Published online July 1, 2005
PEDIATRICS Vol. 116 No. 1 July 2005, pp. e13-e20 (doi:10.1542/peds.2004-2333)
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ELECTRONIC ARTICLE

Risk Factors Associated With Sudden Unexplained Infant Death: A Prospective Study of Infant Care Practices in Kentucky

Lisa B. E. Shields, MD*,{ddagger}, Donna M. Hunsaker, MD*,{ddagger}, Susan Muldoon, PhD§, Tracey S. Corey, MD*,{ddagger} and Betty S. Spivack, MD*,{ddagger}

* Office of the Chief Medical Examiner, Louisville, Kentucky
{ddagger} Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, Kentucky
§ Department of Epidemiology and Clinical Investigation Sciences, School of Public Health/Health Information Sciences, University of Louisville, Louisville, Kentucky

Objective. To ascertain the prevalence of infant care practices in a metropolitan community in the United States with attention to feeding routines and modifiable risk factors associated with sudden unexplained infant death (specifically, prone sleeping position, bed sharing, and maternal smoking).

Methods. We conducted an initial face-to-face meeting followed by a telephone survey of 189 women who gave birth at a level I hospital in Kentucky between October 14 and November 10, 2002, and whose infants were placed in the well-infant nursery. The survey, composed of questions pertaining to infant care practices, was addressed to the women at 1 and 6 months postpartum.

Results. A total of 185 (93.9%) women participated in the survey at 1 month, and 147 (75.1%) mothers contributed at 6 months. The racial/ethnic composition of the study was 56.1% white, 30.2% black, and 16.4% biracial, Asian, or Hispanic. More than half of the infants (50.8%) shared the same bed with their mother at 1 month, which dramatically decreased to 17.7% at 6 months. Bed sharing was significantly more common among black families compared with white families at both 1 month (adjusted odds ratio [OR]: 5.94; 95% confidence interval [CI]: 2.71–13.02) and 6 months (adjusted OR: 5.43; 95% CI: 2.05–14.35). Compared with other races, white parents were more likely to place their infants on their back before sleep at both 1 and 6 months. Black parents were significantly less likely to place their infants on their back at 6 months compared with white parents (adjusted OR: 0.14; 95% CI: 0.06–0.33). One infant succumbed to sudden infant death syndrome at 3 months of age, and another infant died suddenly and unexpectedly at 9 months of age. Both were bed sharing specifically with 1 adult in the former and with 2 children in the latter.

Conclusions. Bed sharing and prone placement were more common among black infants. Breastfeeding was infrequent in all races. This prospective study additionally offers a unique perspective into the risk factors associated with sudden infant death syndrome and sudden unexplained infant death associated with bed sharing by examining the survey responses of 2 mothers before the death of their infants combined with a complete postmortem examination, scene analysis, and historical investigation.

Key Words: sudden infant death syndrome • infant care practices • bed sharing • feeding • smoking

Abbreviations: SIDS, sudden infant death syndrome • OR, odds ratio • CI, confidence interval • SUID, sudden unexplained infant death

Accepted Feb 20, 2005.