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Chapter: Medicine Study Notes : Paediatrics

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).

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


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Medicine Study Notes : Paediatrics


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