Photo by Pavel Danilyuk:

recent study from Children’s Hospital Colorado, which analyzed public health data to study racial/ethnic disparities in infant health, found that the risk of sudden unexpected infant death (SUID), also known as SIDS, is two-to-three times higher in preterm infants compared to full-term infants. It’s especially concerning for non-Hispanic Black infants, who are both more likely to be born preterm and more likely to die of SUID. Black infants make up 15% of all births in the U.S. and 29% of SUIDs. 

SUID is defined as the death of an infant less than 1 year of age that happens suddenly and unexpectedly, and from a cause that is not immediately obvious. SUID accounts for more than 3,500 deaths in infants under the age of 1 in the United States annually.

To better understand the disparities among preterm infants, Sunah Hwang, MD, PhD, MPH, an investigator in the section of neonatology at Children’s Hospital Colorado and the University of Colorado School of Medicine, looked at national data on mothers who delivered preterm infants to determine the mother’s adherence to back sleep positioning.

How to Decrease the Risk of SUID

One of the most effective, modifiable parental behaviors that may reduce risk of SUID is supine sleep positioning or placing babies on their backs to sleep. It’s also best practice for infants under 12 months to sleep in the same room as the parent, but not in the same bed, on a separate, flat firm surface without elevation of the head, and with no unsafe objects such as loose blankets, pillows or dolls. .

More About Persistent Disparities

“While SUID risk and racial disparity in parental adherence to safe infant sleep habits has been well studied in healthy, full-term infants, less is known about racial/ethnic disparity in safe sleep for preterm infants,” shared Dr. Hwang. “Our research found that while safe sleep practices improved across all ethnic and racial groups during the 15-year study period, overall racial/ethnic disparities persisted resulting in the highest risk of SUID among Black preterm infants.”

The research used the Pregnancy Risk Assessment Monitoring System, a long-running Centers for Disease Control and Prevention effort that collects data on maternal attitudes and experiences around birth. They analyzed data on 66,131 mothers of preterm infants from 16 states, collected between 2000 and 2015, and stratified them into early- and late-preterm groups. 

Moving forward, Dr. Hwang believes efforts are needed to better understand factors at individual, hospital, and community levels that influence decision-making related to safe sleep practices among racially-diverse families of preterm infants.

October is Safe Sleep Month — More Safe Infant Sleep Tips:

Make sure everyone who takes care of your baby knows the safest way for them to sleep with this brochure from the Colorado Infant Safe Sleep Partnership (.pdf). A Spanish version (.pdf) is also available.

You should always put a baby to sleep:

  • On their back
  • In their own crib or bassinet
  • On a firm sleep surface
  • With no loose bedding
  • In a sleep sack or onesie
  • In the room with caregivers

You should never put a baby to sleep:


  • On their stomach or side
  • With anyone else (even caregivers!)
  • In an adult bed
  • On a couch
  • Under a blanket
  • On a pillow
  • With stuffed animals
  • In a crib with bumper pads
  • Near tobacco smoke

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