Rate of Infant Mortality Due to Accidental Suffocation and Strangulation Rises

According to a new study the rates of infant mortality due to accidental suffocation and strangulation in bed (ASSB) have quadrupled in the last two decades with the most significant increase seen after 1996.

The report published in the February edition of Pediatrics said the rate of sudden infant death syndrome (SIDS) declined over the same period while the rate of sudden, unexpected infant deaths remained stagnant. What seems like a contradiction in the increase and decrease of deaths of infants are possibly due to the way these are investigated as well as classified said researcher Carrie K. Shapiro-Mendoza, PhD, MPH, from the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

She feels a reason for the decline in SIDS cases could be the national "back to sleep" campaign that, among other things, urges parents to put babies to sleep on their backs. She however is not so sure of why there is a sharp increase in accidental suffocation and strangulation in bed, or ASSB, a subgroup of SUIDs. "It's probably due to poor bedding, blankets in cribs, sleeping with parents or siblings, or bad habits. Or infants getting wedged between the mattress and the wall."

SUIDs include all deaths which are attributed to accidental suffocation and strangulation, SIDS and other unknown causes.

Shapiro-Mendoza reported that between 1984 and 2004 infant deaths attributed to ASSB increased from 2.8 to 12.5 deaths per 100,000 live births. The largest increase of 14 % yearly average was seen between the years of 1996 and 2004 while the mortality rate due to SIDS showed a decline over the same period. This researcher's feel could be due to the changes in the way that SIDS is classified and reported, specifically since 1996.

The report also highlighted that infant mortality attributable to ASSB was highest among infants younger than 3 months, and most cases occurred at 1 month of age. Researchers also noted that deaths occurred more frequently from Sunday through Wednesday compared with Thursday through Saturday. Black males who were younger than 4 months were disproportionately affected by accidental suffocation and strangulation, found the report.

The researchers said that although the overall reason for the increase in ASSB rates is unclear, these deaths are preventable and efforts should be made to target high risk populations and provide caregivers advice on safer sleeping environments.

The CDC in order to improve and standardize the quality of data collection at infant death-scene investigations and promote a more informed assignment of cause-of-death classification released 1996 Sudden Unexplained Infant Death Investigation Report Form guidelines.

The study examined death trends before and after the guidelines and the researchers reported that, "Recent evidence showed that the decline in SIDS, from 1998 through 2001, was offset by an increase in ASSB and 'cause unknown' deaths, suggesting that there has been a change in the way these Sudden Unexplained Infant Deaths [SUIDs] are classified and reported. Researchers need improved scientific knowledge and understanding about the epidemiology of ASSB deaths so that preventive interventions can be effectively designed."

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