Although the infant homicide rate nationally is increasing, some state health officials suspect the rate would at least double if many “unknown cause” deaths were correctly reclassified.  A new study conducted by HRSA and researchers from other federal agencies backs up this contention and urges state officials to improve investigations by providing greater support for state mortality review teams.

“National Underascertainment of Sudden Unexpected Infant Deaths Associated with Deaths of Unknown Cause,” by first author Mary Overpeck, Dr. P.H., HRSA’s Maternal and Child Health Bureau, was published in the February edition of Pediatrics.  Dr. Overpeck and her colleagues compared birth and death certificates for all unexpected U. S. infant deaths during 1983-91 and 1995-96.  They identified 53,470 deaths from Sudden Infant Death Syndrome (SIDS) -- the sudden death of an infant that can’t be explained by medical history or postmortem examinations.  Another 9,071 deaths were related to unintentional injury, 3,473 deaths were connected with intentional or suspicious injury, and 8,097 deaths were classified as having “unknown underlying cause.” 

The study documents many delays throughout the reporting process.  Because cases still under investigation are classified as due to unknown cause, this under-reports how many babies actually die from SIDS, unintentional injury, child abuse or neglect.  Some state health officials say there is 60 percent to 100 percent under-reporting nationally of deaths from child abuse.  Researchers’ data support this estimate while suggesting that less than half the deaths from unknown cause might be caused by SIDS.

Beyond calling for more state resources for investigations, researchers also call for medical examiners to modify death certificates promptly, states to submit timely corrections to national files, and files to note cases as pending rather than indicating unknown cause.  States, social service agencies and health care providers must also work together, researchers emphasize, to develop prevention programs to reduce infant deaths.

HRSA and the National Institute of Child Health and Human Development fund the “Back to Sleep Campaign,” a prevention program that has steadily helped reduce SIDS deaths.  The campaign encourages caretakers to put infants on their backs to prevent choking or suffocation.  HRSA also supports prevention programs on unintentional injury and child abuse.

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