SIDSSIDS

Frank Ferrucci,PA-CAnna Jacques Hospital ED

Frank Ferrucci,PA-CAnna Jacques Hospital ED

DefinitionDefinition

Sudden death of an infant younger than 1 that remains unexplained after a thorough case investigation

One of the most common causes of death between ages 1 mos and 1 year.

Accounts for roughly 25% of deaths in those under the age of 1.

Sudden death of an infant younger than 1 that remains unexplained after a thorough case investigation

One of the most common causes of death between ages 1 mos and 1 year.

Accounts for roughly 25% of deaths in those under the age of 1.

PathophysiologyPathophysiology

Exact cause is still unknownCurrent though is of Triple

risk infant with abnormalities in

cardiorespiratory control critical period of development exogenous stressor

Exact cause is still unknownCurrent though is of Triple

risk infant with abnormalities in

cardiorespiratory control critical period of development exogenous stressor

StatisticsStatistics

Frequency decreased significantly with public health campaigns such as “Back to Sleep.”

58% decrease since launchHow infant sleeps determines

riskSIDS rate for US: 0.54/1000

births

Frequency decreased significantly with public health campaigns such as “Back to Sleep.”

58% decrease since launchHow infant sleeps determines

riskSIDS rate for US: 0.54/1000

births

Risk FactorsRisk Factors

Sleeping positionSmoking during prenatal period Bed sharingBottle feedingNon-pacifier useBundlingBed coverings

Sleeping positionSmoking during prenatal period Bed sharingBottle feedingNon-pacifier useBundlingBed coverings

Risk FactorsRisk Factors

Black/Native American ethnicities independent of youg maternal

age, low birth weight, multi parous etc

Male>femaleAge 2-4 mos

? link between infant development

Black/Native American ethnicities independent of youg maternal

age, low birth weight, multi parous etc

Male>femaleAge 2-4 mos

? link between infant development

HPIHPI

Typically found apneic and pulseless

Recent meal and then put to bedFull term, normal pregnanciesGenerally feed well and gain

weight normallyParents generally report no

symptoms prior to death70% have minor URI

Typically found apneic and pulseless

Recent meal and then put to bedFull term, normal pregnanciesGenerally feed well and gain

weight normallyParents generally report no

symptoms prior to death70% have minor URI

ExamExamFrothy blood-tinged discharge @

nose or mouthRigor mortisLook for obstruction, entrapment

of head, environmental causes etcAutopsy generally unremarkableNo signs of trauma should be

presentPetechiae often found on

thymus,pleura and epicardium

Frothy blood-tinged discharge @ nose or mouth

Rigor mortisLook for obstruction, entrapment

of head, environmental causes etcAutopsy generally unremarkableNo signs of trauma should be

presentPetechiae often found on

thymus,pleura and epicardium

CausesCauses

Triple risk model multifactorial death due to un-deployable defenses

Neuropathology structural and nerve cell

abnormalities ? delayed development of brain stem currently being studied

Triple risk model multifactorial death due to un-deployable defenses

Neuropathology structural and nerve cell

abnormalities ? delayed development of brain stem currently being studied

CausesCauses

Critical development period SIDS most common 2-4 mos dramatic developmental

change near doubling of brain weight

Critical development period SIDS most common 2-4 mos dramatic developmental

change near doubling of brain weight

CausesCauses

Exogenous Stressors changes in oxygen/carbon

dioxide in sleep environment changes in ambient

temperature possible infectious

component

Exogenous Stressors changes in oxygen/carbon

dioxide in sleep environment changes in ambient

temperature possible infectious

component

DiagnosisDiagnosis

Sudden Unexplained Death in Infancy Investigation and Reporting form CDC/Dept of Health and

Human Services

Sudden Unexplained Death in Infancy Investigation and Reporting form CDC/Dept of Health and

Human Services

ALTEALTE

DefinitionFrequency around 1-3%25-50% of ALTE go

unexplainedAssociation between ALTE

and SIDS

DefinitionFrequency around 1-3%25-50% of ALTE go

unexplainedAssociation between ALTE

and SIDS

WorkupWorkup

Differential is hugeData from scene, infant and

family medical/social history and autopsy required to make diagnosis

Notify pediatrician

Differential is hugeData from scene, infant and

family medical/social history and autopsy required to make diagnosis

Notify pediatrician

SIDS EpisodeSIDS Episode

Express condolencesHave family hold their childInform family of autopsyREASSURE family Refer family

Express condolencesHave family hold their childInform family of autopsyREASSURE family Refer family

PreventionPrevention

Sleep supinePacifier useBreastfeedingAvoid bundling and head coveringKeep pillows, comforters etc out of

cribNo smokingAvoid bed sharing

Sleep supinePacifier useBreastfeedingAvoid bundling and head coveringKeep pillows, comforters etc out of

cribNo smokingAvoid bed sharing

ResourcesResources

The Association of SIDS and Infant Mortality Programs

National SIDS/Infant Death Resource Center

American Academy of PediatricsCDChttp://www.emedicinehealth.com/s

udden_infant_death_syndrome_sids/article_em.htm

The Association of SIDS and Infant Mortality Programs

National SIDS/Infant Death Resource Center

American Academy of PediatricsCDChttp://www.emedicinehealth.com/s

udden_infant_death_syndrome_sids/article_em.htm

Questions??Questions??