Sudden Infant Death Syndrome Definition The sudden death

Sudden Infant Death Syndrome 報告者: 吳孟書

Definition The sudden death of an infant under one year of age remains unexplained after a through case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history of the infant and the family. v SIDS was first formally defined in 1969 and the definition was revised in 1989. v Not caused by child abuse, suffocation, aspiration or immunization. v

Apparent Life-Threatening Episode v ALTE characterized by a combination of: Ø Apnea Color change(usually cyanosis but occasionally erythema) Marked change in muscle tone (usually limp) Choking or gagging Ø Ø Ø v v v Ø Ø Ø Severe unexplained apneic episodes during sleeping, requiring vigorous stimulation or resuscitation to terminate the event. Only very small overlap with SIDS. 50% have identifiable cause: Infection Airway obstruction Congenital heart disease Seizure, choking Breath-holding

Description v Predominant age: Rare in first month of life, peak occurs in infants between 2 and 4 months, 80% of death occur by 6 months. v Predominant sex: Male> Female v These babies generally are healthy, or may have had a minor upper respiratory or GI infection in the last 2 weeks of life.

Possible causes Abnormalities in respiratory control and arousal responsiveness v Central and peripheral nervous system abnormalities v Cardiac arrhythmias v Rebreathing in face down position on soft surface leading to hypoxia and hypercarbia v Infection agents v Climatic change v Environmental factors such as hyperthermia or hypo-v

Risk factors v Race v Season- late fall and winter months v Time of day- between midnight and 6 AM v Activity-during sleep v Low birth weight; intrauterine growth retardation (IUGR) v Poverty

Risk factors Maternal factors: teenage mothers; maternal use of cigarettes or drugs(cocaine, opiates) during pregnancy; higher parity; maternal anemia during pregnancy. v Respiratory or GI infection in recent past v Sleep practices- prone and side sleep position, heavier clothing and bedding, soft bedding v Passive cigarette smoke exposure after birth v

Diagnosis v Diagnosis of exclusion v Investigation of the scene of death Ø Ø Where baby was How it was sleeping Who was with it What it was doing v Exploration Ø Ø of medical history Prenatal and perinatal history Baby’s medical history since birth

Diagnosis v Laboratory: Ø Ø Ø Ø CBC/DC ELECTROLYTE LFT TOXICOLOGY SCREEN SEPTIC WORK UP U/A AND TESTS FOR INBORN ERROES OF METABOLISM EKG RADIOLOGICAL SKELETAL SURVEY v Autopsy

AUTOPSY v v v 1) 2) 3) Should be done Helps parents through their grieving process and helps them to understand prevention Nonspecific postmortem findings used to establish the Dx: Retention of periadrenal fat Hepatic erythropoiesis Brain stem gliosis

Treatment Begin resuscitation unless rigor mortis or livedo reticularis are present v According to NALS and PALS guideline v Look for obvious sings of trauma v Parents should not be told that the cause of death is SIDS, if no obvious diagnosis is found at the termination of resuscitation v Allow the family to grieve v Help family to express feeling v

Disposition v Admit all infants who have ALTE for evaluation and monitoring after initial stabilization and resuscitation v Discharge: none

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