TABLE 3.
Associations Between Sleep Environment Characteristics and Sudden Unexpected Infant Death Outcomes; Sudden Unexpected Infant Death Case Registry and Pregnancy Risk Assessment Monitoring System (PRAMS), 2016 to 2017
| Sleep-Related Suffocationb |
Unexplained Infant Deathc |
|||||||
|---|---|---|---|---|---|---|---|---|
| Controls, (N = 448) (%) | Cases, (N = 112) (%) | Crude Exposure Odds Ratio, (95% CI) | Adjusted Exposure Odds Ratioa, (95% CI) | Controls, (N = 1200) (%) | Cases, (N = 300) (%) | Crude Exposure Odds Ratio, (95% CI) | Adjusted Exposure Odds Ratioa, (95% CI) | |
| Sleep position | ||||||||
| On back | 76.1 | 51.8 | Reference | Reference | 77.5 | 63.7 | Reference | Reference |
| Not on back | 21.0 | 45.5 | 3.2 (2.1–4.9) | 1.9 (0.9–4.1) | 18.1 | 32.7 | 2.2 (1.7–2.9) | 1.6 (1.1–2.4) |
| Soft bedding use | ||||||||
| No | 45.8 | 9.8 | Reference | Reference | 42.9 | 14.0 | Reference | Reference |
| Yes | 50.0 | 89.3 | 8.3 (4.3–15.9) | 16.3 (5.0–53.3) | 51.3 | 83.7 | 5.0 (3.5–7.1) | 5.0 (3.2–8.0) |
| Sleep surface | ||||||||
| Crib, bassinet, or portable crib | 33.3 | 15.2 | Reference | Reference | 32.8 | 27.3 | Reference | Reference |
| Not in a crib, bassinet, or portable crib | 62.3 | 84.8 | 3.0 (1.7–5.2) | 3.9 (1.4–10.4) | 62.1 | 72.0 | 1.4 (1.1–1.8) | 1.0 (0.7–1.6) |
| Room sharing with a caregiver | ||||||||
| Yes | 79.9 | 65.2 | Reference | Reference | 75.8 | 65.7 | Reference | Reference |
| No | 16.1 | 33.9 | 2.6 (1.6–4.1) | 18.7 (6.8–51.3) | 19.4 | 31.3 | 1.9 (1.4–2.5) | 7.6 (4.7–12.2) |
| Surface sharingd | ||||||||
| No | 59.8 | 43.8 | Reference | Reference | 59.5 | 44.7 | Reference | Reference |
| Yes | 37.5 | 55.4 | 2.0 (1.3–3.1) | 2.5 (1.1–6.0) | 36.5 | 54.0 | 2.0 (1.5–2.6) | 2.1 (1.4–3.2) |
Missing proportions were <5% for all predictors.
Adjusted for all other listed sleep practices, infant age at the time of survey or death, gestational age at birth, infant sex, plurality, season of survey or death, race or ethnicity, ever breastfed, maternal age, insurance, number of live births, maternal smoking, use of prenatal care.
Cases categorized as sleep-related suffocation per the Sudden Unexpected Infant Death Case Registry classification system: complete scene investigation and autopsy information with strong evidence of suffocation (eg, report of full obstruction of nose and mouth or external compression of the neck or chest) together with a reliable, nonconflicting witness account and no potentially fatal findings or other concerning medical conditions.
Cases categorized into 1 of 3 unexplained infant death groups per the Sudden Unexpected Infant Death Case Registry classification system: (1) no unsafe sleep factors (sudden deaths with complete scene investigation and autopsy information with no unsafe factors documented in the sleep environment); (2) unsafe sleep factors (sudden deaths with complete scene investigation and autopsy information that could not be explained with documentation of unsafe factors in the sleep environment); or (3) possible suffocation with unsafe sleep factors (sudden deaths with complete scene investigation and autopsy information with documented unsafe factors in the sleep environment and evidence of airway obstruction, but lacking all criteria for strong evidence of suffocation).
Among those sharing a sleep surface, only 3 were sharing with an animal, and the rest were sharing with another person.