Sudden Infant Death Syndrome (SIDS)

Overview

Sudden infant death syndrome (SIDS) is the sudden unexplained death of a child under the age of 1 year. It occurs while sleeping or while the child is assumed to be aspleep. Keep an eye out especially between 1-6 months of age. A diagnosis of exclusion. Falls under the umbrella of Sudden Unexplained Infant Deaths (SUID) which can include asphyxiation, foreign body aspirations, cardiac arrhythmias, electricution, trauma etc.

Most common cause of death in infants outside the neonatal period. Accounts for 15,000 deaths worldwide in 2013. Slight male predilection.

• Factors that reduce risk
  • No drug exposure (smoking) during pregnancy
  • Regular ANC visits (promotes a healthy lifestyle in mom)
  • Breastfeeding
  • Immunisation (50% risk reduction)
  • Pacifier use during sleep
  • Sleep in supine position
  • Safe sleep environment (firm matress, no pillows or blankets or stuffed animals)
  • Sleep with parents in the same room w/o sharing bed
  • Smoke-free environment
  • Supervised tummy time (prone position to strengthen shoulder and neck muscles)
• Differentials
  • Child abuse: skeletal and toxicology findings that suggest abuse (cranial injuries, abdominal trauma, hematomas). SIDS is very unlikely after 1 year of age
  • Suffocation: deliberate or accidental. Can appear very identical to SIDS.
    • Intentional suffocation – recurrent issues around one caregiver, age > 6 mos, previous SUIDS under same caregiver, existence of old pulmonary hemorrhage on autopsy
  • Inborn error of metabolism; fatty acid metabolism disorder. Consider in cases with multiple occurences in a single family.
  • Cardiac chanelopathies.

Triple-risk model

Triple-risk model (Kinney, et AL): SIDS results from an intersection of 3 major factors – vulnerable infant, critical developmental period, and exogenous stressors

• Vulnerable infant (non-modifiable)
  • Male sex
  • Prematuriy
  • Blac/Native American race
  • Young maternal age
  • Low SES
  • Prenatal substance exposure
  • Poor prenatal care
• Critical developmental period
  • 91% of cases occurs between 1 and 6 monhs of age (developmental processes become altered for a bit)
• Exogenous stressors
  • Unsafe sleeping environment (adult beds, as opposed to cribs)
  • Prone sleeping position (1994 back to sleep program ; 5-6x more likey)
  • Bed-sharing
  • Nicotine exposure
  • Winter months