Division of Children's Medical Services, Florida Department of Health, Tallahassee, Florida, USA
Independent Statistical Consultant, Tallahassee, Florida, USA.
BMJ Open. 2022 Sep 14;12(9):e059745. doi: 10.1136/bmjopen-2021-059745.
To examine the characteristics and circumstances of infants who died while sleeping or in a sleep environment and compare deaths classified as either unintentional asphyxia or an unexplained cause.
A retrospective cohort study.
Data were extracted from the National Fatality Review Case Reporting System and Florida Vital Statistics databases.
Data on 778 sleep-related infant deaths occurring from 2014 to 2018 in Florida were analysed.
Cause of death classification as unintentional asphyxia or unexplained.
Overall, 36% (n=276) of sleep-related infant deaths in this study sample were classified as resulting from an unexplained cause compared with unintentional asphyxia. Most infants were reported to be in an adult bed (60%; n=464) and sharing a sleep surface with a person or animal (60%; n=468); less than half (44%; n=343) were reportedly placed to sleep on their back. After controlling for the influence of other independent variables, female sex (adjusted risk ratio: 1.36; 95% CI 1.06 to 1.74) and fully obstructed airway condition (adjusted risk ratio: 0.30; 95% CI 0.18 to 0.50) were associated with an unexplained cause of death.
The results of this analysis indicate that sleep environment hazards remain prevalent among infants who die suddenly and unexpectedly, regardless of the cause of death determination. While significant differences were observed for some factors, in many others the distributions of both demographic and incident characteristics were similar between unexplained deaths and those resulting from asphyxia. The results of this study support growing evidence that unsafe sleep environments contribute to all forms of sudden unexpected infant death, underscoring the need for standardising cause of death determination practices and promoting consistent, high-quality forensic investigations to accurately explain, monitor and prevent these deaths.
研究在睡眠或睡眠环境中死亡的婴儿的特征和情况，并比较归类为意外窒息或不明原因的死亡。
回顾性队列研究。
数据取自国家死亡审查案例报告系统和佛罗里达州生命统计数据库。
分析了 2014 年至 2018 年期间佛罗里达州发生的 778 例与睡眠相关的婴儿死亡数据。
死亡原因分类为意外窒息或不明原因。
总体而言，本研究样本中 36%（n=276）的与睡眠相关的婴儿死亡被归类为不明原因导致，而非意外窒息。大多数婴儿被报告睡在成人床上（60%；n=464），与他人或动物睡在同一张床上（60%；n=468）；不到一半（44%；n=343）被报告以仰卧姿势入睡。在控制其他独立变量的影响后，女性（调整风险比：1.36；95%CI 1.06 至 1.74）和完全阻塞气道状态（调整风险比：0.30；95%CI 0.18 至 0.50）与不明原因死亡相关。
该分析结果表明，无论死因确定如何，睡眠环境危害仍然普遍存在于突然和意外死亡的婴儿中。虽然某些因素存在显著差异，但在许多其他因素中，不明原因死亡和窒息导致的死亡在人口统计学和事件特征方面的分布相似。本研究结果支持越来越多的证据表明，不安全的睡眠环境会导致所有形式的婴儿突然意外死亡，强调需要规范死因确定做法，并促进一致、高质量的法医调查，以准确解释、监测和预防这些死亡。
