Sudden infant death syndrome

Sudden infant death syndrome (SIDS) is the abrupt and unexplained death of an infant less than 1 year old. Although the etiology of SIDS remains unclear, evidence suggests that it is caused by a combination of environmental triggers and cardiorespiratory impairment, which then leads to prolonged hypoxia. Most SIDS cases occur in the first 6 months of life. Parents should receive information on how to prevent SIDS during prenatal care and in pediatric check-ups after birth: Recommendations include placing the infant on his/her back to sleep, ensuring a safe sleep environment, and avoiding overheating and second-hand smoke. SIDS is a diagnosis of exclusion; an autopsy is therefore important to rule out differential diagnoses (e.g., congenital cardiac anomalies or battered child syndrome).

Sudden infant death syndrome (SIDS) is the abrupt and unexplained death of an infant. Diagnosis requires that a forensic examination reveals no other cause of death.

References:^[1]

• Peak incidence: 2–6 months ; in rare cases, during the first days of life
• Sex: ♂ > ♀

References:^[2]

Epidemiological data refers to the US, unless otherwise specified.

The etiology of SIDS remains unclear. Evidence suggests that it is caused by a combination of both extrinsic and intrinsic factors, which ultimately lead to acute or chronic hypoxia. Over 90% of cases of SIDS occur during sleep.

Extrinsic factors (triggers)

• Sleeping in the prone position
• Exposure to nicotine during pregnancy and after birth (including 2nd-hand smoking)
• Overheating
• Unsafe sleeping environment or CO₂ rebreathing: e.g., a shared blanket, stuffed animals in the crib (because of the grasping reflex, newborns tend to drag items to their faces)
• Many more correlations: SIDS in siblings, babies born prematurely, young mothers (< 20 years), low socioeconomic status, etc.

Intrinsic factors

• Brainstem disorder that includes morphologic/biochemical abnormalities of serotonin (known as 5-hydroxytryptamine or 5-HT), which impacts the respiratory drive, the ability to wake up, blood pressure, upper respiratory reflexes , and body temperature.

References:^[3]

SIDS is a diagnosis of exclusion. If there is an unexplained death of an apparently healthy infant, an autopsy is required by law to rule out other causes of death.

• Congenital anomalies that could lead to infant death (e.g., cardiac anomalies)
• Intentional suffocation; evidence of battered child syndrome

The differential diagnoses listed here are not exhaustive.

• Definition: a sudden and unexpected event occurring in an infant that is considered life-threatening by the observer and is characterized by some combination of the following:
  • Apnea
  • Changes in skin color (usually cyanosis or pallor) and/or muscle tone (e.g., rigidity, floppiness)
  • Choking/gasping
• Epidemiology: reported incidence is 0.05–6%. ^[4]
• Etiology
  • Most common causes are seizure, respiratory tract infection, gastroesophageal reflux, and cardiac conditions (e.g., arrhythmia)
  • Associated risk factors include age < 10 weeks, prematurity, prior ALTE, feeding difficulties, and/or symptoms of upper respiratory infection
• Clinical features
  • See “Definition.”
  • May occur while the infant is awake or asleep
  • Not associated with SIDS ^[5]
• Prognosis: recurrence is high, but overall mortality is low (< 1%) ^[6]

References:^[5][7]

Parents should receive information on how to prevent SIDS during prenatal care and in pediatric check-ups after birth.

• During pregnancy
  • No smoking, alcohol, or recreational drugs
  • Prenatal care
• Protective factors after birth
  • The infant should be placed to sleep in the supine position
  • Safe sleep environment: firm mattress; no pillows, blankets, stuffed animals, or bumper pads in the crib.
  • In the first 6 months, co-sleeping in the same room without bed-sharing
  • Second-hand smoke and overheating should be avoided
  • Use of pacifier during sleep ^[8]
  • Breastfeeding until the 4^th–6^th month
  • "Tummy time"
  • Immunization in line with the official schedule

References:^{[9][10][11][12][13][14][15]}