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This Child Fatality information provided by the Injury & Violence Prevention section of the Office of Disease Prevention & Epidemiology.
- Special Topics 1. Unexplained Infant Deaths  This section describes infant deaths that are unexplained and unexpected. This type of death is the third leading cause of death for children under one year, behind perinatal conditions and congenital anomalies. This category includes deaths due to Sudden Infant Death Syndrome (SIDS). SIDS is defined as the unexplained and unexpected death of a previously healthy infant before age 1. The diagnosis of SIDS is an exclusionary diagnosis that is made after an autopsy, a death scene investigation, and a complete medical history to exclude any known cause of death. Deaths can come to be classified as due to SIDS in a variety of ways. The most straightforward way is when the person filling out the death certificate (usually a Medical Examiner) assigns SIDS as a cause of death. Often, however, because of the desire to be as accurate as possible, the cause of death is listed on the death certificate as "unexpected" and/or "unexplained", with various descriptions of environmental conditions that may have contributed in an unknown way to the death. For example, a death may be listed as due to an unexplained cause, in the presence of smoking in the household or sleeping in bed with a parent. Because of the difficulties inherent in assigning a cause of death when a likely explanation has not been found, deaths coded as SIDS are grouped together with other unexplained deaths in this section of the report. In 1999, 28 children under one year of age died due to sudden unexplained causes. Deaths to infants due to unexpected and unexplained causes numbered 45 in 1997 and 44 in 1998. In 1999, this included 21 SIDS cases and seven "other" unexplained deaths. The classification of these cases is preliminary; some of the "other" unexplained deaths may be reclassified as SIDS before the data are finalized. More males (19) are represented than females (9). Age at death in Oregon's cases ranged from 3 days to 8 months (see Figure 10). The peak incidence occurred at 2 months. All 28 of these cases were reviewed by local Child Fatality Review teams. Eleven (39%) of the case families had previously been referred to SCF. In seven cases an SCF assessment/referral was made at the time of the fatality.
Information on maternal smoking was obtained from birth certificates. Among the unexplained infant deaths, these babies were 3.9 times more likely to have a mother who smoked than the general Oregon population (50% versus 13%)4. The infant?s usual sleep position was known to the Child Fatality Review team in 36% (10)
cases. Sleep position is known to be a risk factor for SIDS. The American Academy of
Pediatrics (AAP) recommends placing infants on their back to sleep to prevent SIDS. Of those
whose usual sleep position was known, 60% (6) were reported to usually sleep on their
stomach or side. In Oregon, 9% of mothers surveyed by the Pregnancy Risk Assessment
Monitoring System (PRAMS) report that they put their baby down to sleep on their stomach.5
For the 23 cases whose position at discovery was known, 61% were on their stomach.
Because some infants die unexpectedly while sleeping with their parents or siblings, CFR teams also report data on the child?s sleeping arrangement at the time of death. Among the 28 infants who died from unexplained causes, 46% (13) were sleeping alone and 43% (12) were reported to be co-sleeping with another person. While co-sleeping is not a risk factor for SIDS, some medical examiners consider co-sleeping as a potential factor in cases of unintentional suffocation. Recommendations Related to Unexplained Infant Death
Examples of current safety initiatives
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The cause of SIDS is unknown. Known risk factors for SIDS include maternal smoking during
pregnancy and infant sleep position on the stomach. Although there is a strong association
between these risk factors and the occurrence of SIDS, it is unclear how these risk factors
cause SIDS.
