Sleep position and bed-sharing in sudden infant deaths: An examination of autopsy findings

Objective: To determine the effect of sleep position, sleep location, and b ed-sharing on the incidence of sudden unexpected death in infancy and the f requency of significant autopsy findings. Methods: We evaluated the cause of death in infants <1 year of age who died during sleep from January 1, 1986, through September 30, 1999. This retros pective series was compiled from log books and files of the Medical Examine r Office, Palm Beach County, Florida. Results: The incidence of sudden unexpected infant death decreased 50% over the study period (P <.01). Of the 217 infants that fit the study criteria, 62.7% were sleeping prone ton the stomach), 9.7% were supine ton the back) , 5.5% were on their side, 22.1% were in an unknown position, and 40.1% wer e bed-sharing. Significant autopsy findings that could explain death were d ocumented by autopsy in 37.5% of all supine and side sleeping infants and o nly 14.0% of all prone sleeping infants (P <.001). Deaths of supine and sid e sleeping infants were more likely to be classified as a natural disease p rocess other than sudden infant death syndrome (P <.01). Significant autops y findings that could explain death were found in 47.6% of the infants slee ping atone in the supine or side position (P <.01), 18.2% of infants bed-sh aring in the supine or side position, 16.5% of infants sleeping alone white prone, and 9.3% of infants bed-sharing while prone. Conclusions: infant deaths associated with the prone position were less fre quently explained by illness or disease than infant deaths associated with non-prone sleeping positions. Bed-sharing appears to increase the proportio n of unexplained deaths, regardless of the position of the infant. The "Bac k to Sleep" campaign appears to be effective in reducing the incidence of u nexpected steeping infant deaths regardless of the certified cause of death .