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Indiana SIDS Report
Sudden Infant Death Syndrome
 1989-1996

Note: Because of delays with other states' data about Indiana residents who were born or died out-of-state, data for 1996 is not final data but provisional only and not yet available in the same detail as is available for 1991 through 1995. This means that any reference to 1996 in this report is based on provisional data and may change when final data becomes available.

Introduction | Background | Trends | Current 1997 Recommendations | Indiana SIDS 1995-96 Fact Sheet
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Sudden Infant Death Syndrome in Indiana

Sudden Infant Death Syndrome (SIDS) is the sudden, unexpected death of an infant under one year of age that remains unexplained after a complete autopsy, death scene investigation, and review of the medical history. It is a diagnosis of exclusion, being concluded only after other alternatives are eliminated.

While the cause or causes of SIDS are still not known, recent research has identified steps that parents can take to lower their baby's chances of dying from SIDS. This report will provide facts and characteristics of SIDS deaths in Indiana and also determine what impact recent changes in infant sleep positioning practices has had on the incidence of SIDS deaths in Indiana.

Background

In 1992 the American Academy of Pediatrics recommend that full term, healthy infants be placed to sleep on their side or back. This recommendation was the result of numerous research studies done mainly in other countries that showed that risk of SIDS was nearly two and a half times greater for infants who slept on their stomach compared to infants who slept on their side or back. The National Institutes of Health convened a panel of experts to monitor the incidence of SIDS in these countries and to determine whether a public education campaign regarding the association between SIDS and sleep positioning was warranted in the United States. In March 1994, as a result of this panel, the National Institutes of Health launched the Back to Sleep Campaign.

This Campaign contained the following key messages:

  • Full term, healthy infants should be placed to sleep on their side or back.
  • Infants should sleep on a firm surface or mattress, preferably in an approved crib.
  • Mothers should not smoke during pregnancy and should keep infants in a smoke-free environment.
  • Infants should not be allowed to get overheated.
  • If possible, infants should be breastfed.

 

In August 1994, public service announcements regarding these recommendations began appearing on cable television stations throughout Indiana. In May 1995, the Indiana State Department of Health SIDS Advisory Community Council and staff, in conjunction with the Indiana Chapters of the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the Association of Family Practice Physicians, Riley Hospital for Children, and the Central and Northern Indiana Affiliates of the National SIDS Alliance formally launched the Indiana Back to Sleep Campaign.

Trends

Since the introduction of this campaign, the number of SIDS deaths per year in Indiana has fallen by around a third, from an average of 128 from 1989 - 1993 to 84 in 1995 and 87 in 1996. This resulted in a decline in the SIDS rate from 1.5 per 1000 live births between 1989 - 1993 to 1.0 per 1000 live births in 1995 - 1996.

The decline in SIDS deaths was not the result of increases in the number of deaths due to other causes such as asphyxia, pneumonia, suffocation, fetal distress, or "unknown." Combined, the number of deaths for these categories also declined from 1989 - 1993 average to 1995 - 1996.

Current 1997 Recommendations

The Indiana State Department of Health SIDS Advisory Council and staff recommend:

  • placing healthy infants to sleep on their backs;
  • maintaining a smoke-free environment;
  • not over wrapping infants, especially when they are sick;
  • infants sleeping in approved cribs on firm mattresses, with no pillows, comforters, bumper pads, or stuffed animals in the crib;
  • mothers getting early prenatal care when pregnant;
  • immunizing infants;
  • and breastfeeding if at all possible.

Further research is needed to determine the impact of home monitors on SIDS deaths. At this time, the use of home monitors should be decided on a case by case basis. Indiana is fortunate to have James Whitcomb Riley Hospital for Children located in Indianapolis available for referral. Questions should be directed to Deborah Given, M.D., Director of the Apnea and Sleep Disorder Center, 317/274-9650.

INDIANA SIDS 1995-96 FACT SHEET

SIDS in Indiana: Deaths and Rates

FACT

During the years 1991-1996, there were 663 Sudden Infant Death Syndrome (SIDS) deaths in Indiana from the 501,727 infants in Indiana in those years. Of these SIDS deaths, 506 (76%) were White, 151 (23%) were Black. This meant SIDS rates of 1.2 per 1000 live births for Whites and 2.8 per 1000 live births for Blacks.

The majority of SIDS deaths (414, or 62%) were male, and 213 (38%) were female. This meant average SIDS rates of 1.6 per 1000 live male births and 1.0 per 1000 live female births.

Black males, with a rate of 3.1 per 1000 live births, were more at risk than Black females, whose rate was 2.5 per 1000 live births. White males, with a rate of 1.4 per 1000 live births, were more at risk than White females, whose rate was 0.9 per 1000 live births.

Since the introduction of the 'Back to Sleep' campaign in 1994, the number of SIDS deaths has fallen significantly. During the five years prior to the campaign, 1989-1993, the state averaged 128 SIDS deaths per year. In 1996, there were 87 SIDS deaths in Indiana. In 1995, Indiana SIDS deaths numbered 84. This represented a drop from an average SIDS rate of 1.5 per 1000 live births during the years 1989-1993 to a rate of 1.0 per 1000 live births in 1995 and 1996, indicating a drop of one-third in the risk of SIDS death. (Statistically significant: p = 0.001. Relative Risk = 0.68 [0.58<RR<0.81]) (Relative risk is a comparison measure of the risk of some health-related event such as disease or death in two population groups.)

The decrease in the frequency of SIDS deaths was not caused by any increase in the frequency of possible alternative diagnoses in the case of sudden deaths in Indiana infants. Asphyxia and fetal distress in live born infants fell for 1995-1996 from their 1989-1993 averages, but the declines were within the range of normal fluctuations. Suffocation and "unknown" both rose only slightly, also within the range of normal fluctuations. Only infant pneumonia deaths changed significantly and, like SIDS, they fell. (p = 0.047. Relative risk = 0.57 [0.33<RR<1.00]) Combined, the five alternatives fell by around a fifth, but because of their relative infrequency the decline was within the range of normal fluctuation and not statistically significant. (p = 0.086. Relative risk = 0.81 [0.63<RR<1.03])

The improvement in SIDS rates has impacted Whites but not Blacks significantly. For Whites, the average number of SIDS deaths has fallen from 102 per year in 1989 - 1993 to 64 per year in 1995 - 1996. This meant a decline in the White SIDS rate from 1.4 per 1000 live births in 1989 - 1993 to 0.9 per 1000 in 1995 - 1996, indicating a drop in the risk of SIDS death by around one-third. (Statistically significant: p = 0.001. Relative risk = 0.64 [0.53<RR<0.78]) For Blacks the decline from a yearly average of 27 SIDS deaths in 1989 - 1993 to an average of 20 SIDS deaths in 1995-1996, a drop in the rate from 2.9 per 1000 live births to 2.4 per 1000 live births was not statistically significant. (p = 0.264. Relative risk = 0.82 [0.58<RR<1.16])

The difference between Black and White rates is statistically significant. For the years 1995-1996, Blacks infants had more than double the risk of SIDS as White infants. (Statistically significant: p = 0.001. Relative risk = 2.67 [1.88<RR<3.80]) For male babies, Black infants had slightly less than double the risk of White infants. (Statistically significant: p = 0.001. Relative risk = 1.91 [1.16<RR<3.15]) However, for female babies, Black infants had four times the risk as White infants. (Statistically significant: p = 0.001. Relative risk = 4.13 [2.48<RR<6.88])

During the years 1991-1995, the majority of SIDS deaths (54%) occurred during the first two months of life. Another 20% occurred during the third month. Only 5% of SIDS cases happened after the first six months of life.

Of the 576 SIDS deaths during the 1991-1995 years, 257 (or 45%) occurred in one of Indiana's five urban counties, Allen, Lake, Marion, St. Joseph, or Vanderburgh, for an overall urban SIDS rate of 1.6 per 1000 live births. Within suburban counties, there were 242 SIDS deaths (or 42%) for a rate of 1.3 per 1000 live births. Within rural counties, there were 77 SIDS deaths (or 13%) for an overall rural SIDS rate of 1.2 per 1000 live births. Because of differences in the total numbers of live births in urban, suburban, and rural areas and the infrequency of SIDS death, the differences in SIDS rates were not statistically significant.

With an average rate of 1.9 per 1000 live births for the years of 1991-1995, St. Joseph county's SIDS rate was significantly higher than the rest of the state. (p = 0.049. Relative risk = 1.40 [1.00<RR<1.96]) The Central suburban counties, which encircle Indianapolis, and the rural counties of Northwest Indiana had regional SIDS rates significantly below the state rate, 0.8 per 1000 live births and 0.7 per 1000 live births, respectively . (For the Central suburban counties, p = 0.001. Relative risk = 0.57 [0.40<RR<0.80] For the rural counties of Northwest Indiana, p = 0.022. Relative risk = 0.54 [0.32<RR<0.92])

There were 119 SIDS deaths in Marion county, 50 in Lake county, 40 in Allen county, 36 in St. Joseph county, and 20 in Elkhart county during the 1991-1995 years.

Ten Indiana counties had no reported SIDS deaths during the years of 1991-1995: Benton, Boone, Fountain, Franklin, Fulton, Ohio, Pulaski, Switzerland, Vermillion, and Warren.

 

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