SIDS - Pediatric - Lecture Slides, Slides of Pediatrics

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“To Die, To Sleep ...”

A Discussion on SIDS

SIDS - outline

ALTE

not “near-miss SIDS” SIDS background definition etiology control of breathing epidemiology avoidable risk factors

Factoids

prevalence from 0.05% to 6.0% most with ALTE do not die of SIDS combined prevalence of SIDS among other family members of infants w/ ALTE = 11% most with SIDS have never had ALTE 73 - 96% w/o ALTE median age at presentation = 2 months slight male predominance

Causes

GE Reflux 28% Neurologic problems 12% Infection 6% Upper Airway Obstruction 2% Metabolic problems 2% Cardiac problems 1% Idiopathic 47%

Home Monitor?

1986 NIH Consensus Conference on Infantile Apnea and Home Monitoring definitely indicated

• severe ALTE
• tracheostomy <18 months old
• ISAM‟s
• twin of SIDS victim not indicated
• normal infant
• asymptomatic premature infant

Questionable Risk Group

Sib of SIDS moderate ALTE

decision based risks, benefits, liabilities, and limitations parent - provider decision

SIDS background

decreasing infant mortality this century one category of infant death not decreasing 1969 - “SIDS” title given Steinschneider A: Prolonged apnea and the sudden infant death syndrome. Pediatrics 1972; 50 (4): 646. 1991 - definition expanded by NICHD

definition of SIDS

sudden death of an infant under 1 year old that can not be explained despite: autopsy within 24‟ incl. skeletal survey, tox and metabolic screens prompt examination of the death scene including interviews of household members by knowledgeable indevidual review of the clinical history from caretaker, key medical providers and medical records

AAP Addition to Evaluation

Exam of the dead infant at a hospital ED by a child maltreatment specialist 1-5% of SIDS may be infanticide clues to infanticide

• 6 months old

• previous unexpected or unexplained sib death
• simultaneous death of twins

etiology - focused

developing nervous system developing immune system inherited metabolic disease changes in cardiac conduction system changes in respiratory control non-accidental trauma

Baruch‟s Observation

“If all you have is a hammer,

everything looks like a nail.”

epidemiologic studies

NICHD Cooperative Epidemiologic Study of SIDS Risk Factors New Zealand Cot Death Study Avon Infant Mortality Study King County Washington SIDS Study

NICHD SIDS Study

Oct „78 - Dec ' multicenter, population based, case controlled 838 SIDS 1676 controls age-matched living - randomly selected age-matched living - matched for race and low birth weight