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Updated: May 6, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
A prospective study of sudden unexpected infant death after reported maltreatment
Emily Putnam-Hornstein1, Janet U Schneiderman2, Mario A Cleves3
1University of Southern California, School of Social Work, Los Angeles, CA; University of California, Berkeley, California Child Welfare Indicators Project, Berkeley, CA.
Insights
Infants reported for maltreatment face over 3 times the risk of sudden infant death syndrome (SIDS) and sudden unexpected infant death (SUID). This highlights the need for targeted services and better communication to protect vulnerable infants.
Area of Science:
- Public Health
- Pediatrics
- Child Welfare
Background:
- Sudden unexpected infant death (SUID) remains a significant concern.
- The association between child maltreatment reports and SUID risk is not fully understood.
Purpose of the Study:
- To investigate if infants with maltreatment reports have an increased risk of sudden infant death syndrome (SIDS) and other SUID.
- To quantify the risk associated with maltreatment reports in early life.
Main Methods:
- Utilized linked California birth and infant death records (1999-2006) with child protective services data.
- Employed prospective follow-up from birth to 1 year, modeling maltreatment reports as a time-varying covariate.
- Applied multivariable competing risk survival models to estimate adjusted hazard ratios for SIDS and other SUID.
Main Results:
- A prior report of maltreatment significantly predicted SIDS and other SUID.
- Infants reported for suspected maltreatment exhibited over a threefold increased rate of SIDS (Hazard Ratio: 3.22; 95% CI: 2.66, 3.89) after adjusting for baseline risks.
Conclusions:
- Infants reported to child protective services face a substantially higher risk of SIDS and SUID.
- Enhanced interagency communication and targeted interventions are crucial for improving infant safety and reducing mortality.
Objective:
To examine whether infants reported for maltreatment face a heightened risk of sudden infant death syndrome (SIDS) and other leading causes of sudden unexpected infant death (SUID).
Study Design:
Linked birth and infant death records for all children born in California between 1999 and 2006 were matched to administrative child protection data. Infants were prospectively followed from birth through death or 1 year of age. A report of maltreatment was modeled as a time-varying covariate; risk factors at birth were included as baseline covariates. Multivariable competing risk survival models were used to estimate the adjusted relative hazard of postneonatal SIDS and other SUID.
Results:
A previous maltreatment report emerged as a significant predictor of SIDS and other SUID. After adjusting for baseline risk factors, the rate of SIDS was more than 3 times as great among infants reported for possible maltreatment (hazard ratio: 3.22; 95% CI: 2.66, 3.89).
Conclusion:
Infants reported to child protective services have a heightened risk of SIDS and other SUID. Targeted services and improved communication between child protective services and the pediatric health care community may enhance infant well-being and reduce risk of death.
