Individual-, Hospital-, and Community-Level Factors Associated with Sudden Unexpected Infant Death Among Infants Born Preterm in 5 US States.

Objective: To investigate individual-, hospital-, and community-level factors associated with sudden unexpected infant death (SUID) among infants born preterm.

Study Design: The following linked dataset from 5 states (California, Michigan, Oregon, Pennsylvania, and South Carolina) from 2005 through 2020 was used: (1) infant birth and death certificates; (2) maternal and infant birth hospitalization discharge records; (3) birthing hospital data from the American Hospital Association; and (4) community-level data from the Social Vulnerability Index (SVI).) Multivariable models were used to assess the independent association between these multilevel factors and SUID, adjusting for several maternal and infant characteristics.

Results: Overall, we found that maternal demographic factors (race and ethnicity, education, insurance) and infant gestational age were significant predictors of SUID. There was no difference in SUID odds by state, urban influence code, and maternal complications of pregnancy. Compared with mothers who lived in areas with the lowest SVI, those who resided in the highest SVI were more likely to experience SUID. There was no difference in SUID odds between infants who did or did not experience one or more complications of prematurity. For hospital-level factors, there was no difference in SUID odds among infants cared for in teaching vs nonteaching hospitals or in low vs high volume preterm birth hospitals.

Conclusion: Individual- and community-level factors were associated with SUID among infants born preterm. The neonatal intensive care unit hospitalization may provide a critical window of opportunity to engage families about SUID-risk reducing practices.