sids ffrank ferrucci,pa-c fanna jacques hospital ed
TRANSCRIPT
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