INTRODUCTION: In the years that followed the 1994 Back to Sleep Campaign (BSC), a public health initiative designed to prevent Sudden Infant Death Syndrome (SIDS), the prevalence of SIDS decreased by nearly 50%. However, recent research questions the decline in SIDS with an appreciation of contemporaneous factors which may have contributed to it. There is a growing recognition that other, often indiscernible causes of Sudden Unexpected Infant Deaths (SUID) have increased prevalence rates. Several researchers have addressed the possibility of the effects of a diagnostic drift. OBJECTIVE: To evaluate the impact of certain contemporaneous factors on the decline in the prevalence of Sudden Infant Death Syndrome. METHODS: We examined a historically significant time period surrounding the implementation of the BSC, 1984-2009. It is a time-period that incorporates mortality statistics prior to the BSC, as well as immediately following. We utilized 1984-2009 mortality data obtained from the Center for Disease Control and Prevention and evaluated the following prevalence rates: SIDS, unknown and unspecified causes, Accidental Strangulation and Suffocation in Bed (ASSB), and Neglect. We then amalgamated unknown and unspecified causes, ASSB and Neglect into a single representation of non-SIDS SUID. We then proceeded to perform an analysis on these prevalence rates to determine linear trends. RESULTS: All-cause mortality rate decreased linearly by about .929 per 100,000 per year (p<.0001, β=-.929). SIDS mortality rates also experienced a significant decline of about .951 per 100,000 deaths per year (p<.0001, β=-.951). In contrast, the SUID cohort prevalence increased significantly with a rate of .930 per 100,000 per year (p<.0001, β=.930). DISCUSSION: Over our study period, SIDS declined significantly, but by 2001 it experienced a stagnant decline that was different than that from 1984-2000. From 2001 to 2009, our SUID cohort increased dramatically. It is our conclusion that the potential exists for a possible diagnostic drift from SIDS to these other SUID.

Sudden unexplained infant death (SUID) is a sudden death of an infant under 1 year of age that cannot be explained after an investigation or an autopsy. SUID is the leading cause of infant deaths in the United States; SUID is considered a sentinel event to the birth hospital. Birth hospitals are held accountable for education, training, and role modeling of infant safe sleep practices (SSP) to reduce infant sleep-related deaths up to 1 year of age. This educational project was designed to answer the project-focused question of whether the implementation of an evidence-based, safe sleep training program for nurses would improve their knowledge of SSP. Bandura's social cognitive theory and the root cause analysis theory were used to guide the project that provided education on SSP and methods for teaching SSP for 48 nurses who work in a postpartum unit in a large hospital in the northeastern United States. A search of the literature provided the content from the National Institute of Child Health and Human Development for the education program and served the basis for the 15-item multiple-choice test, which was used for the pretest, posttest design project. The test was administered to the nurse participants who ranged in education from associate degree, baccalaureate degree, to master's degrees. The project goal was to increase nurses' knowledge by training and role modeling infant safe sleep environments and to reduce SUIDs. Results of the pretest and posttest evaluation revealed significant improvement in test scores from a pretest M = 72.9 to a posttest M = 90.0 (p <.05). The implications of this project for social change are that each nurse's knowledge and abilities to teach parents and families about SUID prevention strategies improve, sudden infant deaths may decrease in this hospital setting.