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Sudden Infant Death Syndrome

Sudden Infant Death Syndrome (SIDS) Overview – Definition and Diagnosis: – SIDS is a diagnosis of exclusion for infants under one year. – Diagnosis requires […]

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Sudden Infant Death Syndrome (SIDS) Overview
– Definition and Diagnosis:
– SIDS is a diagnosis of exclusion for infants under one year.
– Diagnosis requires unexplained sudden death after thorough investigations.
– Specific causes like suffocation or neglect may be mislabeled as SIDS.
– Age and Incidence:
– Predominantly affects infants under one year, with peak incidence between two to four months.
– Lognormal age distribution sparing newborns distinguishes SIDS from other infant mortality causes.
– Risk Factors:
– Multiple risk factors contribute to SIDS, with no single known cause.
– Social, economic, and cultural factors like maternal education and poverty influence SIDS rates.
– Race Disparities:
– Persistent disparities in SIDS deaths among racial/ethnic groups in the U.S.
– African American infants have a 24% greater risk of SIDS-related death compared to the general population.
– Society and Culture:
– SIDS rates vary among different cultures and countries.
– Western societies may have higher SIDS rates, with the lowest rates among Asian and Pacific Islander infants.

Contributing Factors to SIDS
– Tobacco Smoke:
– Maternal smoking during pregnancy increases SIDS rates.
– Nicotine alters neurodevelopment in babies, correlating with SIDS rates.
– Sleeping Practices:
– Placing infants on their back and avoiding soft bedding reduces SIDS risk.
– Bed-sharing with parents or siblings can increase SIDS risk.
– Genetics and Alcohol:
– SIDS is more prevalent in males, with genetic mutations contributing to some cases.
– Alcohol use by parents is linked to SIDS, doubling the risk with alcohol use disorder.
– Other Factors:
– Premature babies are at four times the risk of SIDS.
– Butyrylcholinesterase activity, cold weather, and bacterial infections may be linked to SIDS.

Diagnosis and Prevention of SIDS
– Diagnosis Challenges:
– Conditions like MCAD deficiency and long QT syndrome can be confused with SIDS.
– Accidental suffocation and instances of infanticide may be initially misdiagnosed as SIDS.
– Prevention Strategies:
– Changing sleeping positions, breastfeeding, and avoiding soft bedding can help prevent SIDS.
– Electronic monitors and certain devices are not effective in preventing SIDS.
– Public Health Recommendations:
– CDC and NIH provide alerts on SIDS risk factors and guidelines for reducing SIDS.
– Increasing awareness of genetic variants and infections in SIDS is crucial for prevention.

Research and Studies on SIDS
– Potential Mechanisms and Biomarkers:
– Interactions between thermoregulation and respiration may play a role in SIDS.
– Butyrylcholinesterase and genetic variants like long-QT syndrome are potential biomarkers.
– Research Findings:
– Studies show reduced SIDS risk with breastfeeding and potential explanations for SIDS.
– Effects of prematurity, infections, and genetic factors on SIDS risk are being studied.
– Immunizations and SIDS:
– Association between SIDS and certain immunizations is under study.
– CDC provides information on vaccine safety and SIDS concerns.

Prevention Strategies and Global Impact
– Causes and Prevention:
– AAP recommendations and meta-analyses on swaddling for reducing SIDS risk.
– Updated guidelines for a safe infant sleeping environment and the impact of pacifier use on breastfeeding.
– Global Impact:
– Efforts to reduce sudden infant death globally and changes in cause-specific infant mortality rates.
– Cultural Competence:
– Literature reviews on cultural competence in addressing SIDS and resources for further reading.
– Recommendations for addressing SIDS from a pathologist’s viewpoint.

Sudden Infant Death Syndrome (Wikipedia)

Sudden infant death syndrome (SIDS), sometimes known as cot death, is the sudden unexplained death of a child of less than one year of age. Diagnosis requires that the death remain unexplained even after a thorough autopsy and detailed death scene investigation. SIDS usually occurs during sleep. Typically death occurs between the hours of midnight and 9:00 a.m. There is usually no noise or evidence of struggle. SIDS remains the leading cause of infant mortality in Western countries, constituting half of all post-neonatal deaths.

Sudden infant death syndrome
Other names
  • Cot death
  • crib death
Safe to Sleep logo
The Safe to Sleep campaign encourages having infants sleep on their back to reduce the risk of SIDS.
Specialty
Usual onsetOne to four months in age
CausesUnknown
Risk factors
Diagnostic method
Differential diagnosis
Prevention
Frequency1 in 1,000–10,000

The exact cause of SIDS is unknown. The requirement of a combination of factors including a specific underlying susceptibility, a specific time in development, and an environmental stressor has been proposed. These environmental stressors may include sleeping on the stomach or side, overheating, and exposure to tobacco smoke. Accidental suffocation from bed sharing (also known as co-sleeping) or soft objects may also play a role. Another risk factor is being born before 39 weeks of gestation. SIDS makes up about 80% of sudden and unexpected infant deaths (SUIDs). The other 20% of cases are often caused by infections, genetic disorders, and heart problems. While child abuse in the form of intentional suffocation may be misdiagnosed as SIDS, this is believed to make up less than 5% of sudden death cases.

The most effective method of reducing the risk of SIDS is putting a child less than one year old on their back to sleep. Other measures include a firm mattress separate from but close to caregivers, no loose bedding, a relatively cool sleeping environment, using a pacifier, and avoiding exposure to tobacco smoke. Breastfeeding and immunization may also be preventative. Measures not shown to be useful include positioning devices and baby monitors. Evidence is not sufficient for the use of fans. Grief support for families affected by SIDS is important, as the death of the infant is sudden, without witnesses, and often associated with an investigation.

Rates of SIDS vary nearly tenfold in developed countries from one in a thousand to one in ten thousand. Globally, it resulted in about 19,200 deaths in 2015, down from 22,000 deaths in 1990. SIDS was the third leading cause of death in children less than one year old in the United States in 2011. It is the most common cause of death between one month and one year of age. About 90% of cases happen before six months of age, with it being most frequent between two months and four months of age. It is more common in boys than girls. Rates of SIDS have decreased in areas with "safe sleep" campaigns by up to 80%.

A literature review published in 1999 in the British Medical Journal estimated that 20% to 40% of sudden infant deaths are, in reality, infanticides, typically committed by the mother. More recent estimates suggest that less than 10% of SIDS are homicides.

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