1. Infant Injury Deaths in
New York City
Martine Hackett Ph.D., MPH
Bureau of Maternal, Infant and Reproductive Health
New York City Department of Health and Mental Hygiene

2. Infant Mortality Rate NYC
1898-2009
2009 Historic
Low IMR: 5.3
deaths/1000
live births
Source: Bureau of Vital Statistics

3. Infant Mortality Rate NYC
by Gestational Age, 1995-2009
Source: BVS

4. Infant Mortality Rate NYC 2009
by Race/Ethnicity
Source: Bureau of Vital Statistics

5. Geographic Disparities in Infant
Mortality NYC 2005-2009
Highest IMR:
Brownsville 11.3
Followed by:
East NY, Bed Stuy,
Jamaica, St.
Albans, Central
Harlem, East
Harlem

6. Leading Causes of Neonatal and
Postneonatal Death, NYC 2009
9 9.0
Neonatal 9
Postneonatal
8
7.1 8
Rate per 10,000 live births
7
Rate per 10,000 live births
7
5.9
6
6
5 5 4.3
4 4 3.5
3 2.7
3
2 2
0.8
1 1
0.1
0 0
Short gestation and LBW Injury
Birth defects Birth Defects
Cardiovascular disorders SIDS
Respiratory distress of the newborn
Other Respiratory Causes
6
Source: Bureau of Vital Statistics; compiled by BMIRH

7. Diagnostic Shift in Classification of
Infant Deaths, Injury vs. SIDS
NYC 1993-2009
80
70
IMR per 100,000 Live Births
60
50
40
30
20
10
0
93
94
95
96
97
98
99
00
01
02
03
04
05
06
07
08
09
19
19
20
20
20
20
19
19
19
19
19
20
20
20
20
20
20
SIDS Injury
Source: Bureau of Vital Statistics; compiled by BMIRH

9. Infant Deaths NYC 2004-2007
Infant injury
N=256
SIDS
N=35
Unintentional Undetermined EXCLUDED:
Intentional &
Injury Deaths Injury Deaths therapeutic
N=53 N=165 complication deaths
Excluded:
Suffocation Deaths Fire, Drowning,
N=38 Falls, Poisoning
Source: Bureau of Vital Statistics

10. What are the characteristics of infants
who die of sleep related injury deaths in
NYC?
• Infant Mortality Review Committee reviewed
data from two sources
– Office of Vital Statistics
• Birth and Death Certificates
– Office of Chief Medical Examiner
• Autopsy
• Death Scene Investigation
• Family Interview
• Provider Interview
• Data from 2004-2007 analyzed for Accidental
Suffocation and Undetermined causes of death
10

11. Demographic Characteristics
• Infants who die of Undetermined Injury
deaths are predominantly:
– Between 28 days-4 months old
– Born full term
– Mothers are Black, non Hispanic
– Mothers are U.S. born
– Mothers age is <20
– Mother’s education is </=12 years

12. Circumstances at time of
death

13. Excess Bedding** at Time of Death by
Cause of Death, NYC 2004-2007*
Excess
Bedding
100% No Excess
43% Bedding
80% 63% 61%
Unknown or
60% Not Applicable
40%
40% 11% 17%
20% 26% 22%
17%
0%
SIDS (N=35) Suffocation (N=38) Undetermined ** Defined as bedding in
excess of bed sheets (any
(N=165) number) and 1 blanket
*Chi-Sq p<.05

14. Prone Position at Time of Death by
Cause of Death, NYC 2004-2007
Prone
100%
35% Not Prone
40% 45%
80%
Unknown or Not
Applicable
60%
51%
40% 54% 47%
20%
8% 14%
6%
0%
SIDS (N=35) Suffocation (N=38) Undetermined
(N=165)

15. Bed Sharing at Time of Death by Cause
of Death, NYC 2004-2007
Yes
6%
100%
No
80% 55%
65%
Unknown or
60% 91% Not
Applicable
40%
45% 29%
20%
3% 5%
0%
SIDS (N=35) Suffocation (N=38) Undetermined
(N=165)

16. Location of Infant When Found Dead by
Cause of Death, NYC 2004-07*
100% Crib/Bassinette/
21% 22% Playpen
80% Adult Bed
80%
Couch/Sofa
60% 53%
62%
Other
40%
13% Unknown or Not
20% 14% 6%
6% 13% 4% Applicable
5%
0%
SIDS (N=35) Suffocation (N=38) Undetermined
(N=165)
*Chi-Sq p<.05

17. Unsafe Sleep Surface by Cause of Death,
NYC 2004-2007*
Unsafe Sleep
Surface
100% 20%
Safe Sleep
80% Surface
79% 72%
60% Unknown or
Not
80% Applicable
40%
22%
20% 21%
6%
0%
SIDS (N=35) Suffocation (N=38) Undetermined
(N=165)
*Chi-Sq p<.05

18. Risk Factors
SIDS: Suffocation: Undetermined:
• Excessive • Excessive • Excessive (soft)
(soft) (soft) bedding
bedding bedding • Prone position
• Prone • Prone • Unsafe sleep
position position surface
• Second hand • Unsafe • Bed sharing
smoke sleep
surface
• Bed sharing

19. Type of Sleep Surface When Infant
Found Dead, NYC 2004-07
n=203
Unknown or NA
6%
Had
Unsafe crib/bassinet
sleep 45%
Crib or
surface
bassinet or (adult bed,
playpen couch, car
seat) No
34% crib/bassinet
62% or unknown
55%
Source: BMIRH

20. Summary
• Accidental injuries (which are preventable) have
replaced SIDS as the second leading cause of
post-neonatal death
• Characteristics of undetermined infant deaths
similar to suffocation and SIDS deaths
– Prone position still being used 15 years after Back
to Sleep
• Many undetermined injury deaths are “sleep-
related”
• Safe Sleep messages are new to many families;
not just SIDS

21. Summary
• Shift the conversation to Injury Prevention
– Parent and provider education on the importance of a safe
sleep environment
– Support families in need by providing the tools for safe sleep
– Consumer advocacy for modeling safe sleep
– Interagency collaborations for consistent messaging and
practices