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More infants dying from accidental suffocation and strangulation in bed

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Infant mortality attributed to accidental suffocation and strangulation in bed has quadrupled over the last two decades, investigators at the US Centers for Disease Control and Prevention report. Recent data indicate that most such deaths occurred in the context of sharing a bed, and the most common mechanism was another individual rolling on top of the infant.

“Accidental suffocation and strangulation in bed includes suffocation by (1) soft bedding, pillow, or waterbed mattress, (2) overlaying or rolling on top of or against infant while sleeping, or (3) wedging and entrapment of an infant between 2 objects such as a mattress and wall, bed frame, or furniture; and strangulation by asphyxiation, such as when an infant’s head and neck become caught between crib railings,” the researchers explain in the February issue of Pediatrics.

Dr. Carrie K. Shapiro-Mendoza and her team obtained National Vital Statistics data for sudden unexplained infant deaths for 1984-2004. They also examined written text from death certificates for 2003 and 2004 cases of accidental suffocation and strangulation.

Infant mortality due to accidental suffocation and strangulation in bed increased during the study period from 2.8 to 12.5 deaths per 100,000 live births. The most striking increase occurred between 1996 and 2004, when rates rose by an average of 14% annually, offsetting the annual 4% decline in mortality due to sudden infant death syndrome.

Data from 2002-2004 for accidental strangulation and suffocation deaths suggest that rates were higher among black infants compared with white infants (27.3 vs 8.5 deaths per 100,000 live births, respectively) and for boys versus girls (12.5 vs 9.6 per 100,000, respectively). Nearly three quarters of deaths occurred during the first 3 months of life.

The most commonly reported mechanisms of suffocation were overlay (33.8%), wedging or entrapment (14.2%), and suffocation by bedding materials (13.8%). Infants were more likely to die while lying on a bed or couch or in a crib than in a car seat or playpen.

“Cosleeping or bed sharing was reported in 53.3% of the cases,” the authors add.

Dr. Shapiro-Mendoza and her colleagues acknowledge that the observed trends could be partially related to changes in classification, investigation, and reporting of sudden unexplained infant deaths.

“A national sudden unexplained infant death surveillance system that captures standardized and consistent information from the death-scene investigation and autopsy” would help define what constitutes a dangerous environment and inform caregivers about how to keep infants safe, the authors say.

Pediatrics 2009;123:533-539.