At least 189 infants died in Connecticut from 2002 to 2013 after falling asleep in an adult bed with parents or siblings or with a bottle, sleeping in a car seat or crib with blanket or pillows, on their stomach, or in other unsafe situations, the state Office of the Child Advocate and State Child Fatality Review Panel said in a Public Health Alert Monday.

The alert said the number of Connecticut children who die from unsafe sleep arrangements is three times the number who die from child abuse.

"Infants in Connecticut are more likely to die from unsafe sleeping conditions than from child abuse, car accidents, choking, drowning, falls or other source of accidental injury," the alert said.

Infants are most at risk of dying due to unsafe sleeping arrangements if one or both parents is depressed, are abusing drugs or alcohol, are obese, isolated or have other mental health challenges, the alert said.

It advocates five steps be taken to prevent deaths from unsafe sleep conditions:

• an annual child fatality hearing to address child deaths and prevention strategies;

• screening of mothers for depression in pediatric, obstetrician-gynecologist and primary care offices;

• more home visit programs for parents and children;

• uniform protocols for emergency responders for sudden infant death investigations;

• more emphasis on safe sleep practices for infants in child welfare case planning.

"Screening and home visiting, while always considered good policy and practice, are also infant fatality prevention strategies," Sarah Eagan, the state's child advocate and co-chairwoman of the review panel, said in a news release. "This sharing of information and provision of support can save lives."

The report gave two examples of infant deaths in 2013. In the first, an 8-week-old baby boy was being taken care of by his maternal grandmother while his mother went out for the evening for the first time since his birth. When the mother returned home, she found her mother asleep on the couch with her son face down in the space between the grandmother and the arm of the couch. The child was blue and not breathing. He was rushed to the Emergency Department of the local hospital and pronounced dead.

In another case, a 7-week-old baby girl, swaddled in a heavy receiving blanket, was laid down to sleep alongside her mother in her mother's bed. When the mother woke, the baby was lying on her stomach and was cold, blue and not breathing. Paramedics called to the home declared the child dead. The mother had a history of opiate addiction and was receiving methadone treatments.

In all, the advocate's office and the panel reviewed 277 infant deaths from 2002 to 2013, and determined that at least 189 involved unsafe sleep conditions. The remaining deaths were attributed to Sudden Infant Death Syndrome - which the report said may not account for unsafe sleep conditions - or undetermined causes.

The child advocate's office and the review panel said they will publish quarterly public health alerts about how children die in Connecticut and how public health systems can prevent these deaths.

j.benson@theday.com