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The classic presentation of sudden infant death syndrome (SIDS) begins with an infant who is put to bed, typically after breastfeeding or bottle-feeding. The observations most commonly reported with Brief Resolved Unexplained Events (BRUEs: formerly Apparent Life-Threatening Events) are as follows: Cyanosis.
What is the classic presentation of sudden infant death syndrome (SIDS)?
SIDS is a diagnosis of exclusion, meaning that other causes of death must be ruled out. The cause of an infant's death can be determined only through a process of collecting information and conducting sometimes-complex forensic tests and procedures. All other recognizable causes of death are investigated prior to making the diagnosis of SIDS.
How is the diagnosis of SIDS made?
SIDS is not predictable or preventable. Infants may experience episodes termed apparent life-threatening events (ALTEs). These are clinical events in which young infants may experience abrupt changes in breathing, color, or muscle tone. Common causes of ALTEs include viral respiratory infection (RSV), gastroesophageal reflux disease, or seizure.
What are apparent life-threatening events in SIDS?
Physical factors associated with SIDS include: Brain defects. Some infants are born with problems that make them more likely to die of SIDS. In many of these babies, the portion of the brain that controls breathing and arousal from sleep hasn't matured enough to work properly. Low birth weight.
What are the physical factors associated with SIDS?
How do you know if a baby died from SIDS?
SIDS has no symptoms or warning signs. Babies who die of SIDS seem healthy before being put to bed. They show no signs of struggle and are often found in the same position as when they were placed in the bed.
Can an autopsy tell the difference between SIDS and suffocation?
Since by autopsy alone, there is usually no way to tell the difference between suffocation and SIDS, the scene investigation is of utmost importance. Increasingly, investigators are using doll reenactments at the home to help parents clarify the situation surrounding their infant's death.
What are the characteristics of SIDS?
They present three key characteristics: small size, with implications for pressure on resources and limited economic diversity; remoteness and isolation, leading to challenges for trading but also to a unique biodiversity and cultural richness; and a maritime environment, leading to strong tourism assets but ...
What are the 4 factors that are associated with SIDS?
Several factors increase a baby's risk of Sudden Infant Death Syndrome.Low birth weight infants.Premature infants.Sex of the baby-boys have a higher incidence of SIDS.Race: African American, American Indian or Native Alaskan babies have a higher risk for SIDS.Babies who sleep on their stomachs.More items...
Can an autopsy confirm SIDS?
The CDC defines SIDS as "the sudden death of an infant less than one year of age that cannot be explained after a thorough investigation is conducted, including a complete autopsy, examination of the death scene and review of the clinical history.” Other known causes of SUID include accidental suffocation or ...
Is SIDS accidental suffocation?
In 2020, there were about 1,389 deaths due to SIDS, about 1,062 deaths due to unknown causes, and about 905 deaths due to accidental suffocation and strangulation in bed.
What is the single most significant risk factor for SIDS?
Stomach sleeping - This is probably the most significant risk factor, and sleeping on the stomach is associated with a higher incidence of SIDS.
When does SIDS peak and decline?
SIDS and Age: When is My Baby No Longer at Risk? Although the causes of SIDS (sudden infant death syndrome) are still largely unknown, doctors do know that the risk of SIDS appears to peak between 2 and 4 months. SIDS risk also decreases after 6 months, and it's extremely rare after one year of age.
When is SIDS most common?
Most deaths happen during the first 6 months of a baby's life. Infants born prematurely or with a low birthweight are at greater risk. SIDS also tends to be slightly more common in baby boys. SIDS usually occurs when a baby is asleep, although it can occasionally happen while they're awake.
What are 5 risk factors for SIDS?
Risk factorsSex. Boys are slightly more likely to die of SIDS .Age. Infants are most vulnerable between the second and fourth months of life.Race. For reasons that aren't well-understood, nonwhite infants are more likely to develop SIDS .Family history. ... Secondhand smoke. ... Being premature.
What is the triple risk model for SIDS?
A triple risk model for the sudden infant death syndrome (SIDS) as described by Filiano and Kinney involves the intersection of three risks: (1) a vulnerable infant, (2) a critical developmental period in homeostatic control, and (3) an exogenous stressor(s).
What Increases SIDS risk?
Babies might have a higher risk of SIDS if: their mother smoked, drank, or used drugs during pregnancy and after birth. their mother had poor prenatal care. they were born prematurely or at a low birth weight.
What test is a post mortem procedure used to determine whether an infant actually breathed prior to its death?
Lung Flotation Test The test is based on the premise that if an infant has breathed then the lungs will be inflated. Hence, if the lungs float when placed in water, this indicates that they are inflated and the infant had breathed and was born alive.
How easy is it for a baby to suffocate?
It takes just a few minutes for a baby to suffocate, and they are too weak to move themselves out of a position where they can't breathe.
What is accidental suffocation?
Accidental Suffocation and Strangulation in Bed, or ASSB, occurs when something limits a baby's breathing like when soft bedding or blankets are against their face or when a baby gets trapped between two objects, such as a mattress and wall.
Do SIDS babies turn blue?
Signs of abnormal airway protection the nurses watch for and you should too are the following: babies should never lose consciousness while choking, babies should not hold their breath longer than 15 seconds, the skin around the mouth may turn a bluish shade but the lips and tongue should not appear blue, babies should ...
How to prevent SIDS?
Place your baby to sleep on his or her back, rather than on the stomach or side, every time you — or anyone else — put the baby to sleep for the first year of life.
Why are infants more vulnerable to SIDS?
A combination of physical and sleep environmental factors can make an infant more vulnerable to SIDS. These factors vary from child to child.
Why do babies die in cribs?
Although the cause is unknown, it appears that SIDS might be associated with defects in the portion of an infant's brain that controls breathing and arousal from sleep. Researchers have discovered some factors that might put babies at extra risk.
What are some ways to protect a baby from SIDS?
Researchers have discovered some factors that might put babies at extra risk. They've also identified measures you can take to help protect your child from SIDS. Perhaps the most important is placing your baby on his or her back to sleep.
What are the factors that increase the risk of sudden infant death?
They include: Sex. Boys are slightly more likely to die of SIDS. Age. Infants are most vulnerable between the second and fourth months of life. Race.
What causes breathing problems in infants with SIDS?
Respiratory infection. Many infants who died of SIDS had recently had a cold, which might contribute to breathing problems.
Which race is more likely to develop SIDS?
Race. For reasons that aren't well-understood, nonwhite infants are more likely to develop SIDS.
When is SIDS suspected?
SIDS is suspected when a previously healthy infant, usually younger than 6 months of age, is found dead in bed. In most cases, no sign of distress is identifiable. The baby typically feeds normally prior to being placed in bed to sleep. The infant is then discovered lifeless, without pulse or respiration.
What are the four avenues of investigation aid in the determination of a SIDS death?
Four major avenues of investigation aid in the determination of a SIDS death: postmortem lab tests, autopsy, death-scene investigation, and the review of victim and family case history.
What is Sudden Infant Death Syndrome (SIDS)?
Sudden infant death syndrome (also known as SIDS) is defined as the sudden death of an infant younger than 1 year of age. If the child's death remains unexplained after a formal investigation into the circumstances of the death (including performance of a complete autopsy, examination of the death scene, and review of the clinical history), the death is then attributed to SIDS. Sudden infant death is a tragic event for any parent or caregiver.
What is the purpose of autopsy?
An autopsy provides clues as to the cause of death. In some sudden, unexpected infant deaths, specific abnormalities of the brain or central nervous system, the heart or lungs, or infection may be identified as the cause of death. The autopsy findings in SIDS victims are typically subtle and yield only supportive, rather than conclusive, ...
How early can a child die from a SIDS?
The cause of death remains unknown despite a careful review of the medical history, scene investigation, X-rays, and autopsy. SIDS is rare during the first month of life. Risk peaks in infants 2-4 months of age and then declines. Most SIDS deaths occur in infants younger than 6 months of age.
How can an infant's death be determined?
The cause of an infant's death can be determined only through a process of collecting information and conducting sometimes-complex forensic tests and procedures. All other recognizable causes of death are investigated prior to making the diagnosis of SIDS.
Is SIDS a cause of death?
The cause (or causes) of SIDS is still unknown. Despite the dramatic decrease in the incidence of SIDS in the United States in recent years, SIDS remains one of the leading causes of death during infancy beyond the first 30 days after birth. It is generally accepted that SIDS may be a reflection of multiple interacting factors.
What is SIDS in autopsy?
Thus, current definitions of SIDS are generally of exclusion, which means that the term “SIDS” can only be used for an infant death once other causes of sudden death have been excluded. This requires very careful interpretation of the autopsy findings to determine whether tissue changes are causative or coincidental, or whether they are merely epiphenomena. Other problems also involve the history and circumstances, which may be typical but are also not diagnostic (3, 4).
What chapter is the autopsy of sudden infant death syndrome?
Chapter 24The Autopsy and Pathology of Sudden Infant Death Syndrome
What are some examples of mistakes made when there is no death scene examination?
A good example of mistakes that may be made if there is not a proper death scene examination involves cases of accidental asphyxia. As both asphyxia and SIDS may have identical autopsy findings (26), cases of wedging or overlaying may only be identified after the death scene has been examined and a doll has been used to reconstruct the infant’s position (8, 27, 28). Scene examination may be crucial in identifying broken or poorly constructed cribs. In addition, other information that can be acquired at the time of scene examination includes the time the infant was put to bed and last seen alive, the time when found, the sleeping position, numbers of sleeping partners, softness/firmness of the sleeping surface, and the quantity and quality of bedding and/or clothing.
How often could a definitive alternative diagnosis be made following a properly performed autopsy?
A question that is frequently asked is: how often could a definitive alternative diagnosis be made following a properly performed autopsy? This has varied over the years, with reduced numbers of sudden deaths in infancy from organic diseases now, most likely due to better antenatal screening, postnatal testing, and therapeutic interventions. Alternative diagnoses to SIDS were made in approximately 8 to 18% of cases of sudden infant death as the “Reduce the Risks” campaigns were launched (15-17). This percentage rose to more than 25% subsequently (18), in part due to improved death scene examinations as part of standard autopsy evaluations (19, 20).
Why do we need to do an external autopsy after death?
The major reasons for this are to check for any unexplained injuries or lesions that may raise suspicions of accidental or inflicted injury , such as bruises (66), and also to compare patterns of lividity with the reported position of the body. Lividity results from pooling of blood in the dependent parts of the body after death. This examination should be done as quickly as possible, with photographs, as lividity will shift for a number of hours after death, resulting in most cases having supine-dependent lividity with buttock and mid-back blanching at the time of autopsy due to positioning on their backs after death (67). Mismatch in lividity patterns may indicate that parents have incorrectly reported the position of their infant when found (68).
What is the International Standardized Autopsy Protocol?
International Standardized Autopsy Protocol. The International Standardized Autopsy Protocol for cases of unexpected infant death represents the first attempt to provide an international protocol aimed at standardizing autopsy practices and diagnoses. (more...)
What is the importance of ante mortem history?
It is important to review the immediate ante-mortem history for evidence of potentially significant disease such as a fever indicating possible fatal infection.
What are the studies done on SIDS victims?
Physician-scientists and scientists are studying neuropathological tissue and genetic material from SIDS victims to ascertain factors that might be responsible for heightening an infant’s vulnerability to SIDS. Others are performing physiologic studies on infants known to have an increased risk for SIDS.
What are the factors that affect SIDS?
The focus is on modification of sleep position, sleep environment, and nicotine exposure. Infants should be placed to sleep in the supine position (on her or his back). The “Back to Sleep” NICHD campaign in 1994 encouraged parents to place their infant to sleep on their back or side, then the AAP campaign in 1996 recommendation that “back is best” (no side sleeping) led to a significant decrease in SIDS. The risks of supine sleep are positional plagiocephaly (malformation of the skull related to position) which can be decreased by giving the infant “tummy time” while awake, avoiding prolonged periods of time in car seats or bouncy chairs, and encouraging upright “cuddle time.” Modifications of sleep environment include placing the infant to sleep on a firm surface without soft bedding, blankets or toys, placing the infant to sleep in the same room as the parent without bed-sharing, and in a bedroom with temperature that is comfortable for a lightly clothed adult. If an additional blanket is to be used, it should be placed on the infant so that the sheet reaches only to the infant’s chest and is tucked in around the crib mattress to prevent it from covering the baby’s face. The rationale is that these actions may reduce the chance of suffocation and overheating for the infant. Offering a pacifier at the onset of sleep is associated with decreased SIDS risk, but pacifier use should be delayed until after 1 month of age if the baby is breastfeeding and should not be reintroduced into the baby’s mouth after (s)he falls asleep. Smoking or second hand exposure for the pregnant woman, new mother, and baby should be avoided to reduce SIDS risk and for many other health reasons.
What causes SIDS in infants?
Considering this, the etiology of SIDS is thought to include, but is not limited to, serotonergic system dysfunction, autonomic nervous system dysfunction, and impaired arousal mechanisms . All of these are inter-related in the baby’s developing nervous system. Serotonin is a neurotransmitter (brain chemical involved in neuron-cell signaling) that has influence over a broad range of functions such as the sleep-wake cycle, thermoregulation, cardiovascular control, and modulation of motor activity. Neuropathological studies have found a decrease in serotonergic receptor binding in the medulla (area of the brain important for homeostatic function) of SIDS victims. Further, the serotonergic system has been found to be abnormal in 50% of SIDS cases. These findings have led to candidate gene studies, primarily based on clues from the neuropathological findings in SIDS victims and the limited clinical information documented before the sudden death; thus far, findings in the serotonergic system and genes expressed in the early embryology of the autonomic nervous system have not identified variations strongly associated with SIDS risk. Testing of additional genes, in larger cohorts, is currently under way.
What is the etiology of SIDS?
Considering this, the etiology of SIDS is thought to include, but is not limited to, serotonergic system dysfunction, autonomic nervous system dysfunction, and impaired arousal mechanisms. All of these are inter-related in the baby’s developing nervous system.
What is SIDS in medical terms?
SIDS is a diagnosis of exclusion which means that it is only determined as the cause of death after thorough investigation of clinical history, scene of death, and autopsy reveal no other cause.
What is the third leading cause of death in infants in the United States?
In 2008, the most recent published data from the National Vital Statistics System indicated that SIDS was listed as the third leading cause of death in infants in the United States. Causes of SIDS are considered to be multifactorial.
Why is there no treatment for SIDS?
Because the diagnosis of SIDS is made after death, there is no treatment. The current recommendations are aimed at reducing risk factors that are associated with SIDS.
How many people die from SIDS?
One of the leading causes of infant mortality worldwide, SIDS claims an estimated 2,500 lives annually in the United States alone.
How many SIDS deaths were there in 2004?
In 2004, 2246 deaths were certified as SIDS, accounting for 8% of infant deaths. In 2006, the National Center for Health Statistics reported a total of 2323 SIDS deaths nationwide, for an incidence of 0.54 per 1000 live births. In many Asian countries, the current incidence of SIDS is 0.04 per 1000 live births.
What is sudden infant death syndrome?
Sudden infant death syndrome (SIDS) are deaths in infants younger than 12 months of age that occur suddenly, unexpectedly, and without obvious cause. SIDS cannot be explained despite a thorough investigation, including a complete autopsy, examination of the death scene, and review of the clinical and social history.
What to do if an infant dies from apnea?
After death. If the infant is pronounced dead, inform the family in a quiet environment.
How many infants have cyanosis?
About 50-60% of infants manifests cyanosis. Breathing difficulties. Half of the infants who had SIDS experience breathing difficulties before death. Abnormal limb movements. Although most of infants are apparently healthy, many parents state that their babies “were not themselves” in the hours before death.
When should SIDS be monitored?
Caregivers are particularly concerned about subsequent infants; recent studies have indicated that the risk for these infants for the first few months of life to help reduce the family’s stress; monitoring is usually maintained until the new infant is past the age of the SIDS infant’s death.
What causes infant deaths?
Infection. At the time of death, 30-50% of otherwise healthy infants have an acute infection, such as gastroenteritis, otitis media, or, in particular, upper respiratory tract infection (URTI); infantile botulism may be the cause of 5-10% of sudden infant deaths. Breastfeeding.
What is the theme of the chapter 1 of SIDS?
In Chapter 1 the various definitions of sudden infant death syndrome (SIDS) were discussed, with the one common theme being the lack of diagnostic features. In a way, pathology represents the weak link in the SIDS chain, as there have never been consistent and reproducible diagnostic tissue markers …
How often could a definitive alternative diagnosis be made following a properly performed autopsy?
A question that is frequently asked is: how often could a definitive alternative diagnosis be made following a properly performed autopsy? This has varied over the years, with reduced numbers of sudden deaths in infancy from organic diseases now, most likely due to better antenatal screening, postnatal testing, and therapeutic interventions. Alternative diagnoses to SIDS were made in approximately 8 to 18% of cases of sudden infant death as the “Reduce the Risks” campaigns were launched (15-17). This percentage rose to more than 25% subsequently (18), in part due to improved death scene examinations as part of standard autopsy evaluations (19, 20).
Is pathology a weak link in the SIDS chain?
In a way, pathology represents the weak link in the SIDS chain, as there have never been consistent and reproducible diagnostic tissue markers (1, 2). Thus, current definitions of SIDS are generally of exclusion, which means that the term “SIDS” can only be used for an infant death once other causes of sudden death have been excluded.
Is autopsy part of the standard work-up for SIDS deaths?
If autopsies are not part of the standard work-up for SIDS deaths, then epidemiological and other research data derived from such populations must be treated very circumspectly. Given that the macro- and microscopic features of SIDS have been well illustrated in standard texts (1, 2, 8), and given the sensitivity of such images, this chapter will instead focus on protocols and controversies in the interpretation of autopsy findings rather than on morphology.
Is there a pathognomonic marker at autopsy?
As there are no pathognomonic markers at autopsy in SIDS deaths, there is a danger that the “diagnosis” will be used inappropriately for natural deaths, accidents, and homicides — John Emery’s “diagnostic dustbin” (5, 6).
Is autopsy required for SIDS?
Despite recommendations for decades that autopsies are a mandatory part of the work-up of SIDS cases, they have not always been performed in cases that have still been classified as “SIDS”. For example, in publications from the 1990s the autopsy rate was less than 25% in Belgium (10) and autopsies occurred in only 50 to 60% of infants in the Netherlands (11). In Australia, in the not-too-distant past, infant and toddler autopsies were either not being done, or were being undertaken by physicians without pathology training. On occasion, cranial cavities were not opened or neuropathology was not undertaken (12, 13). Autopsy rates in infants have ranged from 0 to 100% globally (14). Clearly, without autopsies the causes of death in these cases must be considered undetermined. The quality of autopsy investigations should also be considered, as autopsies may be quite limited in their scope due to differences in local practices. This may not always be obvious when accrued data are being analyzed.
Why do SIDS occur?
Etiology. The cause of SIDS is unknown, although it is most likely due to dysfunction of neural cardiorespiratory control mechanisms. The dysfunction may be intermittent or transient, and multiple mechanisms are probably involved.
How many times more likely are siblings to die from SIDS?
Siblings of infants who die of SIDS are 5 times more likely to die of SIDS; it is not clear whether this is related to genetics or environment (including possible abuse by the affected infant's family). Many risk factors for SIDS apply to non-SIDS infant deaths as well. Table.
How long does it take for autopsy results to be known?
As soon as the preliminary results are known (usually within 12 hours), they should be communicated to the parents. Some clinicians advise a series of home or office visits over the first month to continue the earlier discussions, answer questions, and give the family the final (microscopic) autopsy results.
How many infants with SIDS have prolonged apnea?
Fewer than 5% of infants with SIDS have episodes of prolonged apnea before their death, so the overlap between the SIDS population and infants with recurrent prolonged apnea is very small.
What are the risk factors for sudden infant death syndrome?
Other risk factors (see Table: Risk Factors for Sudden Infant Death Syndrome) include old or unsafe cribs, soft bedding (eg, lamb’s wool), waterbed mattresses, bed-sharing with a parent/caregiver, smoking in the home, and an overheated environment. Siblings of infants who die of SIDS are 5 times more likely to die of SIDS;
How old is a child when they die from sudden infant death syndrome?
Sudden infant death syndrome is the sudden and unexpected death of an infant or young child between 2 weeks and 1 year of age in which an examination of the death scene, thorough postmortem examination, and clinical history fail to show cause.
What is the most common cause of death in infants?
Sudden infant death syndrome (SIDS) is the most common cause of death of infants between 2 weeks and 1 year of age, accounting for 35 to 55% of all deaths in this age group. The rate of SIDS occurrence is 0.5/1000 births in the US; there are racial and ethnic disparities (African American and Native American children have twice the average risk ...
What is sudden infant death syndrome?
The classic presentation of sudden infant death syndrome (SIDS) begins with an infant who is put to bed, typically after breastfeeding or bottle-feeding. Checks of the baby at varying intervals are unremarkable, but the baby is found dead, usually in the position in which he or she had been placed at bedtime or naptime.
Who investigates a child's death?
In the case of a deceased infant, the National Association of Medical Examiners makes it very clear that “medical examiners and coroners have the sole legal authority to investigate deaths that are sudden, unexpected, unexplained, and potentially due to external causes such as injury” and that “examination or manipulation of the deceased body by child maltreatment experts without proper statutory authority or family permission may constitute a tort or be a violation of criminal law.”
What was the baby's tone (eg, limp, stiff, or shaking)?
What was the baby’s tone (eg, limp, stiff, or shaking)? Stiffening or clonic movement followed by apnea suggests postictal apnea
What is the evidence of an autopsy?
At autopsy, the infant usually exhibits signs of normal hydration and nutrition, which is evidence of proper care. No signs of obvious or occult trauma should be present. Gross examination of the organs generally reveals no evidence of a congenital abnormality or acquired disease process consistent with a recognizable cause of death.
What are the environmental factors that contribute to death?
Care should be taken at the scene of death to examine for signs of obstruction of the external airways, accidental entrapment of the head, or other environmental factors (eg, ambient temperature or a source of heating for carbon monoxide exposures) that may have contributed to the death.
What activity did the infant exhibit before the brue?
What activity did the infant exhibit before the BRUE? Apnea following paroxysmal cough, in an infant with upper respiratory infection, suggests pertussis; arching with apnea after feeding—with or without milk or formula in the oronasal passages—suggests gastroesophageal reflux (GER)
How many previous unexplained infant deaths did Reese have?
Reese – More than 1 previous unexplained or unexpected infant death
Why do babies die from sids?
SIDS is sometimes called "crib death" or "cot death" because it is associated with the time when the baby is sleeping. Cribs themselves don't cause SIDS, but the baby's sleep environment can influence sleep-related causes of death.
Can a baby die from a crib?
Cribs themselves don't cause SIDS, but the baby's sleep environment can influence sleep-related causes of death. SIDS is the leading cause of death among babies between 1 month and 1 year of age. About 1,360 babies died of SIDS in 2017, the last year for which such statistics are available. 1.
