Unexpected Infant Death Research Articles

Improving Consistency in Classifying Child Maltreatment for Sudden Unexpected Infant Deaths.

Develop guidelines for child death review teams that will improve the consistency in classifying child maltreatment (CM) and distinguish between classification of exposure to hazards and neglect for sleep-related sudden unexpected infant deaths (SUID). Sleep-related SUID (n = 25 797) were identified from the National Fatality Review-Case Reporting System between 2004 and 2018. Key variables considered when classifying CM among sleep-related SUID were identified. Logistic regression was used to assess the strength of associations and identify factors that distinguished between exposure to hazards and neglect. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Guidelines were developed based on these findings. Among the 13 034 sleep-related SUID with CM identified, hazards in the infant sleep environment were strongly associated with classification of both exposure to hazards and neglect, as were supervisor impairment and child welfare substantiation of the death. Comparing neglect to exposure to hazards, there was no association with sleep environment hazards with ORs ranging from 0.8 to 1.3 (95% CI 0.4-3.0), but sleep-related SUID were approximately twice as likely to be classified as neglect when the supervisor was impaired (OR 2.3, 95% CI 2.0-2.7) or child welfare action was taken (OR 1.8, 95% CI 1.5-2.0). The guidelines recommend classification of exposure to hazards for sleep environment hazards with elevation to neglect if the supervisor was impaired or child welfare substantiated the death. Among sleep-related SUID, classification of exposure to hazards is based on presence of sleep environment hazards, whereas neglect is based on supervisor impairment and child welfare action.

Using Sudden Unexpected Infant Death-Case Registry Data to Drive Prevention.

Sudden unexpected infant death (SUID) is a major contributor to infant death and a persistent public health issue. After an initial decline after the 1994 "Back to Sleep" campaign, SUID numbers plateaued. Currently, ∼10 infants die suddenly and unexpectedly each day in the United States. In 2019, we established a surveillance system for SUID in Cook County, Illinois, partnering our academic medical center, the Cook County Medical Examiner's Office, and child death review to create the Cook County SUID Case Registry. Our data show that, in Cook County, including the city of Chicago, ∼1 infant dies unexpectedly during sleep every week. Of these SUID, ∼25% were because of suffocation/possible suffocation. SUID peaks at 30 to 60 days old. SUID rates are 15 times higher in non-Hispanic Black infants and 3 times higher in Hispanic infants, compared with white infants. Nearly all involved 1 or more unsafe sleep factors. SUID are concentrated in community areas experiencing high hardship. Through our Community Partnership Approaches for Safe Sleep-Chicago team, we have developed collaborative prevention approaches in affected communities, allowing for conversations with families and those who support them to better understand barriers to safe sleep that they experience. These partnerships and our data allow for tailoring of informed prevention approaches to address upstream factors driving disproportionate infant mortality in historically disinvested communities, as well as optimizing the immediate risks posed by the infant sleep environment. Data from our system show the number of SUID declining modestly since our prevention work began.

Collaboration to Reduce Sudden Unexpected Infant Death With Child Fatality Review and Outreach.

Sudden unexpected infant death (SUID) is the leading cause of postneonatal infant mortality in the United States, with disproportionately high rates in Baltimore City and Baltimore County in Maryland. This Advocacy Case Study describes the collaboration between the City and County Child Fatality Review teams to decrease infant mortality. B'more for Healthy Babies, formed in 2009 by the Bureau of Maternal Child Health in Baltimore City with the goal of reducing infant mortality through policy change, service improvements, community mobilization, and behavior change has had a sustained effort to respond to SUID. Recognizing that infants born in Baltimore City often reside in Baltimore County (and vice versa), collaboration with Baltimore County has been essential to increasing B'more for Healthy Babies' scope, reach, and effectiveness. Public health messaging campaigns, creation, and dissemination of a "SLEEP SAFE" testimonial video, and Safe Sleep Summits have involved caregivers, healthcare providers, and community partners. Outcomes of this ongoing collaboration demonstrate a decrease in sleep-related infant mortality rates. Our findings also highlight the need for continued, real time monitoring of sleep-related infant mortality trends with a coordinated, multidisciplinary, and crossjurisdictional response. This initiative can serve as a model of cross-sector communication that can be replicated in other similar geographic locations to further reduce SUID.

Unexplained Infant Deaths Without Unsafe Sleep Factors: 2011 to 2020.

To describe sudden unexpected infant deaths (SUIDs) occurring in safe sleep environments and explore differences in selected characteristics. We examined SUID from 22 jurisdictions from 2011 to 2020 and classified them as unexplained, no unsafe sleep factors (U-NUSF). Data were derived from the Sudden Unexpected Infant Death and Sudden Death in the Young Case Registry, a population-based Centers for Disease Control and Prevention surveillance system built on the National Center for Fatality Review and Prevention's child death review program. SUID classified as U-NUSF included infants who were (1) awake, under supervision, and witnessed to become unresponsive or (2) found unresponsive in a safe sleep environment after sleep (unwitnessed). We calculated frequencies and percentages for demographics, birth and environmental characteristics, medical history, and death investigation findings. Most of the 117 U-NUSF SUID occurred before 4 months of age. Witnessed deaths most commonly occurred at <1 month of age (28%), whereas unwitnessed deaths most commonly occurred at ages 2 to 3 months (44%) Among all U-NUSF, 69% occurred in the infant's home (62% witnessed, 77% unwitnessed). All unwitnessed deaths occurred in a crib; most witnessed deaths occurred while being held (54%) or in a car seat traveling (18%). Most infants (84%) had no history of abuse or neglect. Abnormal autopsy findings were reported in 46% of deaths (49% witnessed, 42% unwitnessed). Characterizing these deaths is key to advancing our knowledge of SUID etiology. Our study revealed a heterogeneous group of infants, suggesting physiologic, genetic, or environmental etiologies.

Focal granule cell bilamination of the dentate gyrus-its prevalence across the human age spectrum and review of the literature.

The prevalence of focal granule cell bilamination (FGCB) in the hippocampal dentate gyrus varies from 0% to 44%, depending on age and study population. FGCB is commonly thought to be a specific feature of temporal lobe epilepsy (TLE) but its prevalence in cases without TLE is unclear. Using formalin-fixed, paraffin-embedded hippocampal sections, this retrospective postmortem study evaluated the prevalence of FGCB and other granule cell pathologies in infants (1-12 months of age, n = 16), children (4-10 years, n = 6), and adults (28-91 years, n = 15) with no known history of epilepsy or seizures. We found FGCB in 6% of infants, 17% of children, and 27% of adults. We then compared our findings with those in published reports of sudden unexpected deaths in infancy (SUDI), childhood (SUDC), and epilepsy (SUDEP), and in surgical specimens from patients with TLE. The reported prevalence of FGCB in those studies was 6%-19% in infants, 0%-17% in children, and 0%-2% in adults in non-seizure-related cases and 9% in children and 3%-25% in adults with TLE. Our findings highlight the presence of FGCB in individuals with no known epilepsy/seizure-related histories in proportions similar to those reported in individuals with clinical epilepsy.

What Has the Sudden Unexpected Infant Death and Sudden Death in the Young Case Registry Learned About Consenting Families for DNA Banking and/or Genomic Research?

Since 2015, the Sudden Unexpected Infant Death (SUID) and Sudden Death in the Young (SDY) Case Registry has characterized sudden and unexpected deaths among young people (0-20 years). Families may provide informed consent to save biospecimens for banking and/or genomic research. We reviewed all consent-eligible cases to describe the frequency, time from death to consent, type (paper, phone, or electronic), and staffing method (Medical Examiner Office-based bereavement counselor vs outsourced genetic counselor). Of 5438 cases from January 2015 to January 2022, 3498 (64%) were eligible for consent and 391 (11%) were successfully consented. Half (54%) were obtained within 60 days of the death, 39% within 48 hours. Most were paper based (73%); 23% were obtained by phone, and 4% electronically. Consent rates varied by site from 3% to 66%. Higher consent rates were achieved within a Medical Examiner Office by a social worker or death investigator. Only 3% of consents attempted by a contracted genetic counselor were successful. Identified barriers include lack of available contact information, inability to reach family using the collected information, and lack of response when contacted. Consent rates were highest shortly after death when families were contacted by the Medical Examiner Office as part of bereavement outreach.

Impact of COVID-19 Pandemic Interventions on Sudden Unexpected Death in Infancy Incidence in France

To study the impact of non-pharmaceutical interventions (NPIs) implemented during the COVID-19 pandemic on the monthly incidence of sudden unexpected death in infancy (SUDI) cases overall and those with a viral or bacterial identification. We conducted an interrupted time-series analysis using seasonally adjusted Poisson regression models from the French national prospective and multicenter SUDI registry, that included all SUDI cases under age one year who died from 2016 to 2021 in mainland France. Of 998 SUDI cases analyzed, 750 were recorded during the pre-pandemic period (January 2016 through March 2020) and 248 during the NPI period (April 2020 through December 2021). We found a significant seasonal pattern of overall monthly SUDI incidence, with a peak observed periodically from November to February. The monthly SUDI incidence decreased significantly from the pre-pandemic to NPI periods (adjusted incidence rate ratio 0.83 [95% confidence interval 0·72-0·96]). In particular, the monthly incidence of SUDI cases with a viral or bacterial identification decreased, while no significant difference was found for SUDI cases without a viral or bacterial identification. NPIs were associated with a significant change in the incidence of SUDI cases with a viral or bacterial identification. Further investigations are needed to analyze the pathophysiologic role of viruses and bacteria in the SUDI.

The French registry of sudden unexpected death in infancy (SUDI): a 7-year review of available data.

This article details the objectives and methods of the French registry of SUDI. It provides initial results relating to thepopulation included in the register and the procedure for accessing the data. • In Western Europe, France is one of the countries with the highest SUDI rate, making it the first cause of death of infants between 28 and 364days. • The development of epidemiological tools on a national and international scale is essential to advance research into the determinants and risk factors of unexpected death in children under 2years of age. • The OMIN registry was created in France in 2015 to collect nationwide standardised social, environmental, clinical, and paraclinical data for cases of unexpected death in children aged 0 to 2years. • To date, the OMIN registry has included 680 data from almost 2000 children unexpectedly deceased, completed by a biocollection since 2020. • Data from the OMIN registry, unique in its field, are freely available for scientific research teams, after acceptation by the scientific committee of the registry.

Community partnership approaches to safe sleep (CPASS) program evaluation

BackgroundSudden unexpected infant death (SUID) continues to be a leading cause of death in infants in the United States (US), with significant disparities by race and socio-economic status. Infant safe sleep behaviors are associated with decreasing SUID risk, but challenges remain for families to practice these routinely. The objective of this program was to implement and evaluate a novel approach for an infant safe sleep pilot program built upon partnerships between hospitals and community-based organizations (CBOs) serving pregnant and parenting families in at-risk communities.MethodsCommunity Partnership Approaches to Safe Sleep (CPASS) was a prospectively implemented infant safe sleep program. CPASS included children’s hospitals partnered with CBOs across five US cities: Portland, OR, Little Rock AR, Chicago, IL, Birmingham, AL, and Rochester, NY. The program consisted of (1) monthly learning community calls; (2) distribution of Safe Sleep Survival Kits; and (3) surveys of sites and families regarding program outcomes. Survey measures included (1) site participation in CPASS activities; (2) recipients’ use of Safe Sleep Kits; and (3) recipients’ safe sleep knowledge and behaviors.ResultsCPASS learning community activities were consistently attended by at least two representatives (1 hospital-based, 1 CBO-based) from each site. Across the five sites, 1002 safe kits were distributed over 9 months, the majority (> 85%) to families with infants ≤ 1 month old. Among participating families, 45% reported no safe sleep location before receipt of the kit. Family adherence to nighttime safe sleep recommendations included: (1) no bedsharing (M 6.0, SD 1.8, range 0–7); (2) sleep on back (M 6.3, SD 1.7, range 0–7); and (3) sleep in a crib with no blankets/toys (M 6.0, SD 2.0, range 0–7). Site interviews described how participation in CPASS influenced safe sleep conversations and incorporated local data into counseling. Hospital-CBO relationships were strengthened with program participation.ConclusionsThe CPASS pilot program provides a new, innovative model built on hospital-community partnerships for infant safe sleep promotion in SUID-impacted communities. CPASS reached families before their infant’s peak age risk for SUID and empowered families with knowledge and resources to practice infant safe sleep. Important lessons learned included improved ways to center and communicate with families.

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

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. To compare prepandemic and intrapandemic rates of SUID and SIDS, assessing for monthly variation. 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. COVID-19 pandemic. 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. 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. 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.

Imaging of sudden unexpected death in infancy: a comprehensive nationwide French survey.

Introduction of post-mortem imaging has helped improve sudden unexpected death in infancy (SUDI) management in Europe. French guidelines were issued in 2007 to homogenise SUDI investigations including imaging. The aim of this study was to evaluate current imaging management of SUDI in France. Between January 2022 and July 2022, all 35 SUDI French referral centres were invited to answer an e-mailed online survey including 29 questions divided into four different sections covering imaging practices for SUDI including radiology department organisation, imaging modalities performed, methods of reading, and current training resources. Partial responses were secondarily completed by a personal call to the SUDI imaging consultant. The current implementation of the 2007 recommendations was compared with a previous evaluation from 2015 and with current North American practices. The participation rate of centres performing SUDI imaging was 100% (35/35). Imaging was systematically performed in 94.3% (33/35) of the centres: 74.3% (26/35) using radiography; 5.7% (2/35) using ultrasound; 94.3% (33/35) using computed tomography (CT), including 89% (31/35) whole-body CT and 5.7% (2/35) brain CT; and 20% (7/35) using magnetic resonance imaging (MRI). Two centres (5.7%, 2/35) did not systematically perform brain imaging. One (2.9%, 1/35) used ultrasound-guided biopsy. In comparison with 2015, rates of brain imaging increased by 25.4% (P=0.008). There was no significant difference in the number of forensic MRIs performed between France and North America (P=0.663). Despite improvements since 2015, full compliance with French guidelines for SUDI investigations remains incomplete. The use of imaging, particularly CT and brain imaging, has increased. Further efforts are needed to standardise imaging practices for optimal SUDI investigations.

The risk of sleep-related death in an inclined sleep environment

BackgroundUnsafe sleep environments are the primary modifiable risk factor for sudden unexpected infant death (SUID). Despite this knowledge, products that deviate from the American Academy of Pediatrics (AAP) safe sleep recommendations continue to be commonplace, such as inclined sleepers. Analyses to estimate risk among these products are lacking, perpetuating their presence in the marketplace. We present a method of comparing risk of SUID in an inclined sleeper to an AAP-recommended sleep environment.MethodsA case-control analysis using publicly available and previously published survey data was conducted for SUID events occurring between January 1, 2018 and April 12, 2019 (the date of the first inclined sleeper recall). SUID deaths were categorized as occurring in an AAP-recommended sleep environments or in an inclined sleeper. Exposure Odds Ratios (OR) are reported as the risk of SUID among infants using inclined sleepers relative to an AAP-recommended sleep environment.ResultsDuring the study period, 4,900,573 births and 4,363 SUID deaths occurred in the US. Control characteristics were similar between previous night users of an AAP-recommended sleep environment (24%) and inclined sleepers (3.8%). Inclined sleepers were associated with a 5-fold (OR: 5.1; 95% CI: 3.2, 7.9) increased risk of SUID among infants < 12 months compared to infants in an AAP-recommended sleep environment. This risk was greatest among infants ≥ 4 months (RR: 10.4; 95% CI: 5.1, 21.5).ConclusionsThis novel analysis fills a longstanding gap in risk assessments of inclined infant sleep products. More timely risk analyses may improve the safety of the marketplace.

Causes of sudden unexpected death in infants with and without pre-existing conditions: a retrospective autopsy study

ObjectiveWe investigated sudden unexpected death in infancy (SUDI) autopsy data from 1996 to 2015 inclusive, comparing findings from infants with and without pre-existing medical conditions.DesignLarge, retrospective single-centre autopsy series.SettingTertiary paediatric...

Management and outcomes of foramen magnum stenosis in children with achondroplasia at a single center over 15 years.

Achondroplasia is associated with foramen magnum stenosis (FMS), which can lead to sudden unexpected death in infants. There is no wide consensus regarding the best management of FMS. This study aimed to analyze the prevalence of FMS in a cohort of children with achondroplasia and to evaluate screening and neurosurgical interventions of FMS regarding its effects and complications. The authors conducted a retrospective cohort study including all children with achondroplasia assessed or treated at Karolinska University Hospital between September 2005 and June 2020. The severity of FMS was graded using the MRI Achondroplasia Foramen Magnum Score (AFMS). The AFMS was correlated with neurological examinations and polysomnography (PSG) results. Severe FMS (AFMS 3-4) was present in 35% of the 51 children included in the study. As many as 65% of the children in the cohort underwent foramen magnum decompression (FMD). Neurological examination had a high specificity (94%) but a low sensitivity (28%) for severe FMS. Signs of central apnea on PSG did not correlate with severity of FMS (p = 0.735). Surgery improved FMS (p < 0.001) with a nonsignificant trend of decreased central apnea (p = 0.070), but carried a 9% risk of severe surgery- and anesthesia-related complications. This study confirmed previous reports that severe FMS is common in children with achondroplasia, that neurological symptoms may be absent even in severe FMS, and that FMD improves FMS and may improve central apnea. The finding that neurological examination had a low sensitivity for severe FMS supports the recommendation that all children with achondroplasia should undergo early MRI.

Maternal Obesity and Sudden Unexpected Infant Death—Beyond the Scale

Maternal Obesity and Sudden Unexpected Infant Death—Beyond the Scale

Maternal Obesity and Risk of Sudden Unexpected Infant Death

Rates of maternal obesity are increasing in the US. Although obesity is a well-documented risk factor for numerous poor pregnancy outcomes, it is not currently a recognized risk factor for sudden unexpected infant death (SUID). To determine whether maternal obesity is a risk factor for SUID and the proportion of SUID cases attributable to maternal obesity. This was a US nationwide cohort study using Centers for Disease Control and Prevention National Center for Health Statistics linked birth-infant death records for birth cohorts in 2015 through 2019. All US live births for the study years occurring at 28 weeks' gestation or later from complete reporting areas were eligible; SUID cases were deaths occurring at 7 to 364 days after birth with International Statistical Classification of Diseases, Tenth Revision cause of death code R95 (sudden infant death syndrome), R99 (ill-defined and unknown causes), or W75 (accidental suffocation and strangulation in bed). Data were analyzed from October 1 through November 15, 2023. Maternal prepregnancy body mass index (BMI; calculated as weight in kilograms divided by height in meters squared). SUID. Of 18 857 694 live births eligible for analysis (median [IQR] age: maternal, 29 [9] years; paternal, 31 [9] years; gestational, 39 [2] weeks), 16 545 died of SUID (SUID rate, 0.88/1000 live births). After confounder adjustment, compared with mothers with normal BMI (BMI 18.5-24.9), infants born to mothers with obesity had a higher SUID risk that increased with increasing obesity severity. Infants of mothers with class I obesity (BMI 30.0-34.9) were at increased SUID risk (adjusted odds ratio [aOR], 1.10; 95% CI, 1.05-1.16); with class II obesity (BMI 35.0-39.9), a higher risk (aOR, 1.20; 95% CI, 1.13-1.27); and class III obesity (BMI ≥40.0), an even higher risk (aOR, 1.39; 95% CI, 1.31-1.47). A generalized additive model showed that increased BMI was monotonically associated with increased SUID risk, with an acceleration of risk for BMIs greater than approximately 25 to 30. Approximately 5.4% of SUID cases were attributable to maternal obesity. The findings suggest that infants born to mothers with obesity are at increased risk of SUID, with a dose-dependent association between increasing maternal BMI and SUID risk. Maternal obesity should be added to the list of known risk factors for SUID. With maternal obesity rates increasing, research should identify potential causal mechanisms for this association.

A Simple and Systematic Approach to Qualitative Data Extraction From Social Media for Novice Health Care Researchers: Tutorial.

Social media analyses have become increasingly popular among health care researchers. Social media continues to grow its user base and, when analyzed, offers unique insight into health problems. The process of obtaining data for social media analyses varies greatly and involves ethical considerations. Data extraction is often facilitated by software tools, some of which are open source, while others are costly and therefore not accessible to all researchers. The use of software for data extraction is accompanied by additional challenges related to the uniqueness of social media data. Thus, this paper serves as a tutorial for a simple method of extracting social media data that is accessible to novice health care researchers and public health professionals who are interested in pursuing social media research. The discussed methods were used to extract data from Facebook for a study of maternal perspectives on sudden unexpected infant death.

More than just a crib: Assessing the prevalence of partnerships between Cribs for Kids and children’s hospitals in the United States

Introduction: Cribs for Kids is a national organization with a mission to reduce sudden infant death syndrome (SIDS) and sudden unexpected infant death (SUID) nationwide through adaptation of best practices in infant safe sleep, community engagement, and increased access to resources in assuring infant safety during time of sleep. One integral partnership that enables Cribs for Kids to cast a wider net in yielding the potential to reach many more infants and their families across the country involves attainment of hospitalwide certification by Cribs for Kids across both academic and community healthcare systems that provide care to infants for up to one year of age. Methods: However to date, the prevalence of these partnerships remains unclear. It follows that the present study sought to uncover this prevalence across the nation. Utilizing the U.S. News and World Report, the researcher acquired a random sample of 110 children’s hospitals. Next utilizing the map locator of hospitals certified at the Gold, Silver and Bronze levels by Cribs for Kids on the organization’s website, prevalence of presence and level of certification was ascertained across this sample of children’s hospitals. Results: Notably, the vast majority of this sample (n=78) had not attained hospitalwide certification with Cribs for Kids. Among the hospitals that had attained certification, there was substantial variation across levels based on a range of health promotion and community engagement practices. Conclusion: Recommendations for harnessing the potential of this collaboration are presented to inform directions in examining these partnerships as a point of intervention for future planning considerations across community engagement and health promotion practices surrounding SIDS reduction.

Gather together in the name of our next generation: A scoping review of the essence and implementation of community baby showers

Introduction: Sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS) collectively represent one of the leading causes of infant mortality worldwide. There are a range of evidence-based modifiable risk factors for both, particularly related to the infant’s sleep environment. Oftentimes, social determinants of health impact optimization of an infant’s sleep environment, thereby compromising their safety and elevating their risk for SIDS and SUID. Many kinds of community interventions that include campaigns and programs have sought to address these environmental modifiable risk factors that contribute towards heightened risk for SIDS and SUID. However given resource limitations, reach and access considerations, and scarcity of a streamlined harmonized process to draw on the strengths of a community in SUID and SIDS reduction, there is mixed success with these interventions. Methods: Although community baby showers are rising as a trending health promotion intervention to optimize access to care, resources and support to infants and their caregivers as well as optimize infant growth and development, there is no review paper to date that consolidates the strengths and limitations in the quality, delivery and evaluation of community baby showers as a continued focus for future public health interventions surrounding the infant population which informs the development of this scoping review. Results: Specifically, this review synthesizes the commonalities, differences, key findings, intervention components as well as gaps in research and practice on community baby showers across published studies (n=20) and secondary sources (n=4). Conclusion: Clinical and public health implications are also closely examined and further inform recommendations for future directions that draw on the strengths and build off the limitations of findings from this review to heighten the clinical and public health impact and further assess the efficacy of community baby showers as an evidence-based community engagement and health promotion intervention for our next generation of infants and their families.

Added value of postmortem mri in sudden unexpected infant death cases.

We aimed to investigate the potential added value of postmortem MRI (PMMRI) in sudden unexpected infant death (SUID) cases referred to our center between September 2020 and June 2023. Ultimately, 19 SUID cases underwent PMMRI alongside standard autopsy procedures, which included technical examinations such as postmortem CT (PMCT). Four radiologists, two with prior PMMRI experience, provided structured reports following consensus. For each case, the responsible forensic medicine specialist documented the cause of death before and after reviewing the PMMRI report. Additionally, they assessed the overall impact of the PMMRI report and had the opportunity to provide written comments. The results of our study indicate that none of the PMMRI reports altered the prior determined cause of death, which included cases of infection, asphyxia, and sudden infant death syndrome (SIDS). However, we observed a moderate impact in one case and a low impact in 10 cases. The moderate impact arose from the PMMRI report identifying hypoxic-ischemic changes, where histologic examination of the brain was perceived as normal. Conversely, in the 10 cases with a low impact, the PMMRI reports supported the autopsy findings, specifically indicating brain injury and intra-alveolar cellular infiltrates. In conclusion, our study suggests that while PMMRI may not be pivotal in determining the cause of death in SUID cases, it could aid in detecting hypoxic-ischemic changes and reinforcing brain and lung observations. However, distinguishing genuine lung pathology from postmortem changes using PMMRI remains challenging. Further research is warranted to clarify the role of PMMRI in forensic SUID investigations.