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Most cases of sudden unexplained infant death (SUID), regardless of sleep location, had multiple unsafe sleep factors present, researchers found.

Of 7,595 cases of SUID, 59.5% were sleep surface sharing when the infants died, and at least 76% had multiple unsafe sleep factors present, reported Alexa Erck Lambert, MPH, of the CDC's National Center for Chronic Disease Prevention and Health Promotion, and colleagues .

Sleep surface sharing infants had a larger number of other unsafe sleep factors, and nearly one-third had all three unsafe sleep factors (soft or loose bedding or objects; not being in a crib; and prone or side position) as compared with 21% of non-sharing infants.

"Clinicians can use evidence from this and previous studies to shape conversations on safe sleep guidance, including understanding motivations for surface sharing and the impact of modeling behavior and giving advice to encourage safe sleep practices," Erck Lambert and colleagues wrote. "Previously reported reasons for surface sharing included breastfeeding, facilitating better sleep for the infant or mother, calming a fussy infant, convenience, keeping a close watch over the infant, and protection from environmental dangers."

Overall among the SUID cases examined, sleep surface sharing infants were more often ages 0 to 3 months, with this age group accounting for the largest proportion of sharing (73.2%) and non-sharing infants (56.7%).

Sharing infants were most commonly non-Hispanic Black (42.2%), and non-sharing infants were most commonly non-Hispanic white (46.2%). Publicly insured infants made up the largest proportion of sharing (75.1%) and non-sharing infants (64.3%).

In addition, they were most often found supine (41.1%) and in an adult bed (75.7%) at the time of death. Exposure to prenatal maternal cigarette smoking was also more common among sharing (41.4%) than non-sharing infants (30.5%), as was being supervised by a parent at time of death (87.2% vs 72.5%). Having a supervisor who was impaired by drugs or alcohol was also more common among sharing (16.3%) compared with non-sharing infants (4.7%).

In a , Erich Batra, MD, of Penn State College of Medicine in Hershey, Pennsylvania, and colleagues noted that, in the U.S., in addition to the two-thirds of child deaths being attributable to injuries each year, approximately 3,600 infants die suddenly, "usually during sleep."

Among a list of recommendations included in the policy statement was that a national surveillance system "should be advocated for other deaths, including SUID and sudden death in the young, by building out the current Centers for Disease Control and Prevention SUID Case Registry system," they said.

They also proposed that, where allowed, childhood fatality review teams "should be encouraged to provide tactful and sensitive feedback to primary care providers and other medical and community agencies that have intersected with the deceased child and family to identify systemic issues that could be improved to prevent future child deaths," they added.

Erck Lambert and colleagues used data from the CDC's SUID Case Registry. They examined SUID among residents of 23 U.S. jurisdictions who died from 2011 to 2020.

Study limitations included that sleep environment data used depends on the availability and accuracy of information documented during a death investigation, "which relies on witness reports of an often chaotic scene," Erck Lambert and colleagues noted.

Other limitations included that the study population was limited to 23 states and jurisdictions, and that the research team was unable to determine risk because the registry used only included infant deaths.

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