Sleep Related Deaths Reviewed by TFIMR 2004_ 2005_ 2006_ 2007

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Sleep Related Deaths Reviewed by TFIMR 2004_ 2005_ 2006_ 2007 Powered By Docstoc
					     Sleep Related Infant Deaths
     Tulsa County 2004 - 2007




 Carol Kuplicki, MPH
 Tulsa Health Department, TFIMR
Tulsa Fetal and Infant Mortality Review Project is supported in part by the Maternal and Child Health Block Grant in the
Department of Health and Human Services, Health Resources and Services Administration, Maternal and child Health Bureau
The FIMR Process
The Cycle of Improvement
Could these deaths have been prevented?

 w Children found on top of the infant.
 w Infant found unresponsive in sleeping bag
   wedged between the wall and bed.
 w Infant found in crib face down between a pillow
   and edge of crib.
 w Infant found unresponsive in bed under some
   pillows.
 w Infant found unresponsive lying under a sibling.
 w The infant had been sleeping in the bed with the
   parents. The child was found under the mother
   in bed.
  Background
w From 2004-2007 there has been a total of 314
  Tulsa County resident infant deaths.

   w 17 Sudden Infant Death Syndrome (SIDS)
   w 35 Other symptoms, signs and abnormal
     clinical and laboratory findings, not elsewhere
     classified “Undetermined”
   w 5 Accidental suffocation and strangulation in
     bed
    Purpose and Definition
Purpose
w To identify and review sleep related infant deaths occurring in
   Tulsa County

Definitions
w Sleep related death – Infant was put to bed either alone or co-
   sleeping or had fallen asleep while being held, and subsequently
   died during sleep
w Co-sleeping – Sharing the same sleep surface
w SIDS-Sudden Infant Death Syndrome, ICD 10, R95 The sudden
   and unexpected death of an infant less than 1 year of age for
   which no exact cause of death can be determined
w Undetermined – ICD 10, R99, Other ill-defined and other
   unspecified causes of mortality
w Asphyxia – ICD 10, W 75 Accidental suffocation and strangulation
   in bed
w Prone – Lying with the front or face downward
w Petechial hemorrhages - subcutaneous hemorrhage occurring in
   very small spots
Sleep Environment
Unsafe Sleep Conditions
w Infant placed or found in a prone position
w Co-sleeping
w Sleeping on a couch, chair or on soft
  bedding
w Bedding, pillows or other items found over
  the infant’s face
Cause of Death/Medical Examiner

w Performs autopsies on sleep related infant
  deaths
w Completes the death certificate as to the
  manner and cause of death
w ~ 2004 the Medical Examiner began to
  standardize review of sleep related infant
  deaths across the state
  w The result was to classify infants that were co-
    sleeping at the time of death as Undetermined.
    Previously the death might have been classified
    as a SIDS death.
 Selection & Method
Selection
w Deaths occurred during 2004 - 2007
w Birth to <365 days old
w Tulsa County resident at birth and death
w Born and died in Tulsa County
w Mother received prenatal care in Tulsa County

Method
w Reviewed medical records, Medical Examiner
  reports, EMSA reports
Cases Selected
N=48 (15.3%)               314 infant deaths, all causes (2004-2007)

 Of the sleep related deaths occurring to Tulsa
 County residents, TFIMR reviewed 48.

                                          2004        2005      2006      2007         Total
 Born outside Tulsa County                     1           3         2          .           6
 Died outside Tulsa county                      .           .         .        1            1
 Non-resident                                   .           .         .        1            1
 Accident, not sleep related                    .           .         .        1            1
 *Other exclusions                             3            .         .        1            4
 Total Excluded                                4           3         2         4          13
 Number reviewed                               6           7       19        16           48
 *Other exclusions could be possible homicide, death certificate received over 1 year
 after death, accident that was not sleep related or any other causes that would not fit into
 the sleep related death definition.
Findings
 Most infants that died never went home from the hospital.

 Infant deaths reviewed by TFIMR: Of infants that were healthy enough to
 be released from the hospital, 57.1% died from sleep related causes.

  Infant Deaths by Year of Death, Discharge Status, and Cause of Death
              Total            Infants       Sleep Related
 Year of     Deaths        Discharge to     Deaths Reviewed   SIDS   Undetermined   Asphyxia
 Death         (Data        Home from         by TFIMR*
             Abstracted)
                           Birth Hospital
 2004           46              13                6            3          2            1
 2005           68              16                7            2          4            1
 2006           79              27                19           8          8            3
 2007         86**              28                16           3         11            2
 Total       279           84 (30.1%)        48 (57.1%)       16         25            7

Of the infant deaths reviewed from 2004- 2007,
only 84 (30.1%) infants were discharged to
home. Of the infants discharged to home 48
(57.1%) died from sleep related causes.

*The number of sleep-related deaths may differ
from total Tulsa County Sleep-related deaths
because of TFIMR case selection criteria.
**Fetal deaths were excluded
Most infants died in a bed or on a couch
while sleeping with someone else.


                      28 (58.3%) Co-sleeping
                       22 with an adult(s)
                       5 with an adult(s) and another child(ren)
                       1 with another child(ren)

                      33 (68.7%) Sleep surface other than bassinet/crib
Most infants died at 2 months of age or less.




                            Deaths by Age:
                            33 (68.7%) were less than 3 months old
                            18 (37.5%) were 2 months old
                            Deaths by Cause:
                            16 (33.3%) SIDS
                            25 (52.1%) Undetermined
                            7(14.6%) Asphyxia

                            Red italic numbers - Co-Sleeping
                            Blue numbers - No co-sleeping
    Sleep Environment - Most infants were
    not placed in a safe sleep environment.
Unsafe sleep environment
w    Prone sleep position
w    Not in a crib or bassinet
w    Co-sleeping
w    Loose blankets, pillows or clothing
     in sleep area


Based on review of available records
39 (81.3%) Unsafe sleep environment
 9* (18.8%) Safe sleep environment

(*of the 9 infants noted to be in a safe sleep environment,
      sleep position was unknown for 5 infants)
Infant Health
w 10 (20.8%) recent illness with cough,
  congestion, or fever in days preceding
  death
w 14 (29.2%) at autopsy had petechial
  hemorrhages on the thymus, plura
  and/or epicardium
Summary Information
w   39 (81.3%) Non-safe environment

w   36 (75.0%) were not in a crib or
    bassinet, or had loose bedding or
    pillows in the crib or bassinet

w   28 (58.3%) were co-sleeping

w   33 (68.7%) occurred prior to the 3rd
    month of life

w   10 (20.8%) had been having
    symptoms of an illness with recent
    cough, congestion, or fever in the
    days preceding death

w   8 (16.7%) were pre-term (<37
    weeks gestation)

w   14 (29.2%) at autopsy had petechial
    hemorrhages on the thymus, plura
    and/or epicardium
Recommendations for Preventing Sleep
Related Deaths
NIH Back to Sleep Campaign Recommendations

1. Always place your baby on his or her back to sleep, for
   naps and at night.

2. Place your baby on a firm sleep surface, such as on a
   safety-approved crib mattress, covered by a fitted sheet.

3. Keep soft objects, toys, and loose bedding out of your
   baby’s sleep area.

4. Do not allow smoking around your baby.
Recommendations for Preventing Sleep
Related Deaths
 5. Keep your baby’s sleep area close to, but separate
   from, where you and others sleep.

6. Think about using a clean, dry pacifier when placing
   the infant down to sleep.

7. Do not let your baby overheat during sleep.

 8. Avoid products that claim to reduce the risk of SIDS.

 9. Do not use home monitors to reduce the risk of SIDS.

10. Reduce the chance that flat spots will develop on your
  baby’s head: provide “Tummy Time”.
Source: NIH Back to Sleep Campaign
Recommendations for Preventing
Sleep Related Deaths
Educational campaign of Safe Sleep Environment
  w Hospitals via discharge instructions, posters,
    informational videos
  w Sleep environment education for the public
  w Clinics – Prenatal care providers, Pediatricians,
    Family Practice
  w Media – Billboards, TV, Radio, Newspapers
  w Faith-based Organizations
  w Tulsa Area Immunization Coalition – KICK
    packets
    Acknowledgements / Further Information

•   Tulsa Fetal and Infant Mortality Review Project is supported in part by the
    Maternal and Child Health Block Grant in the Department of Health and
    Human Services, Health Resources and Services Administration,
    Maternal and Child Health Bureau.

•   For further information contact:
     Ø Carol Kuplicki, MPH, MCH Epidemiologist (918) 595-4499,
        ckuplicki@tulsa-health.org
     Ø Pam Rask, MPH, Manager – School Health/TFIMR (918) 595-4418,
        prask@tulsa-health.org

				
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