Photo: Stock photo by Isaac del Toro/Unsplash

(The Dallas Examiner) – The infant mortality rate in the U.S. hit a record low in 2020 with 541.9 infant deaths per 100,000 live births. However, the rate of sudden infant death syndrome – known commonly as SIDS – increased by 15% between 2019 and 2020, moving it up to the third leading cause of infant death, according to a study Sudden Unexpected Infant Deaths: 2015–2020 by the Center for Disease Control and Prevention.

“With the data that we had available for this study; we couldn’t answer the question of why we saw the increases we did see. Some of our hypotheses are that there were potential changes in how sudden infant deaths were being reported and how they were being certified by death certifier, like medical examiners and coroners,” said Dr. Sharyn Parks Brown, an epidemiologist and senior scientist in the Reproductive Health Division of the CDC.

She went on to explain there were guideline changes released to the medical community in 2019 that may have impacted how deaths were reported. She also suggested the changes could have been a result of the medical examiners and coroners’ offices being overburdened by the influx of COVID pandemic-related deaths, which may have affected the ability to conduct infant death investigations as thoroughly as they normally would.

To understand if the increase in SIDS was related to death certifications or COVID, the study examined the rate of sudden unexpected infant death – also known as SUID – was examined as a group by cause, race and ethnicity. The analysis showed a significant increase in the SIDS rates for Back infants. The rate was nearly triple the rate for non-Hispanic White infants (75.6)

“That was the really surprising, unexpected piece with this analysis. When we stratified by race and ethnicity. We found that the rate of SUID among non-Hispanic Black infants increased from 2019 to 2020. And just for a little bit of context, historically, those SUID rates have been consistently highest for American Indian Alaskan natives followed by non-Hispanic Black infants,” Parks said.

“For the first time since we started tracking the data nationally in 1995 the rate for non-Hispanic Black infants is higher than it was for American Indian Alaskan Native infants,” Parks explained. “I’d like to stress that this was one year of data. It’s possible that it’s just an artifact in the data. So, it’s something that we’re going to have to continue monitoring as the next couple of years of data come out.”

The study found that among the 19,446 infant deaths in 2020, 35 deaths (0.2%) had COVID-19 listed as an underlying cause of death. Among the 3,328 SUID in 2020, less than 10 deaths had a COVID-19 code indicating an additional cause of death, rather than an underlying cause.

“I think we can’t really parse out how COVID may have directly impacted the rates that we saw. We did specifically look at whether any of the SUID cases in our study had a COVID-contributing cause, and we didn’t see any significant proportion of the SUID deaths that had COVID as a contributing cause of death.… So, from 2019 to 2020 we didn’t see any evidence that COVID was a significant driver of SUID,” Parks said.

“But again, we do know that the later variants – the Delta and Omicron variants of COVID – had more of an impact on children and infants. So, that’s something that we’ll be looking more into as we get access to data from 2021 and 2022.”

The study also suggested that the way COVID-19 disproportionately affected the African American community could have been indirectly linked to the increased rate of SUID in Black infants. Many families, especially during the COVID stay-at-home or shelter-in-place orders, resorted to living in multigenerational households. Also, some parents may have felt compelled to place their infants in bed with them or other unsafe sleeping environments, such as sharing with a sibling or another infant/toddler relative.

Parks urged caution, reminding parents and caretakers to follow the basics of infant safe sleep.

“That’s making sure babies are in a safe sleep environment for every sleep that includes nap and bedtime, following the American Academy of Pediatrics recommendations. So, baby on its back in a crib or bassinet with no soft bedding. Hopefully having the infant in the caregiver’s room but not in the same bed for at least the first six months.”

Robyn H. Jimenez/The Dallas Examiner contributed to this report.

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