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Recurrent sudden unexpected death in infancy: a case series of sibling deaths
Joanna J Garstang1,2, Michael J Campbell3, Marta C Cohen4,5
1Children and Family Services, Birmingham Community Healthcare NHS Trust, Aston, UK joanna.garstang@nhs.net.
Insights
Infants born after a sudden unexpected death in infancy (SUDI) have a tenfold higher risk. Many SUDI recurrences are linked to modifiable risks like smoking and unsafe sleep, highlighting the need for parental support.
Area of Science:
- Pediatrics
- Public Health
- Forensic Medicine
Background:
- Sudden unexpected death in infancy (SUDI) poses a significant risk to subsequent siblings.
- Understanding recurrent SUDI is crucial for targeted interventions and support programs.
Purpose of the Study:
- To determine the SUDI rate in infants born into families with a previous SUDI.
- To identify causes of death and child protection concerns in recurrent SUDI cases.
Main Methods:
- An observational study utilizing clinical case records from the UK's Care of Next Infant (CONI) program.
- Analysis of infants registered between January 2000 and December 2015, examining causes of death and risk factors.
Main Results:
- The SUDI rate for infants born after a previous SUDI was 3.93 per 1000 live births, approximately 10 times the general UK SUDI rate.
- Unexplained deaths and accidental asphyxia were common; homicide was rare. Modifiable risk factors like smoking and unsafe co-sleeping contributed to deaths in several cases.
- 10 families experienced child protection concerns.
Conclusions:
- Families with a history of SUDI face a significantly elevated risk for subsequent infants.
- Addressing modifiable risk factors through enhanced parental support and education is critical for SUDI prevention.
- While homicide is a rare cause, the high rate of preventable deaths underscores the need for comprehensive family support services.
Objectives:
To determine the rate of sudden unexpected death in infancy (SUDI) for infants born after a previous SUDI in the same family, and to establish the causes of death and the frequency of child protection concerns in families with recurrent SUDI.
Design:
Observational study using clinical case records.
Setting:
The UK's Care of Next Infant (CONI) programme, which provides additional care to families who have experienced SUDI with their subsequent children.
Patients:
Infants registered on CONI between January 2000 and December 2015.
Main Outcome Measures:
Cause of death, presence of modifiable risk factors for SUDI and child protection concerns.
Results:
There were 6608 live-born infants registered in CONI with 29 deaths. 26 families had 2 deaths, and 3 families had 3 deaths. The SUDI rate for infants born after one SUDI is 3.93 (95% CI 2.7 to 5.8) per 1000 live births. Cause of death was unexplained for 19 first and 15 CONI deaths. Accidental asphyxia accounted for 2 first and 6 CONI deaths; medical causes for 3 first and 4 CONI deaths; and homicide for 2 first and 4 CONI deaths. 10 families had child protection concerns.
Conclusions:
The SUDI rate for siblings is 10 times higher than the current UK SUDI rate. Homicide presenting as recurrent SUDI is very rare. Many parents continued to smoke and exposed infants to hazardous co-sleeping situations, with these directly leading to or contributing to the death of six siblings. SUDI parents need support to improve parenting skills and reduce risk to subsequent infants.
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