{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T14:44:09Z","timestamp":1772030649185,"version":"3.50.1"},"reference-count":23,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T00:00:00Z","timestamp":1663113600000},"content-version":"unspecified","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007305","name":"Maternal and Child Health Bureau","doi-asserted-by":"publisher","award":["6H18MC00010-24-01"],"award-info":[{"award-number":["6H18MC00010-24-01"]}],"id":[{"id":"10.13039\/100007305","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,8,28]]},"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To examine the characteristics and circumstances of infants who died while sleeping or in a sleep environment and compare deaths classified as either unintentional asphyxia or an unexplained cause.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Data were extracted from the National Fatality Review Case Reporting System and Florida Vital Statistics databases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Data on 778 sleep-related infant deaths occurring from 2014 to 2018 in Florida were analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measure<\/jats:title>\n                    <jats:p>Cause of death classification as unintentional asphyxia or unexplained.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 36% (n=276) of sleep-related infant deaths in this study sample were classified as resulting from an unexplained cause compared with unintentional asphyxia. Most infants were reported to be in an adult bed (60%; n=464) and sharing a sleep surface with a person or animal (60%; n=468); less than half (44%; n=343) were reportedly placed to sleep on their back. After controlling for the influence of other independent variables, female sex (adjusted risk ratio: 1.36; 95% CI 1.06 to 1.74) and fully obstructed airway condition (adjusted risk ratio: 0.30; 95% CI 0.18 to 0.50) were associated with an unexplained cause of death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results of this analysis indicate that sleep environment hazards remain prevalent among infants who die suddenly and unexpectedly, regardless of the cause of death determination. While significant differences were observed for some factors, in many others the distributions of both demographic and incident characteristics were similar between unexplained deaths and those resulting from asphyxia. The results of this study support growing evidence that unsafe sleep environments contribute to all forms of sudden unexpected infant death, underscoring the need for standardising cause of death determination practices and promoting consistent, high-quality forensic investigations to accurately explain, monitor and prevent these deaths.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-059745","type":"journal-article","created":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T11:57:22Z","timestamp":1663156642000},"page":"e059745","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Comparing asphyxia and unexplained causes of death: a retrospective cohort analysis of sleep-related infant death cases from a state child fatality review programme"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8842-2974","authenticated-orcid":false,"given":"Megan","family":"Macdonald","sequence":"first","affiliation":[{"name":"Division of Children's Medical Services, Florida Department of Health, Tallahassee, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Thompson","sequence":"additional","affiliation":[{"name":"Independent Statistical Consultant, Tallahassee, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robin","family":"Perry","sequence":"additional","affiliation":[{"name":"Social Work, Florida Agricultural and Mechanical University, Tallahassee, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Brooks","sequence":"additional","affiliation":[{"name":"Division of Children's Medical Services, Florida Department of Health, Tallahassee, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,9,14]]},"reference":[{"key":"2025121411443005000_12.9.e059745.1","unstructured":"United States Department of Health and Human Services (US DHHS) CoDCaPC, National Center for Health Statistics (NCHS), Division of Vital Statistics (DVS) . Linked birth \/ infant death records 2007-2017, as compiled from data provided by the 57 vital statistics jurisdictions through the vital statistics cooperative program, on CDC wonder on-line database 2019. Available: http:\/\/wonder.cdc.gov\/lbd-current.html [Accessed 03 Sep 2019]."},{"key":"2025121411443005000_12.9.e059745.2","unstructured":"Centers for Disease Control and Prevention (CDC) DoRH . National Center for Chronic Disease Prevention and Health Promotion Sudden Unexpected Infant Death and Sudden Infant Death Syndrome 2018. Available: https:\/\/www.cdc.gov\/sids\/about\/index.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fsids%2FAboutSUIDandSIDS.htm [Accessed 03 Oct 2019]."},{"key":"2025121411443005000_12.9.e059745.3","doi-asserted-by":"crossref","unstructured":"Task Force On Sudden Infant Death S . SIDS and other sleep-related infant deaths: updated 2016 recommendations for a safe infant sleeping environment. Pediatrics 2016;138.doi:10.1542\/peds.2016-2938","DOI":"10.1542\/peds.2016-2940"},{"key":"2025121411443005000_12.9.e059745.4","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2016-2940","article-title":"Sids and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment","volume":"138","author":"Moon","year":"2016","journal-title":"Pediatrics"},{"key":"2025121411443005000_12.9.e059745.5","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2017-0087","article-title":"Variations in cause-of-death determination for sudden unexpected infant deaths","volume":"140","author":"Shapiro-Mendoza","year":"2017","journal-title":"Pediatrics"},{"key":"2025121411443005000_12.9.e059745.6","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-0180"},{"key":"2025121411443005000_12.9.e059745.7","doi-asserted-by":"crossref","unstructured":"Shapiro-Mendoza CK , Parks S , Lambert AE . The Epidemiology of Sudden Infant Death Syndrome and Sudden Unexpected Infant Deaths: Diagnostic Shift and other Temporal Changes. In: Duncan JR , Byard RW , eds. SIDS sudden infant and early childhood death: the past, the present and the future. Adelaide: University of Adelaide Press (c) 2018 The Contributors, with the exception of which is by Federal United States employees and is therefore in the public domain, 2018.","DOI":"10.20851\/sids-13"},{"key":"2025121411443005000_12.9.e059745.8","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-0854"},{"key":"2025121411443005000_12.9.e059745.9","doi-asserted-by":"crossref","first-page":"200","DOI":"10.23907\/2017.021","article-title":"An approach to the classification of apparent asphyxial infant deaths","volume":"7","author":"Matshes","year":"2017","journal-title":"Acad Forensic Pathol"},{"key":"2025121411443005000_12.9.e059745.10","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1007\/s00414-019-02126-w","article-title":"An evaluation of pathologists' application of the diagnostic criteria from the San Diego definition of SIDS and unclassified sudden infant death","volume":"134","author":"Shipstone","year":"2020","journal-title":"Int J Legal Med"},{"key":"2025121411443005000_12.9.e059745.11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2004.00421.x"},{"key":"2025121411443005000_12.9.e059745.12","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s12024-014-9650-8","article-title":"Assigning cause for sudden unexpected infant death","volume":"11","author":"Hunt","year":"2015","journal-title":"Forensic Sci Med Pathol"},{"key":"2025121411443005000_12.9.e059745.13","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1007\/s12024-019-00156-9","article-title":"Inconsistent classification of unexplained sudden deaths in infants and children hinders surveillance, prevention and research: recommendations from the 3rd international Congress on sudden infant and child death","volume":"15","author":"Goldstein","year":"2019","journal-title":"Forensic Sci Med Pathol"},{"key":"2025121411443005000_12.9.e059745.14","doi-asserted-by":"crossref","first-page":"i23","DOI":"10.1136\/ip.2010.027037","article-title":"Use of child death review to inform sudden unexplained infant deaths occurring in a large urban setting","volume":"17 Suppl 1","author":"Brixey","year":"2011","journal-title":"Inj Prev"},{"key":"2025121411443005000_12.9.e059745.15","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2011.300613"},{"key":"2025121411443005000_12.9.e059745.16","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2018-3408","article-title":"Sleep-Related infant suffocation deaths attributable to soft bedding, overlay, and wedging","volume":"143","author":"Erck Lambert","year":"2019","journal-title":"Pediatrics"},{"key":"2025121411443005000_12.9.e059745.17","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/01.JAA.0000546475.33947.44","article-title":"Preventing sudden infant death syndrome and other sleep-related infant deaths","volume":"31","author":"Maged","year":"2018","journal-title":"JAAPA"},{"key":"2025121411443005000_12.9.e059745.18","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-014-1520-1"},{"key":"2025121411443005000_12.9.e059745.19","doi-asserted-by":"crossref","DOI":"10.1155\/2009\/368270","article-title":"Donner M. a unifying theory for SIDS","volume":"2009","author":"Mage","year":"2009","journal-title":"Int J Pediatr"},{"key":"2025121411443005000_12.9.e059745.20","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s12024-016-9802-0","article-title":"Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy","volume":"12","author":"Garstang","year":"2016","journal-title":"Forensic Sci Med Pathol"},{"key":"2025121411443005000_12.9.e059745.21","doi-asserted-by":"publisher","DOI":"10.1097\/01.paf.0000257385.25803.cf"},{"key":"2025121411443005000_12.9.e059745.22","unstructured":"Health FDo . 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