs more often chose prone position (10.6%) compared to those attending health department clinics (2.5%) hospital clinics (6.1%) and other sites (8.3%).

Presentation: Assessment of Well Baby Nursery Sleeping Position Policies, Practices,and Discharge Teaching Related to Sudden Infant Death Syndrome (SIDS) in Louisiana Birthing Hospitals, 2003
by Tracy Hubbard, Lousianna Office of Public Health, thubbard@dhh.la.gov

The authors surveyed hospitals in Louisiana to determine variations in SIDS parent education discharge practices. They found wide variation in SIDS education and infant sleep position practices in urban and rural hospitals. They found little difference between private and public hospitals' practices. •36% of urban hospitals placed infants on either the back and side compared to 35% of rural hospitals •57% of urban hospitals placed infants on the back only compared to 19% of rural hospitals •Side only was 7% in urban compared to 42% in rural hospitals •And 1 rural hospital placed infants on the stomach and side

Presentation: SIDS Beliefs and Practices among Black, Non-Hispanic Mothers, Fathers, and Caregivers in New York City.
by Katrina Manzano, New York City Department of Health and Hygiene kmanzano@health.nyc.gov

A survey of NYC households in 2003 found that 36% of Black non-Hispanics reported they most often put their babies to sleep on their stomach, compared to 11% of other respondents. Based on this, the authors conducted six SIDS focus groups to assist in the development of culturally appropriate SIDS education materials and an outreach campaign for African-American mothers, fathers and older caregivers. They found that the message should be targeted toward mothers and caregivers and that SIDS education should be provided in hospitals and in the period immediately after discharge. SIDS education should be “less abstract and distant” for parents/caregivers and should address the infant comfort issue and fear of choking when placed in supine position. They also concluded that trusted “insiders” such as peers, role models, and community members should be involved in educating the target population.

Poster Sessions

Abstract: Co-sleeping Mothers More Compliant with Back to Sleep Recommendations
by Martin Lahr, MD. Oregon Department of Health Services martin.b.lahr@state.or.us

Using PRAMS data from 1998-1999, 9.2% of the over 1,700 respondents said they usually chose prone sleep, while 24.2% chose side and 66.5 chose back. Co-sleeping/bed-sharing was common with 42.6% almost always or always co-slept. Never co-sleeping with ones infant was a significant predictor of prone position. 13.5% of these women chose prone position, while women who sometimes co-slept chose the prone position 9.1% of the time, and those almost always or always co-sleeping between 5.7 and 6.1%. Co-sleeping mothers were more likely to follow back to sleep recommendations. Non-co-sleeping women may be seeking uninterrupted sleep, as prone position is associated with fewer infant awakenings – or other research suggests “infant being in comfortable/ nurtured position” may be more of a concern for those not sleeping with their infants. Given popularity of co-sleeping, additional instruction in addition to the back to sleep message may be important to ensure infant safety.

Abstract: The Association between Maternal Smoking and Infant Mortality in South Carolina, 1999 – 2001 by Joanna Yoon, South Carolina DHEC, yoonj@dhec.sc.gov

Live birth data for years 1999-2001 were linked with infant death data. Mothers who smoked during pregnancy had a higher risk of infant mortality than did mothers who did not smoke regardless of race. There was a significant association between maternal smoking and deaths due to SIDS and accidents.

Abstract: Paternal Contact with Law Enforcement in San Bernardino and Death of an Infant from SIDS (Case Control Study) by Oluwatoyin Akinpelu, MPH

Based on precious studies California birth cohort data was analyzed to identify associations between prior contact of fathers with law enforcement in San Bernardino CA and subsequent deaths from SIDS. Data on 152 SIDS deaths and 304 matched controls were used for the study. A significant association was found between SIDS infant deaths and 16 forms of parental contact with law enforcement before death. 62 cases of SIDS deaths, and 72 cases in the controls had at least one form of parental contact with law enforcement. Infants of these fathers were twice at risk of dying of SIDS than those with no contact. If fathers were arrested for a health or safety code violation, his infant had four times risk of dying from SIDS than unarrested father. The risk was three times higher if the father was suspected of a vehicular code violation. Finding suggest that infants whose fathers have had certain contact with law enforcement prior to their birth are at a higher risk of dying from SIDS.