P0424 - Caregiver Risk Factors Associated with Sudden Unexpected Infant Deaths

Background: Sudden unexpected infant death (SUID) refers to the unanticipated death of a previously healthy infant younger than 1 year old, lacking an obvious cause before investigation. The leading cause of death for infants, SUID includes sudden infant death syndrome (SIDS) and asphyxia from accidental suffocation and strangulation in bed (ASSB). ASSB deaths predominate, are largely preventable, and have been the focus of research, prevention programming and public health educational efforts targeting modifiable risk factors including hazards in the sleep environment. In contrast to environmental risk factors caregiver specific risk factors associated with SUID have been relatively understudied, including impact of psychosocial risk factors on SUID risk; prior studies have focused on young maternal age, limited educational and socioeconomic attainment as potentially contributory to sudden infant death. Little is known specifically about impact of caregiver psychosocial factors including family violence, mental health concerns, criminal and child protective services (CPS) history on SUID risk.

Methods: Case-specific data entered into a state-based SUID case registry system between 2015 and 2019 was retrospectively reviewed for environmental, infant and caregiver psychosocial characteristics. Investigative and clinical information from child welfare, law enforcement, medical, scene investigation and forensic autopsy sources was reviewed. Caregiver specific risk factors included household makeup, whether infant safe sleep education was provided prior to discharge from the infant’s birth hospital, whether toxicology screens were performed during death investigation, whether a home visiting nurse referral existed prior to infant death, and caregiver at time of death. Abstracted caregiver psychosocial variables included maternal and paternal substance use history, maternal and paternal criminal history, maternal and paternal intimate partner violence history and caregiver personal CPS history as a child.

Results: Among 44 included cases, 33 (75%) were classified as SUID, and 11 (25%) medical cause of death. Most infants had unsafe sleep risk factors present based on death scene investigation (n=36, 81.8%); unsafe sleep risk factors was substantially associated with SUID (aOR 18.36). Odds of SUID were substantially greater when maternal substance use (aOR 2.52) and paternal substance use (aOR 5.40) was identified, compared to no substance use. Infants referred to home visiting nursing had 15 times greater odds of SUID compared to non-referred infants (aOR 15.18).

Conclusions: Both environmental and caregiver psychosocial risk factors are associated with greater odds of SUID, suggesting targeted interventions are warranted to support families at risk and prevent SUID outcome. Contribution of psychosocial factors to assessment of SUID risk has been relatively understudied; while this study reflects results from a single jurisdiction, conclusions are potentially broadly generalizable. Universal assessment of psychosocial risk factors by pediatric medical providers and targeted community programming to address risk factors associated with SUID may aid in prevention efforts.