It it known that maternal substance use during pregnancy increases risk of sudden unexpected infant death (SUID), including via unsafe sleep practices. Authors of a study published in Pediatrics sought to indentify targeted prevention opportunities by comparing characteristics of sleep-related SUID among infants born prenatally substance exposed versus nonexposed.

Lead study investigator Stephanie Anne Deutsch, MD, MS, MSCR, FAAP—medical director, Children at Risk Evaluation (C.A.R.E.) Program, Nemours Children's Health, Wilmington, Delaware—joined Contemporary Pediatrics to highlight the study and explain recommendations and preventive measures for families impacted by substance use. Such families, according to the authors, frequently experience disproportionate social drivers of poor health and family vulnerability likely contributory to fatality risk.

"At the local level, I am involved in child fatality review processes in the Delaware Valley region, and we were noticing a trend of increasing SUID among infants that had a history of prenatal substance exposure and concerning circumstances amongst those deaths, including report potentially of caregiver impairment," said Deutsch. "That inspired us to look at this topic at the national level and obtain data from the National Center for Fatality Review and Prevention through their case reporting system."

Using the Sudden Death in the Young Registry, Deutsch and investigators examined SUID with sleep-related death between 2015 and 2020 across infants prenatally exposed versus nonexposed. Distribution of sleep environment characteristics, social drivers of poor health, and family vulnerability factors were examined using descriptive statistics and χ².

Among 2010 infants who experienced sleep-related deaths, 14% (n = 283) were prenatally exposed. Over half (52%; n = 1045) of deaths involved an adult bed or surface sharing (53%, n = 1074) with an adult.

"When we looked specifically at the data, dichotomized by prenatally substance exposed infants versus nonexposed infants, we identified that supervisors of prenatally exposed infants were disproportionately impaired versus supervisors of nonexposed peers [(34%, n = 97 vs 16%, n = 279)]," said Deutsch. "Most prenatally exposed infants whose supervisors were impaired were also bed sharing at the time of the infant death event."

Overall, 1 in 4 deaths of prenatally exposed infants (n = 70) involved child death review-determined supervisors who were both impaired and bedsharing.

Based on study findings, Deutsch and authors concluded that sleep-related SUID in prenatally exposed versus non exposed differ in sleep environment characteristics and contributory social vulnerability. Sleep evnironment hazards for those prenatally exposed "should compel targeted prevention efforts, including safe sleep messaging, discouraging surface sharing, and engaging support persons during impairment periods," wrote the study authors.

"Experts have long suggested that there is a need to provide greater emphasis on safe sleep practices and education for families impacted by substance use, and part of that stems from early studies that were conducted looking at relationship between substance use, caregiver impairment, intoxication, and then potentially placement of that infant into a hazardous environment," Deutsch said in the interview. "So here, we really feel that families of infants born prenatally, substance exposed, may benefit from de-stigmatized and targeted SUID prevention efforts, including specific counseling and anticipatory guidance that discourages surface sharing and that calls for potential engagement of a nonimpaired caregiver at the time the infant may be sleeping, in order to reduce any sort of hazards in the sleep environment."

"We think that safe sleep counseling is very important to be reinforced as anticipatory guidance at every well child visit, but there may be particular guidance that's necessary for families impacted by substance use, as we know, these families may also experience multiple psychosocial adversities that may relate to the substance use, including socioeconomic stressors impacted access to healthcare, education, and mental health treatment services," added Deutsch. "This may also result in limited material access, for example, to an infant safe sleep space like a crib or bed. So it's important for pediatricians to keep in mind that their counseling also addresses the social drivers of health, in addition to that safe sleep messaging."

David Turkewitz, MD

Related content:

Reviewing the AAP's sudden infant death syndrome 2022 guidelines

David Turkewitz, MD, medical director of Newborn Nurseries at Allegheny Health Network in Pittsburgh, Pennsylvania, emphasized the critical role of pediatricians in educating families about strategies to prevent sudden infant death syndrome (SIDS) and sudden unexpected infant death (SUID). He underscored the importance of staying informed about the latest guidelines to better support families during well-infant visits.

Click here to watch this video interview.

Reference:

Deutsch SA, Loiselle CE, Hossain J, De Jong A. Sleep-Related Sudden Unexpected Infant Death Among Infants Prenatally Substance Exposed. Pediatrics. 2024; e2024067372. 10.1542/peds.2024-067372