Presenter Profile
Gina S. Lowell, MD, MPH
Rush University Children's Hospital
Principal Investigator, Cook County SUID Case Registry and Prevention
gina_lowell@rush.edu
Gina Lowell MD, MPH is an academic general pediatrician at Rush University Children’s Hospital in Chicago with specialty interests in childhood injury prevention, child abuse and neglect, and early relational health. As Director of Community Health for Pediatrics she collaborates with public health agencies and community-based organizations to advance maternal-child health equity. She is the current Principal Investigator for the CDC-funded SUID Case Registry and Prevention for Cook County, IL. This team established Community Partnership Approaches for Safe Sleep (CPASS) - Chicago in 2022 and has since expanded their SUID prevention approaches to include training opportunities for public health nurses, doulas, WIC staff, and other community health organizations motivated to partner in SUID prevention.
Presentations
Sleep-related infant death and inclined sleep in Cook County, IL
Gina S. Lowell, MD, MPH
Sumihiro Suzuki, PhD
Rojin Ahadi, MPH
Kyran Quinlan, MD, MPH
Sudden Unexpected Infant Death (SUID) is the leading cause of death for infants once discharged home after birth, causing ~3700 infant deaths yearly in the United States. Inclined sleep products have been implicated in a number of these deaths, and biomechanics studies have demonstrated that inclined surfaces facilitate infant rolling, which may lead to accidental suffocation. These insights informed the manufacturing ban of inclined sleep products in the US, and the Infant Sleep Product Rule safeguards that all infant sleep products have a sleep surface angle of ten degrees or less. However, little is known about the risk related to inclined sleep unrelated to such products. This study describes those SUID in Cook County, IL who were placed to sleep on an incline and subsequently died.
The narrative and scene photo for each sleep-related infant death in the Cook County SUID Case Registry from 2019-2024 were analyzed for indications that the infant was placed to sleep on an estimated sleep surface angle of more than ten degrees. Two reviewers (GL and KQ) categorized the likelihood of inclined sleep as 1) Definite, inclined sleep was clearly indicated; 2) Probable, inclined sleep was probably indicated; 3) Possible, inclined sleep was suggested; 4) Not indicated; 5) Unknown. Deaths categorized as “definite” and “probable” were considered inclined sleep.
Among 247 sleep-related infant deaths, 87 (35%) occurred after an infant was placed to sleep on an incline [definite (69, 28%), probable (18, 7%)]. Inclined surfaces were created by adult pillows (40, 46%); a parent’s arm/chest (20, 23%); a pillow product (15, 17%) such as nursing pillows (9), pregnancy pillows, infant neck pillows, or boppy loungers; and inclined products (11, 13%) such as car seats (5), swings, bouncers, or inclined sleepers. Infants were placed to sleep on inclines in adult beds (57, 66%) and couches/futons (9, 10%), and 58 (67%) infants were surface sharing with adults and/or other children. After being placed to sleep on an incline, 30 (34%) infants were subsequently found unresponsive on their side (14) or stomach (16). Twenty-three (26%) deaths were attributed to accidental suffocation. Inclined sleep deaths peaked at 1-2 months old, and 74 (85%) of these deaths occurred before 6-months-old. These deaths occurred among infants who were born preterm (21/86, 24%); had prenatal and/or household tobacco smoke exposure (17/68, 25%); and had maternal substance use history (30/81, 37%). Infants were placed to sleep on an incline by one of their parents (79, 91%).
More than one-third of sleep-related infant deaths in Cook County occurred when infants were placed to sleep on an incline largely unrelated to an infant sleep product. Inclined sleep products have received needed attention resulting in their recall, but most incline deaths typically involve pillows or a parent’s body while bedsharing. Prevention messaging must be broadened to specifically raise awareness of the danger of inclined sleep unrelated to inclined sleep products.
1. Inclined sleep contributes to more than one-third of sleep-related infant death in Cook County, IL.
2. Inclined sleep surfaces are largely created by pillows or a parent's arm/chest.
3. Implications include broadening prevention messaging and evaluating the biomechanics of inclined sleep unrelated to inclined sleep products.