Layered risk: Sudden Unexpected Infant Death in the 2nd Largest US County

Gina Lowell, MD, MPH
Rojin Ahadi, MPH
Sumihiro Suzuki, PhD
Felicia Clark, D-ABMDI
Christie Lawrence, DNP, RNC-NIC, APN/CNS
Meredith Reynolds, MD
Kyran Quinlan, MD, MPH

Sudden Unexpected Infant Death occurs about once a week in Cook County, Illinois, the second largest county in the United States, where SUID disproportionately affects families from high hardship communities. Factors like prematurity, prenatal smoking, and unsafe sleep environments are known risk factors for SUID. The Cook County SUID Case Registry team reviews each SUID following monthly Child Death Review meetings and these data are analyzed annually to identify possible prevention insights.

Cook County SUID Case Registry data from 2019-2023 were analyzed for descriptive characteristics including infant age, race, ethnicity, gestational age, maternal age, prenatal/household smoke exposure, and sleep environment hazards. Case reviews (including narrative review) identified patterns of risk which were quantified to provide proportions of SUID that occurred among families with histories of domestic violence or substance use; and among families whose infant died when they were away from their usual home (“temporary stays”). SUID that occurred among preterm infants during temporary stays were further analyzed to detail risk among this population.

From 2019-2023 there were 220 SUID, of which 206 (94%) were sleep-related. SUID peaked among infants aged 1-2-months old. 55 (27%) SUID were found to be due to accidental suffocation. Nearly all infants (99%) were found in an unsafe sleep environment. Infants were found on their side or stomach (86, 42%); while bedsharing (134, 65%); in a non-approved infant sleep space (172, 83%); and/or with soft bedding (189, 92%). SUID occurred among 154 (75%) Non-Hispanic Black (NHB) infants, 33 (16%) Hispanic infants, and 17 (8%) non-Hispanic White (NHW) infants. SUID occurred in 56 (28%) preterm infants. SUID occurred among 30/166 (15%) infants with prenatal/household smoke exposure, among 31 (15%) families with a history of domestic violence and 49/181 (27%) families with a history of substance use (when these variables were known). SUID occurred among 33 (16%) infants during temporary stays, whose peak age at death was 4-months-old. Thirteen SUID occurred among preterm infants during temporary stays: Amont these infants, all were Non-Hispanic Black (NHB) and 5 (38%) were one of twins. Four (31%) were categorized as suffocation-related SUID. No crib was present in the temporary stay location for 5/11 (45%) infants for whom this information was known. Multiple unsafe sleep factors [non-supine sleep (5/13, 38%), non-approved sleep surface (13/13, 100%), bedsharing (11/12, 92%), soft bedding (13/13, 100%)] were present. Bedsharing occurred on adult beds (12/13) which were shared by adults [10/13 (77%)], siblings [8/13 (62%)], or both adults and siblings [6/13 (46%)]. Ten families (77%) had a history of child welfare involvement. Six infants (46%) were in the care of non-parent supervisors when they died.

SUID in Cook County is closely tied to complex social issues including domestic violence, substance use and temporary stays. Preventing SUID connected to these issues necessitates partnership with the trusted social agencies that address them.

1. SUID epidemiology in Cook County, IL
2. Proportion of SUID associated with complex social circumstances
3. Local SUID epidemiology may drive new prevention partnerships

Way Beyond the ABC’s: Tailoring Safe Sleep Training for Community Health Agencies

Felicia Clark, D-ABMDI
Christie Lawrence, DNP, RNC-NIC, APN/CNS
Gina Lowell, MD, MPH

Following extensive dissemination of the Cook County SUID Case Registry (SUID-CR) data and Community Partnership Approaches for Safe Sleep (CPASS Chicago) prevention efforts, CPASS Chicago was asked to provide safe sleep training to the City of Chicago’s postpartum home visiting nurses. This invitation spurred our efforts to replicate and expand CPASS Chicago’s approach with families and community members to reach community health partners supporting pregnant and parenting families.

This workshop will provide an overview of the CPASS Chicago approach and lessons learned in tailoring Safe Sleep training to specific community health agency roles and needs. We will share our experience training home visiting nurses, doulas, social workers and WIC providers. We will discuss the value of 1) sharing local epidemiology coupled with individualized SUID case review, 2) describing barriers to safe sleep among specific populations served by community health agencies, 3) listening to community health partners’ experiences within their community, 4) encouraging community health partners to consider their role in SUID prevention, and 5) using a trauma-informed, strengths-based, relational approach.

We will then break out into 3 groups to lead colleagues in considering various approaches to tailoring safe sleep training for their communities. We will share elements of our approach including humanizing data, conversation starters, #clearthecrib challenge, building on agency values, strengths and assets, addressing common myths, and providing tangible resources. At the conclusion of the workshop, colleagues will come away with methods to strengthen their safe sleep training approaches to get way beyond the ABC’s.

1. Identify opportunities within your current workflow to address safe sleep practices in your community.
2. Identify strategies for addressing barriers within a specified population.
3. Analyze the applicable areas of evidenced based practice that address safe sleep barriers & solutions.
4. Summarize opportunities for optimizing safe sleep practices and provide family-centered methods to support safe sleep.