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SIDS - UNEPA

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					           SIDS
Frank Ferrucci,PA-C
Anna Jacques Hospital
ED
                   Definition
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.
        Pathophysiology

Exact cause is still unknown
Current though is of Triple
 risk
  infant with abnormalities in
   cardiorespiratory control
  critical period of development
  exogenous stressor
                    Statistics
Frequency decreased
 significantly with public health
 campaigns such as “Back to
 Sleep.”
58% decrease since launch
How infant sleeps determines
 risk
SIDS rate for US: 0.54/1000
 births
                    Risk Factors

Sleeping position
Smoking during prenatal period
Bed sharing
Bottle feeding
Non-pacifier use
Bundling
Bed coverings
                Risk Factors
Black/Native American
 ethnicities
   independent of youg maternal
    age, low birth weight, multi
    parous etc
Male>female
Age 2-4 mos
   ? link between infant
    development
                              HPI
Typically found apneic and
 pulseless
Recent meal and then put to bed
Full term, normal pregnancies
Generally feed well and gain
 weight normally
Parents generally report no
 symptoms prior to death
70% have minor URI
                            Exam
Frothy blood-tinged discharge @
 nose or mouth
Rigor mortis
Look for obstruction, entrapment
 of head, environmental causes etc
Autopsy generally unremarkable
No signs of trauma should be
 present
Petechiae often found on
 thymus,pleura and epicardium
                             Causes

Triple risk model
  multifactorial
  death due to un-deployable defenses
Neuropathology
  structural and nerve cell
   abnormalities
  ? delayed development of brain stem
  currently being studied
                      Causes


Critical development period
  SIDS most common 2-4 mos
  dramatic developmental
   change
  near doubling of brain weight
                     Causes

Exogenous Stressors
  changes in oxygen/carbon
   dioxide in sleep environment
  changes in ambient
   temperature
  possible infectious component
                 Diagnosis


Sudden Unexplained Death
 in Infancy Investigation and
 Reporting form
  CDC/Dept of Health and
   Human Services
                     ALTE

Definition
Frequency around 1-3%
25-50% of ALTE go
 unexplained
Association between ALTE
 and SIDS
                   Workup

Differential is huge
Data from scene, infant and
 family medical/social history
 and autopsy required to
 make diagnosis
Notify pediatrician
            SIDS Episode

Express condolences
Have family hold their child
Inform family of autopsy
REASSURE family
Refer family
                       Prevention
Sleep supine
Pacifier use
Breastfeeding
Avoid bundling and head covering
Keep pillows, comforters etc out of
 crib
No smoking
Avoid bed sharing
                       Resources
The Association of SIDS and Infant
 Mortality Programs
National SIDS/Infant Death
 Resource Center
American Academy of Pediatrics
CDC
http://www.emedicinehealth.com/
 sudden_infant_death_syndrome_si
 ds/article_em.htm
Questions??

				
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posted:2/6/2013
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