OBJECTIVE Develop guidelines for child death review teams that will improve the consistency in classifying child maltreatment (CM) and distinguish between classification of exposure to hazards and neglect for sleep-related sudden unexpected infant deaths (SUID). METHODS Sleep-related SUID (n = 25 797) were identified from the National Fatality Review-Case Reporting System between 2004 and 2018. Key variables considered when classifying CM among sleep-related SUID were identified. Logistic regression was used to assess the strength of associations and identify factors that distinguished between exposure to hazards and neglect. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Guidelines were developed based on these findings. RESULTS Among the 13 034 sleep-related SUID with CM identified, hazards in the infant sleep environment were strongly associated with classification of both exposure to hazards and neglect, as were supervisor impairment and child welfare substantiation of the death. Comparing neglect to exposure to hazards, there was no association with sleep environment hazards with ORs ranging from 0.8 to 1.3 (95% CI 0.4-3.0), but sleep-related SUID were approximately twice as likely to be classified as neglect when the supervisor was impaired (OR 2.3, 95% CI 2.0-2.7) or child welfare action was taken (OR 1.8, 95% CI 1.5-2.0). The guidelines recommend classification of exposure to hazards for sleep environment hazards with elevation to neglect if the supervisor was impaired or child welfare substantiated the death. CONCLUSIONS Among sleep-related SUID, classification of exposure to hazards is based on presence of sleep environment hazards, whereas neglect is based on supervisor impairment and child welfare action.

中文翻译：

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提高对婴儿猝死的儿童虐待进行分类的一致性。


目的 为儿童死亡审查小组制定指南，以提高儿童虐待 （CM） 分类的一致性，并区分暴露于危险的分类和睡眠相关婴儿意外死亡 （SUID） 的忽视分类。方法 2004 年至 2018 年间，从国家死亡审查病例报告系统中确定了与睡眠相关的 SUID （n = 25 797）。确定了在睡眠相关 SUID 中对 CM 进行分类时考虑的关键变量。使用 Logistic 回归来评估关联的强度并确定区分暴露于危害和忽视的因素。计算比值比 （OR） 和 95% 置信区间 （CI）。根据这些发现制定了指南。结果 在确定的 13 034 例与 CM 相关的睡眠相关 SUID 中，婴儿睡眠环境中的危害与暴露于危险和忽视的分类密切相关，监督者损伤和儿童福利对死亡的证实也是如此。将忽视与暴露于危害进行比较，与睡眠环境危害无关，ORs 范围为 0.8 至 1.3 （95% CI 0.4-3.0），但当监督者受损 （OR 2.3,95% CI 2.0-2.7） 或采取儿童福利行动 （OR 1.8,95% CI 1.5-2.0） 时，睡眠相关 SUID 被归类为忽视的可能性大约是其两倍。该指南建议将暴露于危险的危险分类为睡眠环境危害，如果监督者受损或儿童福利证实了死亡，则将其提升为忽视。结论 在与睡眠相关的 SUID 中，危害暴露的分类基于睡眠环境危害的存在，而忽视则基于监督者损伤和儿童福利行动。