Almost a fifth of infant and child deaths are sudden, unexpected, and have no immediate cause, a report has found. The report, by England’s National Child Mortality Database, said 19% of child deaths remain unexplained.
Less than half can be explained even after all investigations are complete and a detailed review has taken place, it discovered. Those behind the report say sudden deaths were associated with particular circumstances.
In infants under one, unexplained death was significantly more likely to affect those in the most deprived neighbourhoods (42%), compared to those in less deprived areas (8%). They were strongly associated with low birthweight, prematurity, multiple births, larger families, admission to a neonatal unit, maternal smoking during pregnancy, young maternal age, parental smoking and parental drug misuse.
Unexplained deaths were also associated with sleeping arrangements. The vast majority of unexplained deaths (98%) occurred when the infant was thought to be asleep. Over a third of infants (38%) were found on their front and nearly half the infants (47%) were found sharing a sleeping surface in hazardous circumstances (on a sofa or with an adult who had consumed alcohol, drugs or smoked). Baroness Kennedy KC, who chaired the creation of the original investigation protocol for these deaths, said “One striking finding is that in the unexpected deaths of children between one and 18 there is a high incidence of a family history of convulsions.
“What this tells us is that research in this area is now a priority. It is crucial that we identify those factors which contribute to unexpected death in children over one year old.”
Professor Peter Fleming, a lead author on the report and Professor of Infant Health at the University of Bristol, said: “This report represents a new milestone in responding to sudden and unexplained deaths.
“It’s the first national report to look at a population level at all those deaths – infants and children, those that remain unexplained and those where the causes become clear with time.
“It shows us more clearly than ever the need to ensure that infants sleep safely, that unexplained deaths in older children are better understood, and that support is given to make sure all families – especially the poorest – can create a safe environment for their children.”
It comes as the NHS Race and Health Observatory called for more to be done to reduce poor healthcare outcomes among mothers and babies from Black, Asian and ethnic minority backgrounds.
The new research from the observatory, conducted alongside the University of Liverpool and University of Warwick, found that policies by hospitals have a focus on addressing ethnic health inequalities across maternity care.
Dr Daghni Rajasingam from the NHS Race and Health Observatory said: “There is an urgent need for programmes across England which are designed to address, track and evaluate maternal inequalities going forward.”
Meanwhile the Healthcare Safety Investigation Branch (HSIB) warned that time allocated for pregnancy and postnatal blood clot risk assessments is “not enough”.
The watchdog warned that pregnant women – who are at higher risk of developing dangerous blood clots – could suffer a potentially fatal blood vessel blockage if their risk is not properly assessed during pregnancy and the first six weeks after birth.
