1. Of the various mechanisms causing infant suffocation during sleep, soft bedding, overlaying, and wedging were the most commonly identified contributing factors, with soft bedding as the most common overall.
2. Regardless of mechanism, suffocation most often happened when the infant was sleeping in an adult bed.
Evidence Rating Level: 2 (Good)
Study Rundown: Suffocation is the leading cause of infant injury-related death in the United States, with rates of suffocation or strangulation in bed rising in recent years. In this study, researchers reviewed a registry of sudden unexpected infant deaths and identified those caused by suffocation. Of those identified, further review was completed to determine the specific mechanism of suffocation. Though suffocation as the cause of death was only identified in a small portion of the cases reviewed, soft bedding, overlaying (airway obstructed by rolling on top of or up against infant), and wedging (airway obstructed by being trapped against wall or inanimate object) were the 3 most common mechanisms of suffocation identified, with soft bedding as the most common mechanism. Regardless of mechanism, the most common sleep location associated with suffocation was an adult bed. In those deaths caused by suffocation from soft bedding, infants were most often found prone as opposed to supine or on their side. Though this study offers insight in the specific mechanisms of infant sleep-related death secondary to suffocation, it does little to unearth why such deaths are on the rise and leaves unanswered ways to prevent such deaths, aside from more targeted parental education.
In-Depth [retrospective cohort]: In this study, researchers used a Center for Disease Control Case Registry of Sudden Unexpected Infant Death, which includes deaths in children <1 year old from 2011 to 2014 in Arizona, Colorado, Georgia, Louisiana, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, and Wisconsin. Of the 1812 deaths in the registry, 250 (14%) were attributed to suffocation, while the others were classified as unexplained. Cases were assigned 1-2 mechanisms of suffocation, thus totaling 281 mechanisms for 250 cases. Soft bedding (N=190, 69%), overlay (N=51, 19%), and wedging (N=33, 12%) were the most commonly identified mechanisms of suffocation. The infant was found in prone position in 82% of cases caused by soft bedding. Among all mechanisms, sleeping in an adult bed was the most common location of the accident (49% for soft bedding, 71% for overlay, 73% for wedging).
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