Macdonald M, Thompson D, Perry R, Brooks R. Comparing asphyxia and unexplained causes of death: a retrospective cohort analysis of sleep-related infant death cases from a state child fatality review programme.
BMJ Open 2022;
12:e059745. [PMID:
36104144 PMCID:
PMC9476159 DOI:
10.1136/bmjopen-2021-059745]
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Abstract
OBJECTIVES
To examine the characteristics and circumstances of infants who died while sleeping or in a sleep environment and compare deaths classified as either unintentional asphyxia or an unexplained cause.
DESIGN
A retrospective cohort study.
SETTING
Data were extracted from the National Fatality Review Case Reporting System and Florida Vital Statistics databases.
PARTICIPANTS
Data on 778 sleep-related infant deaths occurring from 2014 to 2018 in Florida were analysed.
PRIMARY OUTCOME MEASURE
Cause of death classification as unintentional asphyxia or unexplained.
RESULTS
Overall, 36% (n=276) of sleep-related infant deaths in this study sample were classified as resulting from an unexplained cause compared with unintentional asphyxia. Most infants were reported to be in an adult bed (60%; n=464) and sharing a sleep surface with a person or animal (60%; n=468); less than half (44%; n=343) were reportedly placed to sleep on their back. After controlling for the influence of other independent variables, female sex (adjusted risk ratio: 1.36; 95% CI 1.06 to 1.74) and fully obstructed airway condition (adjusted risk ratio: 0.30; 95% CI 0.18 to 0.50) were associated with an unexplained cause of death.
CONCLUSIONS
The results of this analysis indicate that sleep environment hazards remain prevalent among infants who die suddenly and unexpectedly, regardless of the cause of death determination. While significant differences were observed for some factors, in many others the distributions of both demographic and incident characteristics were similar between unexplained deaths and those resulting from asphyxia. The results of this study support growing evidence that unsafe sleep environments contribute to all forms of sudden unexpected infant death, underscoring the need for standardising cause of death determination practices and promoting consistent, high-quality forensic investigations to accurately explain, monitor and prevent these deaths.
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