Rates of Sudden Unexpected Infant Death Before and During the COVID-19 Pandemic

Emma G. Guare, BA; Rong Zhao, MS; Paddy Ssentongo, MD, PhD; Erich K. Batra, MD; Vernon M. Chinchilli, PhD; Catharine I. Paules, MD

Abstract


IMPORTANCE

Infection has been postulated as a driver in the sudden infant death syndrome (SIDS)
cascade. Epidemiologic patterns of infection, including respiratory syncytial virus and influenza, were
altered during the COVID-19 pandemic. Comparing month-to-month variation in both sudden
unexpected infant death (SUID) and SIDS rates before and during the pandemic offers an
opportunity to generate and expand existing hypotheses regarding seasonal infections and SUID
and SIDS.


OBJECTIVE
To compare prepandemic and intrapandemic rates of SUID and SIDS, assessing for
monthly variation.


DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study assessed US mortality data
provided by the Centers for Disease Control and Prevention for January 1, 2018, through December
31, 2021. Events with International Statistical Classification of Diseases and Related Health Problems,
Tenth Revision codes for SIDS (R95), unknown (R99), and accidental suffocation and strangulation
in bed (W75) causes of death were examined. The data analysis was performed between November
2, 2023, and June 2, 2024.

EXPOSURE COVID-19 pandemic.

MAIN OUTCOMES AND MEASURES

The primary and secondary outcomes were the monthly rates
of SUID and SIDS during the COVID-19 pandemic (March 1, 2020, to December 31, 2021) compared
with the prepandemic period (March 1, 2018, to December 31, 2019) as measured using generalized
linear mixed-effects models. Seasonal trends in RSV and influenza rates were also examined.
RESULTS There were 14 308 SUID cases from January 1, 2018, to December 31, 2021 (42% female
infants). Compared with the prepandemic period, the risk of SUID increased during the
intrapandemic period (intensity ratio [IR], 1.06; 95% CI, 1.05-1.07). Monthly assessments revealed an
increased risk of SUID beyond the prepandemic baseline starting in July 2020, with a pronounced
epidemiologic shift from June to December 2021 (ranging from 10% to 14%). Rates of SIDS were
elevated throughout the intrapandemic period compared with the prepandemic baseline, with the
greatest increase in July 2021 (IR, 1.18; 95% CI, 1.13-1.22) and August 2021 (IR, 1.17; 95% CI, 1.13-1.22).
Seasonal shifts in RSV hospitalizations correlated with monthly changes in SUID observed
during 2021.

CONCLUSIONS AND RELEVANCE

This cross-sectional study found increased rates of both SUID
and SIDS during the COVID-19 pandemic, with a significant shift in epidemiology from the
prepandemic period noted in June to December 2021. These findings support the hypothesis that
off-season resurgences in endemic infectious pathogens may be associated with SUID rates, with
RSV rates in the US closely approximating this shift. Further investigation into the role of infection in
SUID and SIDS is needed.

JAMA Network Open. 2024;7(9):e2435722. doi:10.1001/jamanetworkopen.2024.35722



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