By Kate Marino

Infant mortality in the United States decreased by 24.2% between 1999 and 2022. Researchers from Virginia Commonwealth University and Children’s Hospital of Richmond at VCU discovered this improvement in research recently published in Journal of the American Medical Association Pediatrics.

However, the same study found that infant mortality from Sudden Unexpected Infant Death (SUID) rose significantly – by 11.8% – between 2020 and 2022.

Elizabeth Wolf, M.D., a pediatrician at CHoR and associate professor in VCU School of Medicine’s Department of Pediatrics, was the lead author on the study and provides a closer look at what it means.

First, the good news. Infant mortality overall is going down. What do you attribute to this trend?

Research and technology have led to enhancements in health care over the past 25 years. Improved screening and treatment for maternal diseases, better obstetric management and neonatal care are likely all contributing factors to the declining infant mortality rates.

Before we get into the cause of increasing SUID, can you explain what is SUID?

SUID stands for Sudden Unexpected Infant Death. As the name states, it’s the sudden and unexpected death of a baby younger than 1 year of age, meaning there was no known underlying health condition. SUID includes sudden infant death syndrome (SIDS), accidental suffocation and strangulation in bed, and other deaths from unknown causes.

Why are we seeing an increase in SUID?

It’s difficult to pinpoint exact causes, but COVID-19 and parental opioid use are two potential factors. Social media may also be playing a role. In social media posts, infants are frequently seen in unsafe sleep positions, for example on their stomach instead of on their back, and in unsafe sleep environments such as adult beds, couches and baby swings. Infant positioners and other products can entrap infants and result in their airways being blocked.

Are all groups at equal risk of SUID?

SUID mortality is up across all racial and ethnic groups, but there are large disparities. The rate for Black infants is 10 times higher compared to Asian infants and three times higher than white infants. This could reflect unsafe sleep position, prematurity, tobacco exposure and/or infant feeding, but further research is needed to understand with confidence.

What can be done to reduce infants’ risk of SUID and reverse this upward trend?

An infant dying from SUID is a horrific tragedy and causes incomprehensible trauma to the family. Although not all SUID is preventable, there are some ways to reduce an infant’s risk.

Here are safe sleep tips for infants:

• Place an infant on their back to sleep (face up).
• Place an infant in a separate bassinet or crib with a firm mattress intended for infant sleep (no co-sleeping).
• Do not place an infant in a baby swing for sleep.
• Have the infant sleep in the parents’ room (but not in the same bed) for the first 6-12 months of their life.
• Do not place other objects in the crib that could potentially suffocate the infant (no pillows, loose blankets or bumpers).
• Refrain from drug or alcohol consumption while caring for an infant.
• If an infant falls asleep during a car ride, when arriving at home, take them out of the car seat and place them in their crib or bassinet.