Sleep Related Infant Mortality in Alaska, 2012-2014

BACKGROUND:  Since 1992, Alaska has experienced an average of 20.2 sleep-related infant deaths each year. These are deaths that occur out of the hospital and in the sleep environment. During July of 2014 there were more than 5 sleep-related infant deaths, the most in any single months since January 2009. This increase triggered a case series review of recent sleep-related deaths in order to summarize demographic, behavioral, and environmental similarities among these fatalities.

METHODS:  An extraction tool was developed to review case files for sleep-related infant deaths that occurred between January 1, 2012 and September 30, 2014. Information pertaining to family history and infant sleep environment was extracted from Medical Examiner reports, investigator reports, child protective service summary reports, WIC, and Medicaid. All infant deaths were linked to birth and death certificate files provided by the Bureau of Vital Statistics (BVS) to summarize demographic factors. Deaths with a clear medical cause were excluded. 

RESULTS:  Sleep-related infant deaths accounted for 53 (29%) of the 182 infant deaths reported by BVS. Compared to the distribution of live births, a higher proportion of infant deaths occurred among infants with mothers who were Alaska Native race, unmarried, or did not have a college degree. A number of socioeconomic and behavioral factors were shared among the caregivers and families of the infants. 93% of the mothers (biological or adoptive) were enrolled in Medicaid and/or WIC. 57% of the infants had at least one caregiver who had pre-incident contact with OCS as an adult or historical contact as a child. 49%of the families had a history of dysfunction, which included arrests, domestic violence, or substance abuse. 

CONCLUSIONS:  These recent cases indicate that Alaska needs to continue to find ways to engage with new mothers and provide accurate information on safe sleep environments and risk factors for infant mortality. Low SES families may need additional support or assistance in taking steps to create a safe sleep environment for their infant. Many of these families are already known to Alaska Department of Health and Social Services (DHSS) either through Medicaid, WIC, or OCS. These agencies are potential avenues for future safe sleep education efforts.