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AAP Grand Rounds 21:8 (2009)
© 2009 American Academy of Pediatrics

Sudden Unexpected Infant Death Associated With Bassinet Use

Investigators from the Children’s National Medical Center, Washington, DC, performed a retrospective review of infant deaths associated with bassinet sleeping reported to the Consumer Product Safety Commission (CPSC) between 1990 and 2004.

PICO Question: What are the circumstances and risks associated with infant deaths in bassinets? Question type: Harm Study design: Case series

 

Cases were obtained through a search of three CPSC databases: Death Certificate, Injury and Potential Injury Incidents, and InDepth Investigations. Information in the databases is based on voluntary reports by police, fire departments, insurance investigators, health care professionals, manufacturers, retailers, and consumers from all 50 states and the District of Columbia.

Data on 53 deaths of infants sleeping in bassinets were analyzed. The mean age at death was 84 days, and 90% occurred at between 30 and 180 days of age. Six infants (11%) were born prematurely and one each had congenital syphilis and myotonic dystrophy. The cause of death was anoxia, asphyxiation, or suffocation in 85% and sudden infant death syndrome (SIDS) in 9%. The remaining three infants died of thermal burns, anoxia and heat stress, or unspecified causes.

In the 35 patients with known initial sleep positioning, 20 (57%) were positioned prone. Information on position when found dead was known for 39 infants; 30 of these children (77%) were found prone. Five infants who were reportedly put to sleep on their sides were found prone. Six infants were found with their faces "wedged against the side of the bassinet." In 74% of deaths, nonessential objects (anything other than mattress, fitted sheet, rattle, or pacifier) were found in the bassinet. These items included blankets, stuffed toys, bottles, plastic bags, and adult pillows. In 17% of cases, mechanical failures or defects of the bassinet were reported.

The authors conclude that health care professionals and other caregivers should discuss the unique risks of bassinets with parents of young infants.

Commentary by Michael B. Aldous, MD, FAAP

Private practice, Nampa, ID

 
Dr. Aldous has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Key Words: bassinet • sudden infant death/SIDS • sleep position

The authors are to be commended for this study of bassinet use, a common exposure about which little safety information is available. Bassinets are among the sleep locations recommended by the AAP.^1,2

The results of the present study are thought provoking, but are not an indictment of bassinet sleeping in general. This case series does not allow calculation of death rates in bassinets or comparison with other sleep locations, although such comparative data are needed.

While the prone sleeping rate in the US changed dramatically during the period of study, the proportion of infants found prone in this study seems higher than expected.¹ This observation raises the question of whether infants in bassinets are more likely to find themselves prone than infants in other types of beds. Contrary to current recommendations, the majority of victims were found with nonessential items in the bassinet.¹ Such objects may pose a greater suffocation risk in a bassinet, where they are likely to be closer to the sleeping infant than in a larger bed.

Despite substantial recent declines in SIDS deaths, approximately one in 500 infants dies in the postneonatal period.² Many of these deaths occur during sleep. The present study is a reminder that some caretakers of infants still either don’t know or don’t follow safe sleeping recommendations.

Perhaps a few tragic deaths can be prevented by asking specific questions about an infant’s sleep environment during a health supervision visit, including sleep position, the type and condition of the bed, bedding, and other objects in and around the bed, and by reinforcing AAP safe sleeping recommendations.¹

Editors’ Note

There are few topics in pediatrics that produce as much controversy and emotion as SIDS or sudden unexplained death in infancy (SUDI). Unfortunately, this study provides more heat than light because, as is pointed out in the commentary, the study methodology makes it impossible to determine whether infants sleeping in bassinets are at increased risk of SUDI or whether the deaths described are simply a representative sample of all such events occurring during the study period. It is important to recognize that during the first 2+ years of the study, the prone position was still recommended for young infants. Finally, because of agonal events or resuscitative efforts, how an infant is found after death may not accurately describe how the child was sleeping before the SUDI event occurred.^3,4

References

1. Task Force on Sudden Infant Death Syndrome. Pediatrics. 2005;116:1245–1255.[Abstract/Free Full Text]
2. CDC. CDC Wonder. Compressed Mortality, 19992005. Available at: http://wonder.cdc.gov/mortSQL.html. Accessed October 30, 2008.
3. Beal SM, et al. J Paediatr Child Health. 1991;27:334–339.[Medline]
4. Bergman AB, et al. Pediatrics. 1972;49:860–870.[Abstract/Free Full Text]

This Article Extract Full Text (PDF) Take the CME quiz: Vol. 21 No. 1, January 2009 Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Aldous, M. B. Search for Related Content PubMed Articles by Aldous, M. B.