Analysis of First and Second Sleep Environments in Unexplained Sudden Deaths in Infants Based on Scene Reenactment Data

The American Academy of Pediatrics (AAP) recommends that a safe sleep environment consist of an infant lying supine on a separate, uncluttered, approved sleep surface. Infant awakenings may lead to moving the infant from the initial sleep environment to a second one. The Connecticut Office of the Chief Medical Examiner electronic database was searched from 2018 through 2022 for infant deaths with non-homicidal manner in which scene reenactments were performed; 87 such deaths were identified. The most common causes of death were unsafe sleep environments (64.4%) and asphyxia (21.8%). Of the total cases, 79.3% had a single sleeping environment and 20.7% involved a second. Of the second sleep environments, 77.8% were less safe than the initial sleep environment and 21.8% had evidence of airway obstruction when found unresponsive. Only 4.6% of the infants were in a recommended sleep location at any time during the last sleep. Infant awakenings do not often lead to movement to a second sleep environment, but when they do, the second environment is often less safe than the first. This study reinforces the importance that the sleep environment plays in infant deaths and that scene reenactments play in their investigation.