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JAMA. 2006;295:2351.

MMWR. 2006;55:212-213

CDC, in collaboration with other federal agencies and organizations representing medical examiners, coroners, death-scene investigators, law enforcement officials, forensic nurses, sudden infant death syndrome (SIDS) researchers, infant death review experts, and parents of infants who died from SIDS, launched an initiative in 2004 to improve the investigation and reporting of sudden, unexplained infant deaths (SUIDs). As part of this effort, on March 1, 2006, CDC released the Sudden, Unexplained Infant Death Investigation (SUIDI) Reporting Form for state and local use in infant death-scene investigations. The SUIDI Reporting Form replaces the Investigation Report Form that accompanied the 1996 Guidelines for the Death Scene Investigation of Sudden, Unexplained Infant Death.¹

Each year in the United States, approximately 4,500 infants die suddenly of no immediately obvious cause. Half of these SUIDs are attributed to SIDS, the leading cause of SUID and of all deaths among infants aged 1-12 months. By definition, SIDS can only be diagnosed after a thorough examination of the death scene, a review of the clinical history, and an autopsy fail to find an explanation for the death.²

Since 1990, SIDS rates in the United States have declined by approximately 50%, concomitant with a steady decline in the infant prone sleeping rate; prone and side sleep positions are associated with an increased risk for SIDS.^3-4 However, studies indicate that, since 1999, certain deaths previously reported as SIDS are now reported as accidental suffocation or unknown/unspecified cause of death.^5-6 This change in reporting of cause of death might account for part of the recent decline in SIDS rates.

The 1996 form was developed to establish a standard death-scene investigation protocol for all SUIDs. However, a 2001 national survey indicated that the form was not being used widely because it was poorly organized, lengthy, and cumbersome.⁷ Inaccurate or inconsistent cause-of-death determination and reporting hamper the ability of CDC, state and local health departments, and partners to monitor national trends, assess risk factors, and design and evaluate programs to prevent these deaths.

To address these concerns, CDC convened a national work group to revise the 1996 form. The new SUIDI Reporting Form includes questions to establish cause and manner of death, determined by a 2004 national survey of medical examiners and coroners, in addition to new questions about recently recognized risk factors for SIDS (e.g., unaccustomed prone sleep position) (S.C. Clark, Ph.D., Occupational Research Associates, Inc., unpublished data, 2004). The new form is shorter and simpler than the 1996 form. For example, most questions can be answered by checking the appropriate box or filling in the blank provided. The form is available online at http://www.cdc.gov/SIDS.

Of equal importance are well-trained death-scene investigators and certifiers. Previously, no national training materials on investigation of an infant death scene were available. In collaboration with a steering committee and a team of national advisors, CDC developed a comprehensive training curriculum and materials. CDC will use these materials to conduct five regional train-the-trainer academies during the next 2 years.

CDC plans a promotional campaign for the new form and training materials among its partners and stakeholders. Accurately collecting and reporting infant death-scene data depends on the widespread use of these tools. These measures will allow improved surveillance and research aimed at preventing infant deaths. Additional information on the SUID Initiative is available at http://www.cdc.gov/SIDS.

REFERENCES
1. CDC. Guidelines for death scene investigation of sudden, unexplained infant deaths: recommendations of the Interagency Panel on Sudden Infant Death Syndrome. MMWR. 1996;45(No. RR-10):1-22. PUBMED 2. Willinger M, James LS, Catz C. Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institute of Child Health and Human Development. Pediatr Pathol. 1991;11:677-684. PUBMED 3. Task Force on Sudden Infant Death Syndrome. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics. 2005;116:1245-1255. FREE FULL TEXT 4. Malloy MH, Freeman DH. Age at death, season, and day of death as indicators of the effect of the back to sleep program on sudden infant death syndrome in the United States, 1992-1999. Arch Pediatr Adolesc Med. 2004;158:359-365. FREE FULL TEXT 5. Shapiro-Mendoza CK, Tomashek KM, Anderson RN, et al. Recent national trends in sudden, unexpected infant deaths: more evidence supporting a change in classification or reporting. Am J Epidemiol. 2006;163:762-769. FREE FULL TEXT 6. Malloy MH, MacDorman M. Changes in the classification of sudden unexpected infant deaths: United States, 1992-2001. Pediatrics. 2005;115:1247-1253. FREE FULL TEXT 7. Hauck F. Final report: National survey to evaluate use of the Sudden Unexplained Infant Death Investigation Report Form (SUIDIRF). Charlottesville, VA: University of Virginia Health System; 2001.

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