Sudden unexpected death in infancy: place and time of death.

In recent years, many babies who die of Sudden Unexpected Death in Infancy (SUDI) in Northern Ireland are found dead in bed--i.e. co-sleeping--with an adult. In order to assess its frequency autopsy reports between April 1996 and August 2001 were reviewed and linked to temporal factors. The day and month of death, and the place where the baby was found were compared to a reference population of infant deaths between one week of age and the second birthday. Although the rate of SUDI was lower than the UK average, 43 cases of SUDI were identified, and two additional deaths with virtually identical autopsy findings that were attributed to asphyxia caused by suffocation due to overlaying. Thirty-two of the 45 (71%) were less than four months of age. In 30 of the 45 cases (67%) the history stated that the baby was bed sharing with others; 19 died sleeping in an adult bed, and 11 on a sofa or armchair. In 16 of the 30 (53%) there were at least two other people sharing the sleeping surface, and in one case, three. SUDI was twice as frequent at weekends (found dead Saturday-Monday mornings) compared to weekdays (p<0.02), and significantly more common compared to reference deaths (p<0.002). Co-sleeping deaths were also more frequent at weekends. Almost half of all SUDI (49%) occurred in the summer months--more than twice the frequency of reference deaths. While sharing a place of sleep per se may not increase the risk of death, our findings may be linked to factors such as habitual smoking, consumption of alcohol or illicit drugs as reported in case-control studies. In advising parents on safer childcare practices, health professionals must be knowledgeable of current research and when, for example, giving advice on co-sleeping this needs to be person-specific cognisant of the risks within a household. New and better means of targeting such information needs to be researched if those with higher risk life-styles are to be positively influenced.

Social deprivation and childhood injuries in North and West Belfast.

Injuries in childhood represent a major public health concern. North and West Belfast is an area in which a high rate of emergency department attendance due to injury has been observed, and in which social deprivation is widespread. We carried out a cross sectional survey of 479 injuries in children aged 0-12 years presenting to four emergency departments serving North and West Belfast. Injury rates were compared between the most deprived and least deprived areas, selected on the basis of Noble Economic Deprivation scores. A significant correlation between economic deprivation and injury rate was demonstrated (r = 2.14, p < or = 0.001). Children living within the most deprived areas were particularly likely to be involved in road traffic accidents (relative risk RR = 3.25, p = 0.002). We conclude that children living within the most deprived areas of North and West Belfast are at greater risk of injury than those in less deprived areas. Specific causes of injury, for example burns and scalds, high falls, and motor vehicle accidents are particularly associated with deprivation. Targeting should be taken into account when injury prevention strategies are being developed.