Infant mortality rate is generally regarded as a fundamental indicator of population health and is often used to validate public health interventions. Hamilton County, Ohio, has one of the highest rates in the nation. Most deaths that do not occur in the hospital fall under the jurisdiction of a coroner/medical examiner. We reviewed all infant deaths evaluated by the Hamilton County Coroner from 2006 to 2013 in order to identify opportunities for public health interventions. We predicted that the majority of these infant deaths were unintentional, but preventable. The eligible population included live born infants, who died less than one year of age. There were 217 cases of infant deaths during this time frame and 14 primary causes of death identified in this cohort. Sleep related deaths made up the majority of deaths (n = 141, 65%), a mean of 17.6 per year. This analysis identifies unsafe sleep patterns, particularly co-bedding and inappropriate sleep surface, as the most frequent contributing factors. Therefore, the coroner/medical examiner, working with public health and healthcare providers can generate information to drive targeted improvements in the outcome for infants.