Risk Factors for Sleep-Related Infant Deaths in In-Home and Out-of-Home Settings

• Published in: Pediatrics (Evanston) Vol. 138; no. 5
• Main Authors: Kassa, Hilina, Moon, Rachel Y, Colvin, Jeffrey D
• Format: Journal Article
• Language: English
• Published: United States 01.11.2016
• Subjects: Beds; Cause of Death; Cross-Sectional Studies; Databases, Factual; Environment; Female; Humans; Infant; Infant, Newborn; Logistic Models; Male; Odds Ratio; Prevalence; Prone Position; Retrospective Studies; Risk Assessment; Sleep - physiology; Sudden Infant Death - epidemiology; Sudden Infant Death - etiology; Supine Position; United States
• ISSN: 1098-4275
• DOI: 10.1542/peds.2016-1124

Multiple environmental risk factors are associated with sleep-related infant deaths. Little is known about differences in risk factors for deaths occurring in-home and out-of-home. We sought to compare risk factors for in-home and out-of-home infant deaths. We conducted a cross-sectional analysis of sleep-related infant deaths from 2004 to 2014 in the National Child Fatality Review and Prevention database. The main exposure was setting (in-home versus out-of-home) at time of death. Primary outcomes were known risk factors: sleep position, sleep location (eg, crib), objects in the environment, and bed sharing. Risk factors for in-home versus out-of-home deaths were compared using the χ test and multivariate logistic regressions. A total of 11 717 deaths were analyzed. Infants who died out-of-home were more likely to be in a stroller/car seat (adjusted odds ratio, 2.6; 95% confidence interval, 2.1–3.4; P < .001) and other locations (adjusted odds ratio, 1.9; 95% confidence interval, 1.5–2.3; P < .001), and placed prone (adjusted odds ratio, 1.18; 95% confidence interval, 1.05–1.32; P < .01. There were no differences in sleeping on a couch/chair or objects in the sleep environment. Sleep-related infant deaths in the out-of-home setting have higher odds of having certain risk factors, such as prone placement for sleep and location in a stroller/car seat, rather than in a crib/bassinet. Caregivers should be educated on the importance of placing infants to sleep supine in cribs/bassinets to protect against sleep-related deaths, both in and out of the home.