385 - Reducing unexplained Sudden Unexpected Infant Death (SUID) in the US. A different public health approach to tackle the risk of hazardous bed-sharing.

Publication Number: 385.6206

Peter S. Blair, University of Bristol, Bristol, England, United Kingdom

Background: After the welcome and dramatic 40% decline of unexplained Sudden Unexpected Infant Deaths (SUID) in the 1990s the SUID mortality rate in the US has slightly risen in the last two decades from 0.94 per 1000 live births in 2000 to 1.01 deaths in 2022. This is in contrast with other Western countries, including England and Wales, where the initial 60% fall after the ‘Back to Sleep’ campaign in the 1990s has been followed by a further 50% decline from 0.61deaths per 1000 live births in 2000 to 0.30 deaths in 2021. One of the major risk factors is hazardous bed-sharing and the risk-reduction approach taken in the UK (acknowledging bed-sharing happens) rather than the risk-elimination approach taken in the US (advising against bed-sharing) may have played a role.

Objective: To set out the evidence behind the risk-reduction approach in the UK and why this may have led to better engagement with the at-risk population.

Design/Methods: Using combined data of 400 unexplained SUID and 1036 age-matched surviving control infants from two prospective English population-based case-control studies conducted in 1993-6 and 2003-6 and national data from 124 unexplained SUID in 2020.

Results: From the combined data over a third of the unexplained SUID infants (36%) were found co-sleeping with an adult at the time of death compared to 15% of control infants after the reference sleep (multivariate OR=3.9 [95% CI: 2.7–5.6]). The multivariable risk associated with co-sleeping on a sofa (OR=18.3 [95% CI: 7.1–47.4]) or next to a parent who drank more than two units of alcohol (OR = 18.3 [95% CI: 7.7–43.5]) was very high. The risk associated with co-sleeping next to someone who smoked was also significant (OR=4.04 [2.41–6.75]). The multivariable risk associated with bed-sharing in the absence of these hazards was not significant (OR = 1.1 [95% CI: 0.6–2.0]). Data from 2020 show that just over half (51.6%) of the unexplained SUID infants were found co-sleeping and at least one hazard was present in 90% of these deaths.
Based on this evidence our approach (supported by UNICEF UK) is to acknowledge (taking a non-judgement approach) that bed-sharing happens whether intentional or not, allowing us to engage in a conversation as to when it would be inappropriate to bed-share. This also allows for recently-developed targeted intervention tools to be used to increase awareness and safety.

Conclusion(s): There could be several reasons as to why the US unexplained SUDI rates have not fallen in the last two decades but taking a different approach to public health advice on such a widespread infant care practice may reduce deaths further.