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SIDS rates still a mystery, state investigator says
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The declining number of Sudden Infant Death Syndrome cases in New Mexico and other states might well have nothing to do with SIDS, said Ross Zumwalt, chief of the New Mexico Office of the Medical Investigator.
SIDS is a diagnosis of exclusion, something hard to define, he said.
It's not caused by a baby suffocating on an object like a sofa cushion or from being put to bed on its stomach, Zumwalt said.
It's much more mysterious.
"The cause is still unknown," Zumwalt said.
When he started working as a medical investigator 30 years ago, SIDS was a catch-all definition for a variety of infant deaths, including suffocation and a host of unexplained causes, he said.
The "Back to Sleep" campaign, which encouraged parents to put babies to sleep on their backs instead of their stomachs to avoid suffocation, was highly successful in dropping the death rate that has been attributed to SIDS, Zumwalt said.
But those cases don't appear to be the same thing as SIDS, he said.
"I think it was overclassified in the past," Zumwalt said. "Putting babies on their backs decreased the number of SIDS cases, but there are still plenty of infants who die while sleeping on their backs, and nobody knows why."
In New Mexico, except for cases from American Indian reservations, all cases of infant deaths attributed to SIDS are reviewed by a team of investigators at OMI, Zumwalt said.
From Jan. 1, 2000, to Dec. 31, 2004, there were 74 SIDS cases reported in New Mexico, at a rate of 4.07 cases per 100,000 people - which is on par with the national average, according to the U.S. Centers for Disease Control and Prevention in Atlanta.
In 2006, there were 16 certified SIDS cases in the state, eight asphyxial deaths and five undetermined, Zumwalt said.
"We were usually running 30-40 SIDS cases a year when I first came here," Zumwalt said. "But when you do a really complete investigation, you find some of these are asphyxial deaths."
Still, every state organizes its SIDS deaths differently - so cases of asphyxia in other states could be classified as SIDS, and still other SIDS cases might not be classified as SIDS at all, said Mike Landen, deputy state epidemiologist.
"Any physician could write the SIDS diagnosis on a death certificate," Landen said. "And in some states that may or may not end up getting investigated by a local coroner or investigator."
In some areas, doctors don't believe in SIDS as a viable diagnosis at all, Zumwalt said.
"They don't believe in the concept. So they call these deaths undetermined, or they call them something else," Zumwalt said.
There are plenty of theories about why some babies die while sleeping on their backs, without being suffocated by something, he said.
It could be infectious disease, environmental, congenital or genetic - but nobody really knows for sure, Zumwalt said.
That's why it's important to narrow down the description - so that a more accurate picture of the problem can be collected, he said.
"It's still an unknown cause," Zumwalt said. "There's a lot of research going on, but there needs to be more."
