Sudden Infant Death Syndrome in the Hispanic Community:
A Selected Annotated Bibliography

This bibliography provides information about risk factors for and occurrences of sudden infant death syndrome in the Hispanic community in the United States.

These articles have been selected by Resource Center staff from PubMed, a service of the National Library of Medicine that includes over 19 million citations from MEDLINE and other life science journals for biomedical articles back to 1948. PubMed includes links to full text articles and other related resources.

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Fu LY, Colson ER, Corwin MJ, Moon RY.
Infant sleep location: associated maternal and infant characteristics with sudden infant death syndrome prevention recommendations.
J Pediatr. 2008 Oct;153(4):503-8. Epub 2008 Jun 25.

OBJECTIVE: To identify factors associated with infant sleep location. STUDY DESIGN: Demographic information and infant care practices were assessed for 708 mothers of infants ages 0 to 8 months at Women, Infants and Children centers. Generalized linear latent mixed models were constructed for the outcome, sleeping arrangement last night (room-sharing without bed-sharing versus bed-sharing, and room-sharing without bed-sharing versus sleeping in separate rooms). RESULTS: Two-thirds of the mothers were African-American. A total of 48.6% mothers room-shared without bed-sharing, 32.5% bed-shared, and 18.9% slept in separate rooms. Compared with infants who slept in separate rooms, infants who room-shared without bed-sharing were more likely to be Hispanic (odds ratio [OR], 2.58, 95% CI 1.11-5.98) and younger (3.66- and 1.74-times more likely for infants 0-1 month old and 2-3 months old, respectively, as compared with older infants). Compared with infants who bed-shared, infants who room-shared without bed-sharing were more likely to be 0 to 1 month old (OR, 1.57; 95% CI, 1.05-2.35) and less likely to be African-American (OR, 0.43; 95% CI, 0.26-0.70) or have a teenage mother (OR, 0.37; 95% CI, 0.23-0.58). CONCLUSIONS: Approximately one-third of mothers and infants bed-share, despite increased risk of sudden infant death syndrome (SIDS). The factors associated with bed-sharing are also associated with SIDS, likely rendering infants with these characteristics at high risk for SIDS.

Mathews TJ, MacDorman MF.
Infant mortality statistics from the 2005 period linked birth/infant death data set.
Natl Vital Stat Rep. 2008 Jul 30;57(2):1-32.

OBJECTIVES: This report presents 2005 period infant mortality statistics from the linked birth/infant death data file by a variety of maternal and infant characteristics. The linked file differs from the mortality file, which is based entirely on death certificate data. METHODS: Descriptive tabulations of data are presented and interpreted. Excluding rates by cause of death, the infant mortality rate is now published with two decimal places. RESULTS: The U.S. infant mortality rate was 6.86 infant deaths per 1,000 live births in 2005, which is statistically unchanged from 6.78 in 2004. Infant mortality rates ranged from 4.89 deaths per 1,000 live births for Asian or Pacific Islander (API) mothers to 13.63 for non-Hispanic black mothers. Among Hispanics, rates ranged from 4.42 for Cuban mothers to 8.30 for Puerto Rican mothers. Infant mortality rates were higher for infants who were born in multiple deliveries or whose mothers were born in the 50 states and the District of Columbia or were unmarried. Infant mortality was also higher for male infants and infants born preterm or at low birthweight. The neonatal mortality rate was essentially unchanged from 2004 (4.52) to 2005 (4.54). The postneonatal mortality rate increased 3 percent from 2.25 in 2004 to 2.32 in 2005. Infants born at the lowest gestational ages and birthweights have a large impact on overall U.S. infant mortality. For example, more than one-half (55 percent) of all infant deaths in the United States in 2005 occurred to the 2 percent of infants born very preterm (less than 32 weeks of gestation). Infant mortality rates for late preterm infants (34-36 weeks of gestation) were three times those for term infants (37-41 weeks). The three leading causes of infant death--congenital malformations, low birthweight, and sudden infant death syndrome (SIDS)--accounted for 44 percent all infant deaths. The percentage of infant deaths that were "preterm-related" increased from 34.6 percent in 2000 to 36.5 percent in 2005. The preterm-related infant mortality rate for non-Hispanic black mothers was 3.4 times higher and the rate for Puerto Rican mothers was 87 percent higher than the rate for non-Hispanic white mothers.

Heron M.
Deaths: leading causes for 2004.
Natl Vital Stat Rep. 2007 Nov 20;56(5):1-95.

OBJECTIVES: This report presents final 2004 data on the 10 leading causes of death in the United States by age, race, sex, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the annual report of final mortality statistics. METHODS: Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2004. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. RESULTS: In 2004, the 10 leading causes of death were (in rank order) Diseases of heart; Malignant neoplasms; Cerebrovascular diseases; Chronic lower respiratory diseases; Accidents (unintentional injuries); Diabetes mellitus; Alzheimer's disease; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Septicemia and accounted for about 78 percent of all deaths occurring in the United States. Differences in the ranking are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2004 were (in rank order) Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Respiratory distress of newborn; Bacterial sepsis of newborn; Neonatal hemorrhage; and Diseases of the circulatory system. Important variation in the leading causes of infant death is noted for the neonatal and postneonatal periods.

Malloy MH, Eschbach K.
Association of poverty with sudden infant death syndrome in metropolitan counties of the United States in the years 1990 and 2000.
South Med J. 2007 Nov;100(11):1107-13.

BACKGROUND: Sudden infant death syndrome (SIDS) has been associated with poverty indirectly in the United States with the use of vital statistics data by using proxies of socioeconomic status such as maternal education. OBJECTIVES: The objective of this analysis was to examine the relationship of poverty to SIDS at an ecologic level, by examining the association between poverty within metropolitan counties of the United States and the occurrence of SIDS within those metropolitan counties. METHODS: The percentage of each US county's population below established federal poverty guidelines (poverty index) was obtained from US Census data for 1990 and 2000 by race (Hispanic-HISP, non-Hispanic white-NHW, and non-Hispanic black-NHB). These data were merged by year of birth, county, and race with US Vital Statistics Linked Birth and Infant Death Certificate data. RESULTS: Fourth (highest poverty quartile) versus first quartile poverty odds ratios (OR) were significantly increased in 1990 and 2000 for NHB (OR1990 = 1.84, OR2000 = 2.29) and NHW (OR1990 = 1.87, OR2000 = 2.17), but not for HISP (OR1990 = 0.64, OR2000 = 0.59). CONCLUSIONS: There is a significant association between poverty and SIDS at the metropolitan county level for NHB and NHW. Hispanics do not demonstrate this association.

Lahr MB, Rosenberg KD, Lapidus JA.
Maternal-infant bedsharing: risk factors for bedsharing in a population-based survey of new mothers and implications for SIDS risk reduction.
Maternal Child Health J. 2007 May;11(3):277-86. Epub 2006 Dec 29.

OBJECTIVES: Maternal-infant bedsharing is a common but controversial practice. Little has been published about who bedshares in the United States. This information would be useful to inform public policy, to guide clinical practice and to help focus research. The objective was to explore the prevalence and determinants of bedsharing in Oregon. METHODS: Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) surveys a population-based random sample of women after a live birth. Women were asked if they shared a bed with their infant "always," "almost always," "sometimes" or "never." RESULTS: 1867 women completed the survey in 1998-99 (73.5% weighted response rate). Of the respondents, 20.5% reported bedsharing always, 14.7% almost always, 41.4% sometimes, and 23.4% never. In multivariable logistic regression, Hispanics (adjusted odds ratio [ORa] 1.69, 95% Confidence Interval [CI] 1.17-2.43), blacks (ORa 3.11, 95% CI 2.03-4.76) and Asians/Pacific Islanders (ORa 2.14, 95% CI 1.51-3.03), women who breastfed more than 4 weeks (ORa 2.65, 95% CI 1.72-4.08), had annual family incomes less than $30,000 (ORa 2.44, 95% CI 1.44-4.15), or were single (ORa 1.55, 95% CI 1.03-2.35) were more likely to bedshare frequently (always or almost always). Among Hispanic and black women, bedsharing did not vary significantly by income level. Bedsharing black, American Indian/Alaska Native and white infants were much more likely to be exposed to smoking mothers than Hispanic or Asian/Pacific Islander infants (p < .0001). CONCLUSIONS: Bedsharing is common in Oregon. The women most likely to bedshare are non-white, single, breastfeeding and low-income. Non-economic factors are also important, particularly among blacks and Hispanics. Campaigns to decrease bedsharing by providing cribs may have limited effectiveness if mothers are bedsharing because of cultural norms.

Heron MP, Smith BL.
Deaths: leading causes for 2003.
Natl Vital Stat Rep. 2007 Mar 15;55(10):1-92.

OBJECTIVES: This report presents final 2003 data on the 10 leading causes of death in the United States by age, race, sex, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the annual report of final mortality statistics. METHODS: Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2003. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. RESULTS: In 2003, the 10 leading causes of death were (in rank order): Diseases of heart; Malignant neoplasms; Cerebrovascular diseases; Chronic lower respiratory diseases; Accidents (unintentional injuries); Diabetes mellitus; Influenza and pneumonia; Alzheimer's disease; Nephritis, nephrotic syndrome and nephrosis; and Septicemia and accounted for about 78 percent of all deaths occurring in the United States. Differences in the ranking are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2003 were (in rank order): Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Newborn affected by complications of placenta, cord and membranes; Accidents (unintentional injuries); Respiratory distress of newborn; Bacterial sepsis of newborn; Neonatal hemorrhage; and Diseases of the circulatory system. Important variation in the leading causes of infant death is noted for the neonatal and postneonatal periods.
PMID: 17408087 [PubMed - indexed for MEDLINE]

Barnes-Josiah DL, Eurek P, Huffman S, Heusinkvelt J, Severe-Oforah J, Schwalberg R.
Effect of "this side up" T-shirts on infant sleep position.
Maternal Child Health J. 2007 Jan;11(1):45-8.

OBJECTIVES: To assess the impact of "This Side Up" T-shirts on parental practices in Nebraska. METHODS: A random sample of 3,210 Nebraska women who gave birth in 2004, stratified by race/ethnicity, was mailed a brief questionnaire on their receipt of a T-shirt and SIDS risk reduction materials at their birthing hospital, and on infant sleep position. RESULTS: Response rates were low (25.9%), ranging from 10.6% for Native American mothers to 46.4% for White mothers. Half (52.0%) had received a T-shirt and 71.6% had received SIDS information. Two-thirds (64.0%) reported that their infants slept on their backs; African-American and Hispanic infants were significantly less likely to back sleep. In univariate logistic regression models, African-American race, Hispanic ethnicity and maternal age 30-39 were significant negative predictors of back sleeping; White race and having received a SIDS brochure were positive predictors. In the fully controlled model African American and Asian race and Hispanic ethnicity were negative predictors of back sleeping; neither receiving SIDS information nor the infant T-shirt was significant. Effects of maternal age and a SIDS informational brochure appeared in models stratified by race/ethnicity. CONCLUSIONS: In these data, receiving an infant T-shirt was not related to how mothers placed their infants to sleep. Additional research is needed on effective methods of delivering targeted counseling and promoting safe sleep practices among families, particularly among racial and ethnic subgroups.

Leslie JC, Diehl SJ, Galvin SL.
A comparison of birth outcomes among US-born and non-US-born Hispanic Women in North Carolina.
Maternal Child Health J. 2006 Jan;10(1):33-8.

OBJECTIVE: To compare birth outcomes between non-US-born and US-born Hispanic women in North Carolina (NC). METHODS: A retrospective comparison of birth outcomes from linked NC birth/death certificate data (1993-1997) for 22,234 Hispanic births by mother's place of birth was conducted. RESULTS: Mexico-born Hispanic women (58%) had significantly fewer medical risks, tobacco or alcohol use during pregnancy; however, they also had significantly less education and prenatal care than US-born Hispanic women (21%). Infant mortality rate, low birth weight, and prematurity were low and did not differ significantly. Lethal anomalies were the primary cause of infant mortality in non-US-born Hispanics versus Sudden Infant Death Syndrome (SIDS) in US-born Hispanics. CONCLUSIONS: Despite increased risk factors among US-born women, we found no difference in Hispanic birth outcomes in NC by mother's place of birth. These data contradict national data and may be related to findings of both positive and negative aspects of acculturation in NC.

Logan BK, Gordon AM.
Death of an infant involving benzocaine.
J Forensic Sci. 2005 Nov;50(6):1486-8.

This report describes the death of a four-month-old Hispanic male which may be related to benzocaine toxicity. A toxicological evaluation revealed benzocaine at a concentration of 3.48 mg/L, and postmortem methemoglobin of 36% (normal 0.4-1.5). Methemoglobinemia is a complication of benzocaine toxicity. In light of the toxicology findings, the coroner investigated the source of the benzocaine and discovered that the child was treated with Zenith Goldline Allergen Ear Drops containing 0.25% w/v benzocaine and 5.4% w/v antipyrine. There was an admission by a caregiver that on the day prior to the child's death, he had been treated with three times the prescribed dose. Blood benzocaine concentrations in nine other unrelated cases were determined and concentrations ranged from <0.05-5.3 mg/L (mean 1.48 mg/L). Seven of the nine cases were positive for drugs of abuse, and one additional case was described as a known drug user. Methemoglobin in these benzocaine positive cases ranged from 6-69%; however, methemoglobin concentrations in postmortem cases are frequently elevated and should be interpreted with caution. The unknown significance of the benzocaine, and the circumstances of the case raise questions about the ultimate attribution of this death to SIDS.

Colson ER, McCabe LK, Fox K, Levenson S, Colton T, Lister G, Corwin MJ.
Barriers to following the back-to-sleep recommendations: insights from focus groups with inner-city caregivers.
Ambul Pediatr. 2005 Nov-Dec;5(6):349-54.

BACKGROUND: African American infants have a higher incidence of SIDS and increased risk of being placed in the prone position for sleep. OBJECTIVE: To determine new barriers and more information about previously identified barriers that interfere with adherence to the Back-to-Sleep recommendations among inner-city, primarily African Americans. DESIGN/METHODS: We conducted 9 focus groups with caregivers of infants and young children from women, infants, and children centers and clinics in New Haven and Boston. Themes were identified using standard qualitative techniques. RESULTS: Forty-nine caregivers participated, of whom 86% were African American, 6% were Hispanic, 4% were white, and 4% were other. Four themes were identified: 1) Safety: Participants chose the position for their infants based on which position they believed to be the safest. Some participants did not choose to put their infants in the supine position for sleep because they feared their infants would choke; 2) Advice: Participants relied on the advice of more experienced female family members. Health care providers were not uniformly a trusted source of advice; 3) Comfort: Participants made choices about their infants sleeping positions based on their perceptions of whether the infants appeared comfortable. Participants thought that their infants appeared more comfortable in the prone position; 4) Knowledge: Some participants had either limited or erroneous knowledge about the Back-to-Sleep recommendations. CONCLUSIONS: We identified multiple barriers to adherence to recommendations regarding infant sleep position. Data obtained from these focus groups could be used to design educational interventions aimed at improving communication about and adherence to the Back-to-Sleep recommendations.

Lahr MB, Rosenberg KD, Lapidus JA.
Bedsharing and maternal smoking in a population-based survey of new mothers.
Pediatrics. 2005 Oct;116(4):e530-42.

OBJECTIVE: Sudden infant death syndrome (SIDS) remains the number 1 cause of postneonatal infant death. Prone infant sleep position and maternal smoking have been established as risk factors for SIDS mortality. Some studies have found that bedsharing is associated with SIDS, but, to date, there is only strong evidence for a risk among infants of smoking mothers and some evidence of a risk among young infants of nonsmoking mothers. Despite the lack of convincing scientific evidence, bedsharing with nonsmoking mothers remains controversial. In some states, nonsmoking mothers are currently being told that they should not bedshare with their infants, and mothers of infants who died of SIDS are told that they caused the death of their infant because they bedshared. The objective of this study was to explore the relationship between maternal smoking and bedsharing among Oregon mothers to explore whether smoking mothers, in contrast to nonsmoking mothers, are getting the message that they should not bedshare. METHODS: Oregon Pregnancy Risk Assessment Monitoring System surveys a stratified random sample, drawn from birth certificates, of women after a live birth. Hispanic and non-Hispanic black, non-Hispanic Asian/Pacific Islander and non-Hispanic American Indian/Alaskan Native women, and non-Hispanic white women with low birth weight infants are oversampled to ensure sufficient numbers for stratified analysis. The sample then was weighted to reflect Oregon's population. In 1998-1999, 1867 women completed the survey (73.5% weighted response). The median time from birth to completion of the survey was 4 months. Women were asked whether they shared a bed with their infant "always," "almost always," "sometimes," or "never." Frequent bedsharing was defined as "always" or "almost always"; infrequent was defined as "sometimes" or "never." RESULTS: Of all new mothers, 35.2% reported bedsharing frequently (always: 20.5%; almost always: 14.7%) and 64.8% infrequently (sometimes: 41.4%; never: 23.4%). Bedsharing among postpartum smoking mothers was 18.8% always, 12.6% almost always, 45.1% sometimes, and 23.6% never; this was not statistically different from among nonsmoking mothers. Results for prenatal smokers were similar. When stratified by race/ethnicity, there was no association between smoking and bedsharing in any racial or ethnic group. In univariable and multivariable logistic regression, there were no statistical differences in frequent or any bedsharing among either prenatal or postpartum smoking mothers compared with nonsmokers; the adjusted odds ratio for postpartum smokers who frequently bedshared was 0.73 (95% confidence interval [CI]: 0.42-1.25) and for any bedsharing was 1.05 (95% CI: 0.57-1.94). Results for prenatal smoking were similar. This is the first US population-based study to look at the prevalence of bedsharing among smoking and nonsmoking mothers. Bedsharing is common in Oregon, with 35.2% of mothers in Oregon reporting frequently bedsharing and an additional 41.4% sometimes bedsharing. There was no significant association between smoking and bedsharing for either prenatal or postpartum smokers among any racial or ethnic group. Smoking mothers were as likely to bedshare as nonsmoking mothers. The frequency of bedsharing in Oregon was similar to estimates from other sources. Our study has the advantage of being a population-based sample drawn from birth certificates, weighted for nonresponse. CONCLUSIONS: Although a number of case series have raised concerns about the safety of mother-infant bedsharing, even among nonsmoking mothers, this has not yet been confirmed by careful, controlled studies. There have been 9 large-scale case-control studies of the relationship between bedsharing and SIDS. Three case-control studies did not stratify by maternal smoking status, but found no increased risk for SIDS. Six case control studies reported results stratified by maternal smoking status: 1 study, while asserting an association, provided an unexplained range of univariable odds ratios without CIs; 3 found no increased risk for older infants of nonsmoking mothers; and 2 found a risk only for infants <8-11 weeks of age. Despite the preponderance of evidence that bedsharing by nonsmoking mothers does not increase the risk for SIDS among older infants, the recent specter of bedsharing as a cause of SIDS, based on uncontrolled case series and medical examiners' anecdotal experience, has led some medical examiners to label a death "suffocation" or "overlay asphyxiation" simply because the infant was bedsharing at the time of death. This "diagnostic drift" may greatly complicate future studies of the relationship between bedsharing and SIDS. Epidemiologic evidence shows that there is little or no increased risk for SIDS among infants of nonsmoking mothers but increased risk among infants of smoking mothers and younger infants of nonsmoking mothers. It seems prudent to discourage bedsharing among all infants <3 months old. Young infants brought to bed to be breastfed should be returned to a crib when finished. It would be worthwhile for other researchers to reanalyze their previous data to evaluate the consistency of the interaction of young infant age and bedsharing. Large controlled studies that include infants who are identified as dying from SIDS, asphyxia, suffocation, and sudden unexplained infant death, analyzed separately and in combination, are needed to resolve this and other issues involving bedsharing, including the problem of diagnostic drift. Recommendations must be based on solid scientific evidence, which, to date, does not support the rejection of all bedsharing between nonsmoking mothers and their infants. Cribs should be available for those who want to use them. Nonsmoking mothers should not be pressured to abstain from bedsharing with their older infants; they should be provided with accurate, up-to-date scientific information. Infants also should not co-sleep with nonparents. In Oregon, if not elsewhere, the message that smoking mothers should not bedshare is not being disseminated effectively. Because it is not known whether the risk caused by smoking is associated with prenatal smoking, postpartum smoking, or both, bedsharing among either prenatal or postpartum smokers should be strongly discouraged. Much more public and private effort must be made to inform smoking mothers, in culturally competent ways, of the very significant risks of mixing bedsharing and smoking. Public health practitioners need to find new ways to inform mothers and providers that smoking mothers should not bedshare and that putting an infant of a nonsmoking mother to sleep in an adult bed should be delayed until 3 months of age.

 

Shields LB, Hunsaker DM, Muldoon S, Corey TS, Spivack BS.
Risk factors associated with sudden unexplained infant death: a prospective study of infant care practices in Kentucky.
Pediatrics. 2005 Jul; 116(1):e13-20.

Objective: To ascertain the prevalence of infant care practices in a metropolitan community in the United States with attention to feeding routines and modifiable risk factors associated with sudden unexplained infant death (specifically, prone sleeping position, bed sharing, and maternal smoking). Methods: We conducted an initial face-to-face meeting followed by a telephone survey of 189 women who gave birth at a level I hospital in Kentucky between October 14 and November 10, 2002, and whose infants were placed in the well-infant nursery. The survey, composed of questions pertaining to infant care practices, was addressed to the women at 1 and 6 months postpartum. Results: A total of 185 (93.9%) women participated in the survey at 1 month, and 147 (75.1%) mothers contributed at 6 months. The racial/ethnic composition of the study was 56.1% white, 30.2% black, and 16.4% biracial, Asian, or Hispanic. More than half of the infants (50.8%) shared the same bed with their mother at 1 month, which dramatically decreased to 17.7% at 6 months. Bed sharing was significantly more common among black families compared with white families at both 1 month (adjusted odds ratio [OR]: 5.94; 95% confidence interval [CI]: 2.71-13.02) and 6 months (adjusted OR: 5.43; 95% CI: 2.05-14.35). Compared with other races, white parents were more likely to place their infants on their back before sleep at both 1 and 6 months. Black parents were significantly less likely to place their infants on their back at 6 months compared with white parents (adjusted OR: 0.14; 95% CI: 0.06-0.33). One infant succumbed to sudden infant death syndrome at 3 months of age, and another infant died suddenly and unexpectedly at 9 months of age. Both were bed sharing specifically with 1 adult in the former and with 2 children in the latter. Conclusions: Bed sharing and prone placements were more common among black infants. Breastfeeding was infrequent in all races. This prospective study additionally offers a unique perspective into the risk factors associated with sudden infant death syndrome and sudden unexplained infant death associated with bed sharing by examining the survey responses of 2 mothers before the death of their infants combined with a complete postmortem examination, scene analysis, and historical investigation.

Leslie JC, Diehl SJ, Galvin SL.
A comparison of birth outcomes among US-born and non-US-born Hispanic women in North Carolina.
Matern Child Health J. 2005 Dec 13;1-6 [E pub ahead of print]

Objective: To compare birth outcomes between non-US-born and US-born Hispanic women in North Carolina (NC). Methods: A retrospective comparison of birth outcomes from linked NC birth/death certificate data (1993-1997) for 22,234 Hispanic births by mother's place of birth was conducted. Results: Mexico-born Hispanic women (58%) had significantly fewer medical risks, tobacco or alcohol use during pregnancy; however, they also had significantly less education and prenatal care than US-born Hispanic women (21%). Infant mortality rate, low birth weight, and prematurity were low and did not differ significantly. Lethal anomalies were the primary cause of infant mortality in non-US-born Hispanics versus Sudden Infant Death Syndrome (SIDS) in US-born Hispanics. Conclusions: Despite increased risk factors among US-born women, we found no difference in Hispanic birth outcomes in NC by mother's place of birth. These data contradict national data and may be related to findings of both positive and negative aspects of acculturation in NC.

Bruckner T, Catalano RA.
Economic antecedents of Sudden Infant Death Syndrome.
Ann Epidemiol. 2005 Sep 22; [E-pub ahead of print]

Purpose: To test the hypothesis that labor market contraction is associated with an elevated number of deaths due to sudden infant death syndrome (SIDS). Methods: We apply time-series methods to monthly counts of SIDS deaths and total employment from the state of California beginning January 1989 and ending December 2001. The methods control for trends, seasonal cycles, and other forms of autocorrelation that could induce spurious associations. Results: Decreases in the number of employed persons in California preceded higher than expected monthly values of SIDS cases among black, non-Hispanic White and Hispanic infants. In addition, Blacks and Hispanics appear to respond more strongly than non-Hispanic Whites to economic contraction. Conclusions: We infer support for the hypothesis that economic contraction may inhibit salutary behavior related to SIDS. We discuss various mechanisms through which the economy may affect SIDS and recommend further investigation.

Mathews TJ, Menacker F, MacDorman MF; Centers for Disease Control and Prevention, National Center for Health Statistics
Infant mortality statistics from the 2002 period: linked birth/infant death data set.
Natl Vital Stat Rep. 2004 Nov 24; 53(10):1-29.

Objectives: This report presents 2002 period infant mortality statistics from the linked birth/infant death data file by a variety of maternal and infant characteristics. The linked file differs from the mortality file, which is based entirely on death certificate data. Methods: Descriptive tabulations of data are presented and interpreted. Results: The U.S. infant mortality rate increased from 6.8 infant deaths per 1000 live births in 2001 to 7.0 in 2002. The rate for infants of non-Hispanic white mothers was 5.7 in 2001 compared with 5.8 in 2002. The rate for infants of non-Hispanic black mothers was 13.5 in 2001 compared with 13.9 in 2002. Neither of the changes for non-Hispanic white nor non-Hispanic black was significant. Between 2001 and 2002, overall cause-specific rates increased 5 percent for low birthweight and 14 percent for maternal complications. The rate rose significantly for infants of mothers who smoked, 10.5 to 11.1. It also increased significantly from 10.7 to 11.5 for infants of mothers aged 15-17 years. The rate dropped significantly for triplet births, 71.4 to 60.1. Infant mortality rates ranged from 3.0 per 1000 live births for Chinese mothers to 13.9 for non-Hispanic black mothers. Among Hispanics, rates ranged from 3.7 for Cuban mothers to 8.2 for Puerto Rican mothers. Infant mortality rates were higher for those infants whose mothers were born in the 50 States and the District of Columbia, were unmarried, or smoked during pregnancy. Infant mortality was also higher for male infants, multiple births, and infants born preterm or at low birthweight. The three leading causes of infant death-Congenital malformations, low birthweight, and Sudden infant death syndrome (SIDS)-taken together accounted for 45 percent of all infant deaths. For infants of non-Hispanic black mothers, the cause-specific infant mortality rate for low birthweight was nearly four times that for infants of non-Hispanic white mothers. For infants of non-Hispanic black and American Indian mothers, the SIDS rates were at least double the rate for non-Hispanic white mothers. A more intensive analysis of the rise in the infant mortality rate utilizing information on maternal and infant health risk factors available in the linked birth/infant death and fetal death data files is forthcoming.

Corwin MJ, Lesko SM, Heeren T
Secular changes in sleep position during infancy: 1995-1998.
Pediatrics 2003 Jan; 111(1): 52-60.

Objective: Prone sleeping among infants has been associated with an increased risk of sudden infant death syndrome. The objective of this study was to compare factors associated with sleep position in 1995-1996 and 1997-1998 and to assess secular trends in use of prone infant sleep position from 1995 through 1998 among families stratified by race and education. Methods: A prospective cohort study was conducted in eastern Massachusetts and northwest Ohio of 12 029 mothers of infants who weighed > or =2500 g at birth. Descriptive statistics and multivariate odds ratios were used to relate maternal and infant characteristics to prone and supine sleeping. Results: A total of 14 206 mothers (25% of those eligible) were enrolled. A total of 12 029 mothers (85% of enrolled) responded to the 1-month and 11 552 mothers (81% of enrolled) responded to the 3-month follow-up questionnaire. A decline in use of the prone sleep position and increase in use of the supine position was observed during the 4 years of the study. Factors associated with prone and supine sleep position were similar in 1995-1996 and 1997-1998. In 1997-1998, use of prone sleeping at 1 month of age reached the goal of < or =10% only among infants of white and Asian women, married women, women who were older than 25 years, women who were college graduates, and women with incomes >$55 000 per year. At 3 months of age, however, prone sleeping increased to 12% to 17% in these groups. These same groups were most likely to use the supine position; 38% to 45% were supine at 1 month, increasing to 56% to 64% by 3 months of age. However, as of the end of 1998, approximately 27% of infants of non-college-educated black and Hispanic mothers were placed to sleep in the prone position and only 20% to 30% were being placed to sleep in the supine position at 3 months of age. Conclusions: Recommendations to avoid prone sleep position and especially the recommendation that supine sleep position is preferred have not been effectively delivered to black and Hispanic families and to families of low-income and less than a college education.

Pollack, H.A.; Frohna, J.G.
Infant sleep placement after the Back to Sleep Campaign.
Pediatrics 2002 Apr; 109(4): 608-614.

The Back to Sleep campaign has been credited with recent declines in the incidence of sudden infant death syndrome. Using survey data for the 1996-1998 birth cohorts, this epidemiologic study examines infant sleep position in a large, population-based sample. Data concerning infant sleep position were drawn from the 1996-1998 Pregnancy Risk Assessment Monitoring System for 15 states. Weighted multiple logistic regression analysis was used to examine correlates of infant sleep position. The prevalence of prone infant sleeping significantly declined between 1996 and 1998 (adjusted odds ratio [AOR] = 0.70; 95 percent confidence interval [CI] = [0.63: 078]). African Americans were more likely than non-Hispanic whites to sleep prone, (AOR = 1.45; 95 percent CI = 1.33, 1.59), and were less likely to sleep supine (AOR = 0.52; 95 percent CI = 0.48, 0.57). Hispanic/Latinos were less likely overall than non-Hispanic whites to sleep prone (AOR = 0.81; 95 percent CI = 0.69, 0.95), but were also less likely to sleep supine (AOR = 0.78: 95 percent CI = 0.69, 0.87). Adherence to sleep position recommended by the American Academy of Pediatrics increased sharply among Hispanic/Latino infants. Very low birth weight infants and infants in larger families were less likely to sleep in the recommended supine position. Infants born between 1001 and 1500 g (AOR = 0.57; 95 percent CI = 0.45, 0.72) were especially unlikely to sleep supine. Infants in households with more than 3 other children (AOR = 1.72; 95 percent CI = 1.08, 2.74) were more likely to sleep prone. Conclusions: Showed the prevalence of supine infant sleep increased between 1996 and 1998. Low adherence to sleep position recommendations of the American Academy of Pediatrics among African Americans, very low birth weight infants, and infants in large families remain public health concerns.

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November 2009

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