Sudden Infant Death Syndrome (SIDS)

Sudden Infant Death Syndrome (SIDS)

·        Defn: death < 1 year, and still unexplained after autopsy, review of clinical history and examination of the death scene (in practice none of these is usually done well)

·        Epidemiology:

o   1990: approx 4.5 per 1000 live births

o   2000: approx 1 per 1000 live births (about 70 per year).  Pakeha lower, Maori about 4 per 1000

·        Epidemiological risk factors:

o   Age (3 – 5 months)

o   Maternal smoking – now greatest modifiable risk factor given sleeping on back well established

o   Prone sleeping position

o   ?Bed sharing

o   Seasonal (winter worse)

o   Previously well

o   Race (eg higher in indigenous minorities)

o   Male

o   Low birth weight

o   Low maternal age

o   Low Socio-economic status

·        Theories:

o   Re-breathing of expired gases (eg prone or bed sharing)

o   Hyperthermia

o   Co-sleeping (bed sharing)

·        Differential diagnosis:

o   Child abuse (eg shaking injury, suffocation)

o   Metabolic disease

o   Cardiac disease (congenital or acquired)

o   Overwhelming sepsis

o   Accidental asphyxia (eg in bed) – requires good death scene exam and history

·        SIDS follow-up:

o   Explanation of death

o   Explanation of grieving process

o   Follow up with next child

o   Screen for risk factors

o   Role of monitoring (no evidence of effectiveness but reassuring for parents)

·        Prevention:

o   Supine sleep position

o   No smoking

o   Own cot

o   Avoid bed sharing or sofa if tired or smoker or alcohol intake or pillows

o   Dress for room temperature (ie don‟t let them get too hot, no hat in bed)

o   Make up bed so they can‟t slip under the covers (ie short-sheet the bed)

·        Complications of prone position: Plagiocephaly (flat spot on skull). Prevent by varying position of the head when lying