Individual-, Hospital-, And Community-Level Factors Associated With Sudden Unexpected Infant Death Among Infants Born Preterm in 5 US States

Sunah S Hwang; Stephanie L Bourque; Kathleen E Hannan; Molly Passarella; Joshua Radack; Brielle Formanowski; Scott A Lorch

doi:10.1016/j.jpeds.2024.114445

Individual-, Hospital-, And Community-Level Factors Associated With Sudden Unexpected Infant Death Among Infants Born Preterm in 5 US States

J Pediatr. 2024 Dec 24:114445. doi: 10.1016/j.jpeds.2024.114445. Online ahead of print.

Authors

Sunah S Hwang¹, Stephanie L Bourque², Kathleen E Hannan², Molly Passarella³, Joshua Radack³, Brielle Formanowski³, Scott A Lorch³

Affiliations

¹ Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine. Electronic address: Sunah.hwang@childrenscolorado.org.
² Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine.
³ Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania.

PMID: 39725311
DOI: 10.1016/j.jpeds.2024.114445

Abstract

Objective: To investigate individual-, hospital-, and community-level factors associated with sudden unexpected infant death (SUID) among infants born preterm.

Study design: The following linked dataset from 5 states (California, Michigan, Oregon, Pennsylvania, and South Carolina) from 2005 through 2020 was used: 1) infant birth and death certificates; 2) maternal and infant birth hospitalization discharge records; 3) birthing hospital data from the American Hospital Association; and 4) community-level data from the Social Vulnerability Index (SVI).) Multivariable models were used to assess the independent association between these multi-level factors and SUID, adjusting for several maternal and infant characteristics.

Results: Overall, we found that maternal demographic factors (race and ethnicity, education, insurance) and infant gestational age were significant predictors of SUID. There was no difference in SUID odds by state, urban influence code, and maternal complications of pregnancy. Compared with mothers who lived in areas with the lowest SVI, those who resided in the highest SVI were more likely to experience SUID. There was no difference in SUID odds between infants who did or did not experience one or more complications of prematurity. For hospital-level factors, there was no difference in SUID odds among infants cared for in teaching versus non-teaching hospitals or in low versus high volume preterm birth hospitals.

Conclusion: Individual- and community-level factors were associated with SUID among infants born preterm. The neonatal intensive care unit hospitalization may provide a critical window of opportunity to engage families about SUID-risk reducing practices.