CNN
—
Every year, thousands of babies die suddenly and unexpectedly, and more than 3,300 young lives were lost in 2020. Rates have remained stubbornly high in the first year of the Covid-19 pandemic, even as overall infant mortality has dropped to a record low.
A study published Monday in the journal Pediatrics found that the rate of black babies in particular had increased, widening an already stark disparity.
About 1 in 6 infant deaths was considered Sudden Unexpected Infant Death Syndrome, or SUID, a broad classification of deaths that includes Sudden Infant Death Syndrome, known as SIDS, as well as suffocation and strangulation accidental in bed and other unknown causes.
While the SUID rate for white babies fell to the lowest since 2017, the rate for black babies in 2020 was the highest since then. Rates that were already about twice as high for black babies in 2017 have become nearly three times as high in 2020, the study found.
Sharyn Parks Brown, an epidemiologist with the Division of Reproductive Health at the U.S. Centers for Disease Control and Prevention and co-author of the study, said the research team reanalyzed the data multiple times to make sure that she correctly interpreted the results.
For decades, SUID rates had remained constant within every racial and ethnic group and were consistently highest among Native American infants. But in 2020, the rate in black infants exceeded that of Native American infants.
“We would typically – ideally – look at five years of data to see any sort of trend emerge. So these are very preliminary results,” Parks Brown said. “But that’s something we’re going to have to keep monitoring.”
In a comment responding to the research, the doctors said the high rates of sudden and unexpected infant deaths in the United States — and the growing disparities — “reflect our societal failures.”
Socio-economic disparities “translate not only into limited access to health care and education, but also in the fact that many families do not have a stable and safe place for their children to sleep”, they wrote.
In 2020, 41% of all sudden unexpected infant deaths were attributed specifically to SIDS, 27% were identified as accidental suffocation and strangulation in bed, and 31% were classified as an unknown cause.
Deaths attributed specifically to SIDS jumped between 2019 and 2020, rising from the fourth leading cause of infant death to the third.
But this particular trend could highlight just how little we know about these deaths, the new study suggests.
The lines between the three classifications within the SUID category are blurred and the proportions have changed over the years. Experts say there have been wide variations in the way medical examiners and coroners code them, and they are less distinct than they appear.
“The root causes and the distinction between SIDS and an unknown cause of death are poorly defined,” said Cheryl L. Clark, associate director of epidemiology, evaluation and measurement at the Association of Maternal and Child. Health Programs, which was not involved. in the new study.
Those responsible for death certification have come together for a few key meetings in recent years with the specific intention of finding consistency in practice. And according to the new study, the unexpected increase in SIDS deaths in 2020 is most likely the result of changing diagnostic criteria.
While the rate of SIDS increased by around 15% from 2019 to 2020, the broader rate of SUID – which also includes deaths attributed to accidental suffocation and other unknown causes – only increased by 3 % that year, an increase that is not considered statistically significant, the researchers found.
Still, the latest data underscores why continued focus – and better understanding – of the subject is important.
“In a way, it was reassuring that the SUID rate didn’t go up,” Parks Brown said.
“But that only further underscores what we’ve seen over the past two decades: we’re failing to move the needle to reduce these deaths.”
And unraveling the specific causes of all sudden and unexpected infant deaths is essential.
“The bottom line is you can’t prevent something if you don’t know what’s causing it,” she said. “It is important to understand what happened in each death. This includes doing a thorough autopsy and getting a very detailed death scene investigation to find out what happened to the infant.
Despite the attempt to better differentiate within the broader category of sudden and unexpected infant death syndrome, experts say there is a key underlying thread.
“Almost all SUID deaths have at least one risk factor for unsafe sleep. Over 95% of them,” said Dr. Rebecca Carlin, a pediatrician at Columbia University Vagelos College of Physicians and Surgeons.
This could include a baby sleeping face down, sleeping in a parent’s bed instead of a crib, having soft bedding or pillows in the crib, or the parent’s smoking.
These unsafe sleep practices become risk factors because they decrease how easily infants wake up when they need to, usually every two hours, said Carlin, co-author of the commentary published alongside the study on Monday.
“There is almost always one – and often several – risk factors that are truly preventable with additional societal help,” she said.
“Being a new parent is tough. And it’s hard to talk about these issues without talking about the supports we have for new parents as a society.
Going back to work six weeks or sooner after the birth of a child and waking up every three hours with it isn’t really feasible, she said. It’s understandable that parents turn to unsafe sleep practices in an effort to get their child to sleep longer.
“Funding to assess and adequately support the changes needed to address the root causes of adverse and inequitable societal conditions and systems that disproportionately impact Black and Indigenous communities is critical, focusing on community-led efforts. community that can increase protective factors and reduce risk,” Sabra said. Anckner, associate director for clinical and community collaboration at the Association of Maternal and Child Health Programs, who was not involved in the new study.
Many socioeconomic factors that disproportionately put black babies and their families at risk of poor health overall have only been exacerbated during the pandemic, experts say. For families with infants, these stressors could have crept in and affected safe sleep patterns.
“Safe sleep is hard,” said Judy Bannon, CEO and founder of Cribs for Kids, a national group that provides cribs to those in need and advocates safe sleep practices for infants and did not participate in the new research.
Experts agree that ongoing education and community support to reinforce safe sleep practices is essential, and that time spent in hospital after childbirth is a crucial opportunity.
Among other programs, Cribs for Kids has a hospital certification program that has recognized hundreds of hospitals nationwide for their commitment to safe sleep practices.
He also has a public safety initiative, working with local law enforcement EMS to keep tabs on where a baby is sleeping when they are in a home for any reason.
“It’s a question parents hear about it from everywhere they go,” Bannon said.