Sudden Infant Death Syndrome

Aka: Sudden Infant Death Syndrome, Crib Death, SIDS

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II. Epidemiology

  1. Incidence: 0.57 per 1000 live births
  2. Responsible for 2200 deaths per year in the United States
  3. Ages affected: 1 to 6 months (peaks at ages 1-4 months)
  4. Most often occurs between midnight and 8 am

III. Pathophysiology

  1. Triple-Risk Model (SIDS is final common pathway of 3 contributing factors)
    1. Underlying Vulnerability (e.g. Prolonged QT, Autonomic Dysfunction)
    2. Exogenous Stress (e.g. prone position, smoke exposure)
    3. Stress occurs during critical time in development (age <1 year old)

IV. Risk Factors: Ordered by Level of Risk

  1. Major Risk Factors
    1. Bed Sharing with smoking mother (OR 13.90)
    2. Gestational age <37 weeks (OR 11.67)
    3. Bed Sharing with infant <12 weeks old (OR 10.37)
    4. Soft bedding material (OR 5.10)
    5. Prone sleeping position (OR 4.30)
    6. Bed Sharing with non-smoking mother (OR 2.09)
    7. Mother smoked during pregnancy (OR 2.06)
  2. Other Risk Factors
    1. Side sleeping position (OR 1.9)
    2. Smoke exposure as infant (OR 1.65)
  3. Protective Factors
    1. Up-to-date Immunizations
    2. Pacifier use
  4. References
    1. Adams (2009) Am Fam Physician 79(10): 870-4 [PubMed]

V. Risk Factors: Overall

  1. Bed Sharing (Co-Sleeping) prior to 4 months of age (especially with smoking mother)
  2. Prone sleeping position (also side sleeping to lesser extent)
  3. Parental Smoking (associated with 61% of SIDS deaths)
  4. Low birth weight
  5. Teenage parents
  6. Maternal Alcohol Abuse (associated with 16% of SIDS deaths)
  7. Maternal Drug Abuse
  8. Minimal Prenatal Care
  9. Family History of previous SIDS deaths

VI. History: By coroner or medical provider

  1. Reporting demographics
    1. Time infant was last normal
    2. Name of person who found the infant
  2. Infant status when found
    1. Respiratory status of infant when found (i.e. breathing or apneic)
    2. Sleep environment and surface on which the infant was found
    3. Items present around the infant when found (e.g. blankets)
    4. Position of infant when found (e.g. prone)
  3. Contributing factors
    1. Co-Sleeping
    2. Recent illness

VII. Diagnosis: Autopsy

  1. Assess for other possible cause
  2. Findings consistent with SIDS
    1. Intrathoracic Petechiae
    2. Mild respiratory tract congestion
    3. Brainstem gliosis
    4. Extramedullary hematopoiesis

VIII. Differential Diagnosis

  1. Apparent Life-Threatening Events In Children (ALTE)
    1. ALTE events are not related to SIDS and are not a risk for SIDS
  2. Anoxia (Aspiration, Asphyxiation, Drowning)
  3. Cardiac Arrhythmia or Congenital Heart Defect
  4. Dehydration
  5. Inborn Errors of Metabolism
  6. Overwhelming infection (e.g. Neonatal Sepsis, Pneumonia)
  7. Poisoning
  8. Trauma (including Non-accidental Trauma)
  9. Hyperthermia

IX. Management: Emergency Department

  1. Avoid cleaning baby post-Resuscitation
  2. Evaluate neck flexibility on intubation (stiff or flexible)
    1. Stiffness may suggest longer duration since time of death
    2. Rigor mortis cannot otherwise be determined in infants due to lack of musculature
  3. Describe secretions found in the airway
    1. Do not clear the suction canister of secretions until examined by coroner
  4. Toxicology Screening
    1. May be performed during Resuscitation
    2. Coroner will perform if not already done
  5. Imaging
    1. Skeletal Survey is typically performed by coroner (multiple views, without limitations of radiation exposure)

X. Management: Family Support

  1. Counseling services

XI. Resources

  1. American SIDS Institute
    1. http://sids.org/

XII. Prevention

  1. Avoid Bed Sharing (especially prior to 4 months of age)
    1. Room sharing is recommended
  2. Infants should sleep in their own bassinet or crib
    1. See Crib Safety
    2. Firm sleep surface
    3. No pillows, comforters, toys or bedding
  3. Child should sleep in supine position (Back to sleep campaign)
    1. Practice prevention of Deformational Plagiocephaly
    2. Gross Motor Delays may occur due to supine positioning, but resolve by 18 months old
  4. Tobacco Cessation for parents (prior to pregnancy or prenatally is best)
  5. Keep Immunizations up-to-date
  6. Infant monitors are not recommended by AAP (not effective in preventing SIDS)
  7. Breast Feeding substantially reduces SIDS Risk (OR 0.27)
    1. Hauck (2011) Pediatrics 128(1): 103-10 [PubMed]

XIII. References

  1. Bertone and Spangler in Herbert (2013) EM:Rap 13(11): 8-9
  2. Merenstein (1994) Handbook Pediatrics, Lange
  3. (1996) BMJ 313:191 [PubMed]
  4. (1996) BMJ 313:195 [PubMed]
  5. Adams (2015) Am Fam Physician 91(11): 778-83 [PubMed]
  6. Adams (2009) Am Fam Physician 79(10): 870-4 [PubMed]
  7. Alexander (2005) J Forensic Sci 50(1): 147-51 [PubMed]

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