PC3034: Richmond Child Safety Collaboration – Curbing Sleep-related Infant Deaths in Virginia

Background: After natural disease, sleep-related infant death (SRID) is the leading cause of infant mortality in Virginia. In 2014, Virginia’s State Child Fatality Review Team (VSCFRT) analyzed all infant deaths in 2009 that occurred in the sleep environment. Findings included the preventable nature of these deaths and need for safe sleep messaging to families. The Richmond Child Safety Collaboration (RCSC) is an organization that mobilizes medical students for community outreach. As SRID is highly preventable, RCSC designed a safe sleep curriculum to be used in healthcare and community settings.

Methods: VSCFRT reviewed deaths where an infant died in the sleep environment in 2009. Cause of death was determined by the Virginia Office of the Chief Medical Examiner. Inclusion criteria: Infants (0-364 days), death between Jan 1, 2009-Dec 31, 2009, infants who died or were found unresponsive when sleeping, death was unexpected and not due to trauma, violence, or pre-existing medical condition, cause of death was SIDS, SUIDS, undetermined (while asleep, no anatomical/pathological cause after autopsy) or asphyxia (suffocation or wedging while asleep). Risk factors analyzed: Male sex, Black race, Native American ethnicity, prematurity, low birth weight, maternal age, prenatal care, maternal substance use during pregnancy, exposure to environmental tobacco, prone/side sleep, sleep surface, co-sleeping. VSCFRT extracted and reviewed available data from child, parental/caregiver, medical, first responder and social service records. Descriptive analyses were performed and compared among SRID cases. RCSC used the report’s findings to create a safe-sleep curriculum to be used as an educational tool.

Results: Of the 119 infants who died, 95% of deaths were preventable and 90% were related to sleep environment. Approximately one infant every three days died while asleep. Most at risk group was Black males ages 2-4 months. Leading risk factors included: soft sleep surface, environmental tobacco exposure, co-sleeping, prone sleeping. 75% of families who experienced SRID had access or bassinet or crib and 72% had seen a pediatrician in the 30 days preceding death.

Conclusion: SRID is preventable yet remains a major threat to infants in Virginia. It is not due to lack of access to safe sleep environment, but rather lack of proper safe sleep practices among caregivers. Physicians are critical partners in safe sleep education. RCSC created an evidence-based safe sleep curriculum using the VSCFRT report and AAP guidelines. As medical students are uniquely suited to serve as public health educators, the curriculum has been taught at Richmond Redevelopment and Housing Authority events and in pediatric clinics. RCSC aims to ultimately implement our curriculum within Richmond Public School health classes.