Sudden infant death syndrome

Background

• Abbreviation: SIDS
• Unexpected death of infants <1yr for which no pathologic cause can be determined
  • Most deaths occur between 2-4 months of age
  • Rare in <1 month of age
• Diagnosis of exclusion

Risk Factors

• Prone sleeping
  • Odds ratio of 4.92, one of biggest modifiable risk factors
  • Likely from combination of hypercarbia and hyperthermia (heat dissipated through head)
• Soft bedding
• Bed-sharing
• Parental smoking
• URI
• Male sex
• Prematurity / Developmental delay
• Socioeconomic disadvantage
• Mothers <20 yo
• Maternal exposure to smoking, alcohol, drugs of abuse

Protective Factors

• Use of pacifier
• Breastfeeding
• Immunizations
• Home monitoring is NOT protective

Clinical Features

• Unexpected death of infants <1yr for which no pathologic cause can be determined

Management

• Infants with rigor mortis, livedo reticulrais, pH <6, or reduced temperature in absence of environmental hypothermia should not be resuscitated
• Examine for signs of nonaccidental trauma
  • Bruising, petechiae (especially to face on conjunctivae), torn frenulum, blood in mouth or nares
• Do not manipulate body- all cases require evaluation by coroner/ME
• SIDS is a post-mortem diagnosis; ED chart should read "sudden unexpected death in infancy"

Disposition

• Deceased, by definition

See Also

• Neonatal resuscitation

References

• The Sudden Infant Death Syndrome. N Engl J Med 2009; 361:795-805