Related Experiment Video
Updated: Mar 26, 2026
Laryngeal Mask Airway LMA Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway SGA
Published on: July 14, 2023
Sudden infant death with external airways covered: case-comparison study of 206 deaths in the United States
N J Scheers1, C M Dayton, J S Kemp
1Division of Hazard Analysis, US Consumer Product Safety Commission, Bethesda, MD, USA.
Insights
Sudden infant deaths with covered airways were common, especially with soft bedding like pillows and comforters. Removing these items can reduce the risk of accidental suffocation in infants.
Area of Science:
- Pediatrics
- Public Health
- Forensic Science
Background:
- Sudden infant death syndrome (SIDS) remains a leading cause of postneonatal mortality.
- A significant subset of SIDS cases involves airway obstruction by bedding.
- Understanding risk factors for airway covering is crucial for prevention.
Purpose of the Study:
- To investigate factors contributing to sudden infant deaths where the infant's nose and mouth were covered by bedding.
- To differentiate risk factors for airway covering from general SIDS risk factors.
Main Methods:
- A case-comparison study design was employed.
- Death-scene investigations and reconstructions were conducted in 18 metropolitan areas.
- Data from 206 SIDS cases were analyzed using logistic regression and latent class analysis.
Main Results:
- Twenty-nine percent of infant deaths studied involved covered airways.
- Prone sleep position (OR, 2.86) and soft bedding (OR, 5.28) significantly increased the risk of airway covering.
- Specific soft bedding items like pillows (OR, 3.31) and comforters (OR, 2.46) were associated with higher risk.
Conclusions:
- Soft bedding, including pillows and comforters, poses a substantial risk for airway obstruction in infants, independent of sleep position.
- Recommendations include removing pillows, comforters, and other soft bedding from the infant sleep environment.
- These findings underscore the importance of a safe sleep environment to prevent suffocation deaths.
Objective:
To study factors associated with sudden infant deaths occurring with the external airways (ie, nose and mouth) covered by bedding.
Design:
Case-comparison study of infants dying with vs those dying without the external airways covered.
Setting:
Death-scene investigation and reconstruction at the site of death using an infant mannequin; 18 metropolitan areas.
Participants:
Caregivers for a consecutive sample of infants who died of sudden infant death syndrome (SIDS). Complete data from 206 of 382 eligible cases.
Main Outcome Measures:
Among infants dying suddenly and unexpectedly, an analysis of whether sociodemographic risk factors for SIDS, sleep practices, or bedding increased the risk of dying with the external airways covered.
Results:
Data were analyzed by using univariate and 2 types of multivariate risk analysis, logistic regression and latent class. Of the victims, 59 (29%) were found with the external airways covered. Conventional risk factors for SIDS did not affect the risk of death with the external airways covered. Factors increasing the risk of death with the external airways covered included prone sleep position (odds ratio [OR], 2.86) and using soft bedding (OR, 5.28), such as comforters (OR, 2.46) and pillows (OR, 3.31). Infants at low risk for death with the external airways covered slept in the prone position, but rarely on a pillow, comforter, or other bedding that allowed a pocket to form beneath the face. All 9 infants who were positioned supine or on one side for sleep and found with the external airways covered had turned and were found dead in the prone position.
Conclusions:
Sudden infant deaths with the external airways covered were common in the United States when most infants slept prone. Soft bedding, including pillows and comforters, increased the risk that an infant who died would be found with the external airways covered. Therefore, these items should not be placed near infants, regardless of the sleep position.
More Related Videos
06:22Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
Published on: April 7, 2021
05:50International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
Published on: March 12, 2020