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Sudden unexplained death of a child of less than one year of age

Medical condition

Sudden infant death syndrome
Other names Cot death, crib death
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Safe to Sleep logo
Specialty Pediatrics
Symptoms Death of a kid less than one year of age[1]
Usual onset Sudden[1]
Causes Unknown[1]
Take a chance factors Sleeping on the breadbasket or side, overheating, exposure to tobacco fume, bed sharing[two] [iii]
Diagnostic method No cause found after an investigation and autopsy[4]
Differential diagnosis Infections, genetic disorders, heart problems, kid abuse[2]
Prevention Putting newborns on their back to sleep, pacifier, breastfeeding, immunization[5] [half-dozen] [seven]
Treatment Support for families[2]
Frequency one in one,000–10,000[2]

Sudden babe decease syndrome (SIDS), too known as cot decease or crib death, is the sudden unexplained death of a kid of less than one year of historic period.[1] Diagnosis requires that the death remain unexplained even later on a thorough dissection and detailed decease scene investigation.[iv] SIDS unremarkably occurs during sleep.[2] Typically expiry occurs between the hours of midnight and 9:00 a.1000.[eight] There is usually no dissonance or evidence of struggle.[9] SIDS remains the leading cause of infant mortality in Western countries, contributing to half of all mail service-neonatal deaths.[x]

The exact crusade of SIDS is unknown.[3] The requirement of a combination of factors including a specific underlying susceptibility, a specific time in development, and an environmental stressor has been proposed.[2] [3] These environmental stressors may include sleeping on the stomach or side, overheating, and exposure to tobacco fume.[3] Accidental suffocation from bed sharing (also known as co-sleeping) or soft objects may also play a role.[two] [11] Another run a risk factor is being born before 39 weeks of gestation.[7] SIDS makes up about 80% of sudden and unexpected babe deaths (SUIDs).[2] The other 20% of cases are often caused by infections, genetic disorders, and centre problems.[two] While child abuse in the form of intentional suffocation may exist misdiagnosed as SIDS, this is believed to brand up less than 5% of cases.[2]

The about constructive method of reducing the risk of SIDS is putting a child less than ane year old on their back to slumber.[7] Other measures include a firm mattress split from but shut to caregivers, no loose bedding, a relatively cool sleeping environs, using a pacifier, and avoiding exposure to tobacco fume.[5] Breastfeeding and immunization may also be preventive.[5] [6] Measures not shown to be useful include positioning devices and infant monitors.[5] [six] Testify is not sufficient for the use of fans.[5] Grief support for families affected by SIDS is important, as the death of the baby is sudden, without witnesses, and frequently associated with an investigation.[ii]

Rates of SIDS vary nearly tenfold in developed countries from ane in a one thousand to one in ten thousand.[2] [12] Globally, it resulted in most xix,200 deaths in 2015, down from 22,000 deaths in 1990.[thirteen] [14] SIDS was the third leading cause of death in children less than one twelvemonth quondam in the Usa in 2011.[15] Information technology is the almost mutual cause of death betwixt one month and one yr of age.[7] About 90% of cases happen before six months of age, with it beingness most frequent between 2 months and four months of historic period.[two] [7] It is more common in boys than girls.[seven] Rates of SIDS have decreased in areas with "safety sleep" campaigns by up to eighty%.[12]

Definition [edit]

SIDS is a diagnosis of exclusion and should be applied to only those cases in which an infant's death is sudden and unexpected, and remains unexplained later on the performance of an adequate postmortem investigation, including:

  1. an dissection (by an experienced pediatric pathologist, if possible);
  2. investigation of the expiry scene and circumstances of the death; and
  3. exploration of the medical history of the babe and family.

Later on investigation, some of these infant deaths are found to be caused by suffocation, hyperthermia or hypothermia, neglect or another divers cause.[16]

Commonwealth of australia and New Zealand are shifting to the term "sudden unexpected death in infancy" (SUDI) for professional person, scientific, and coronial clarity.

The term SUDI is now oft used instead of sudden infant death syndrome (SIDS) because some coroners prefer to apply the term 'undetermined' for a death previously considered to exist SIDS. This change is causing diagnostic shift in the mortality data.[17]

In add-on, the U.S. Centers for Disease Control and Prevention (CDC) has recently proposed that such deaths exist called "sudden unexpected baby deaths" (SUID) and that SIDS is a subset of SUID.[eighteen]

Age [edit]

SIDS has a iv-parameter lognormal age distribution that spares infants shortly after birth — the time of maximal risk for almost all other causes of not-trauma babe death.

By definition, SIDS deaths occur under the age of i year, with the peak incidence occurring when the infant is 2 to four months onetime. This is considered a disquisitional flow because the infant's power to rouse from slumber is not yet mature.[ii]

Risk factors [edit]

The verbal cause of SIDS is unknown.[3] Although studies have identified gamble factors for SIDS, such every bit putting infants to bed on their bellies, there has been piffling understanding of the syndrome's biological procedure or its potential causes. Deaths from SIDS are unlikely to exist due to a single cause, just rather to multiple risk factors.[19] The frequency of SIDS does appear to be influenced by social, economic, or cultural factors, such as maternal teaching, race or ethnicity, or poverty.[20] SIDS is believed to occur when an infant with an underlying biological vulnerability, who is at a critical development age, is exposed to an external trigger.[2] The following risk factors by and large contribute either to the underlying biological vulnerability or represent an external trigger:

Tobacco fume [edit]

SIDS rates are higher in babies of mothers who smoke during pregnancy.[21] [22] Between no smoking and smoking 1 cigarette a day, on average, the risk doubles. Nigh 22% of SIDS in the United States is related to maternal smoking.[23] SIDS correlates with levels of nicotine and its derivatives in the baby.[24] Nicotine and derivatives crusade alterations in neurodevelopment.[25]

Sleeping [edit]

Placing an infant to sleep while lying on the abdomen or side rather than on the back increases the risk for SIDS.[5] [26] This increased risk is greatest at ii to three months of age.[5] Elevated or reduced room temperature as well increases the run a risk,[27] as does excessive bedding, article of clothing, soft sleep surfaces, and stuffed animals in the bed.[28] Bumper pads may increase the hazard of SIDS due to the take chances of suffocation. They are non recommended for children under one twelvemonth of historic period, as this risk of suffocation greatly outweighs the risk of head bumping or limbs getting stuck in the bars of the crib.[five]

Sharing a bed with parents or siblings increases the risk for SIDS.[29] This risk is greatest in the beginning three months of life, when the mattress is soft, when 1 or more persons share the infant'south bed, peculiarly when the bed partners are using drugs or booze or are smoking.[5] The risk remains, however, even in parents who do non smoke or use drugs.[30] The American Academy of Pediatrics thus recommends "room-sharing without bed-sharing", stating that such an arrangement can decrease the risk of SIDS by up to fifty%. Furthermore, the Academy has recommended against devices marketed to brand bed-sharing "safe", such equally "in-bed co-sleepers".[31]

Room sharing as opposed to solitary sleeping is known to decrease the risk of SIDS.[32]

Breastfeeding [edit]

Breastfeeding is associated with a lower take chances of SIDS.[33] It is non clear if co-sleeping amidst mothers who breastfeed without any other run a risk factors increases SIDS risk.[34]

Pregnancy and infant factors [edit]

SIDS rates decrease with increasing maternal age, with teenage mothers at greatest hazard.[21] Delayed or inadequate prenatal intendance likewise increases risk.[21] Low nascence weight is a pregnant risk factor. In the United states from 1995 to 1998, the SIDS death rate for infants weighing 1000–1499 g was 2.89/chiliad, while for a birth weight of 3500–3999 g, information technology was only 0.51/1000.[35] [36] Premature birth increases the risk of SIDS death roughly fourfold.[21] [35] From 1995 to 1998, the U.Due south. SIDS charge per unit for births at 37–39 weeks of gestation was 0.73/1000, while the SIDS charge per unit for births at 28–31 weeks of gestation was 2.39/1000.[35]

Anemia has too been linked to SIDS[37] (nevertheless, per particular six in the list of epidemiologic characteristics below, extent of anemia cannot be evaluated at dissection because an babe'due south total hemoglobin tin but be measured during life[38]). SIDS incidence rises from zero at birth, is highest from 2 to 4 months of age, and declines toward nil after the babe's first year.[39]

Genetics [edit]

Genetics plays a office, every bit SIDS is more prevalent in males.[xl] [41] There is a consistent l% male backlog in SIDS per 1000 live births of each sex. Given a v% male excess birth rate, there appears to exist three.15 male SIDS cases per ii female cases, for a male fraction of 0.61.[forty] [41] This value of 61% in the US is an boilerplate of 57% black male person SIDS, 62.two% white male person SIDS and 59.4% for all other races combined. Notation that when multiracial parentage is involved, infant race is arbitrarily assigned to one category or the other; almost frequently information technology is chosen by the female parent. The X-linkage hypothesis for SIDS and the male person excess in babe mortality have shown that the 50% male excess might exist related to a ascendant X-linked allele, occurring with a frequency of 1⁄iii that is protective confronting transient cerebral anoxia. An unprotected male would occur with a frequency of 2⁄3 and an unprotected female person would occur with a frequency of 4⁄nine .

About x to 20% of SIDS cases are believed to be due to channelopathies, which are inherited defects in the ion channels which play an of import function in the wrinkle of the eye.[42]

Genetic evidence published in November 2020 concerning the case of Kathleen Folbigg, who is in prison over the death of 4 of her children, showed that at least two of the children had genetic mutations in the CALM2 gene that predisposed them to heart complications.[43]

Alcohol [edit]

Drinking of alcohol by parents is linked to SIDS.[44] One study found a positive correlation between the two during New Years celebrations and weekends.[45] Some other establish that alcohol utilise disorder was linked to a more than doubling of risk.[46]

Other [edit]

SIDS has been linked to common cold atmospheric condition, with this association believed to be due to over-bundling and thus, overheating.[47] Premature babies are at 4 times the risk of SIDS, possibly related to an underdeveloped power to automatically control the cardiovascular system.[48]

A 1998 report found that antimony- and phosphorus-containing compounds used every bit fire retardants in PVC and other cot mattress materials are not a cause of SIDS.[49] The written report too states that toxic gas cannot be generated from antimony in mattresses and that babies suffered SIDS on mattresses that did not contain the chemical compound.

It has been suggested that some cases of SIDS may exist related to Staphylococcus aureus and Escherichia coli infections.[50]

Diagnosis [edit]

Differential diagnosis [edit]

Some weather condition that are often undiagnosed and could be confused with or comorbid with SIDS include:

  • medium-chain acyl-coenzyme A dehydrogenase deficiency (MCAD deficiency);[51]
  • infant botulism;[52]
  • long QT syndrome (bookkeeping for less than 2% of cases);[53]
  • Helicobacter pylori bacterial infections;[54]
  • shaken baby syndrome and other forms of child abuse;[55] [56]
  • overlaying, child smothering during carer's sleep[57]

For instance, an infant with MCAD deficiency might die past "classical SIDS" if establish swaddled and prone, with its head covered, in an overheated room where parents were smoking. Genes indicating susceptibility to MCAD and Long QT syndrome practice not protect an baby from dying of classical SIDS. Therefore, the presence of a susceptibility gene, such as for MCAD, means the babe might have died either from SIDS or from MCAD deficiency. Information technology is currently impossible for a pathologist to distinguish between them.

A 2010 report looked at 554 autopsies of infants in North Carolina that listed SIDS as the crusade of death, and suggested that many of these deaths may have been due to accidental suffocation. The report plant that 69% of autopsies listed other possible risk factors that could have led to death, such as dangerous bedding or sleeping with adults.[58]

Several instances of infanticide have been uncovered in which the diagnosis was originally SIDS.[59] [60] The estimate of the percentage of SIDS deaths that are actually infanticide varies from less than 1% to up to 5% of cases.[61]

Some accept underestimated the risk of two SIDS deaths occurring in the same family; the Imperial Statistical Guild issued a media release refuting practiced testimony in one U.k. example, in which the confidence was subsequently overturned.[62]

Prevention [edit]

A number of measures have been institute to be effective in preventing SIDS, including irresolute the sleeping position to supine, breastfeeding, limiting soft bedding, immunizing the baby and using pacifiers.[5] [63] The use of electronic monitors has non been found to be useful equally a preventative strategy.[five] The event that fans might take on the take a chance of SIDS has not been studied well plenty to make whatever recommendation nearly them.[five] Bear witness regarding swaddling is unclear regarding SIDS.[5] A 2016 review found tentative evidence that swaddling increases the risk of SIDS, peculiarly among babies placed on their bellies or sides while sleeping.[64]

Measures not shown to exist useful include positioning devices and baby monitors.[five] [6] Companies that sell the monitors do not take FDA blessing for them every bit medical devices.[65]

Sleep positioning [edit]

SIDS rate from 1988 to 2006

Sleeping on the dorsum has been establish to reduce the adventure of SIDS.[66] It is thus recommended by the American University of Pediatrics and promoted equally a all-time practice by the United states National Constitute of Child Health and Human Development (NICHD) "Safe to Sleep" entrada. The incidence of SIDS has fallen in a number of countries in which this recommendation has been widely adopted.[67] Sleeping on the back does not appear to increase the risk of choking, even in those with gastroesophageal reflux disease.[five] While infants in this position may slumber more lightly, this is non harmful.[5] Sharing the same room as the parents but in a unlike bed may subtract the SIDS risk by half.[5]

Pacifiers [edit]

The use of pacifiers appears to decrease the risk of SIDS, although the reason is unclear.[5] The American Academy of Pediatrics considers pacifier use to prevent SIDS to be reasonable.[five] Pacifiers exercise not announced to affect breastfeeding in the showtime iv months, fifty-fifty though this is a common misconception.[68]

Bedding [edit]

Product safe experts advise against using pillows, overly soft mattresses, slumber positioners, bumper pads (crib bumpers), blimp animals, or fluffy bedding in the crib, and recommend instead dressing the child warmly and keeping the crib "naked."[69]

Blankets or other wear should non be placed over a baby's caput.[70]

The use of a "infant sleep pocketbook" or "sleep sack", a soft pocketbook with holes for the baby'southward artillery and head tin be used as a blazon of bedding that warms the baby without covering its caput.[71]

Vaccination [edit]

Infants typically receive several vaccinations betwixt the ages of 2 and 4 months, which is besides the peak age for SIDS. Due to this coincidence, a number of studies have investigated the possible role of vaccinations as a crusade of SIDS. These have plant either no relation between vaccinations and SIDS, or a reduction of the risk of SIDS following vaccination.[72] [73] [74] [75] [76] [77] A 2007 meta-analysis found that vaccinations were associated with a halving of the risk of SIDS, and argued that immunisation should be a part of SIDS prevention campaigns.[75] [78]

Epidemiology [edit]

Arcutio, a device designed to prevent babe death by suffocation, Philosophical Transactions 422 (1732)

Globally, SIDS resulted in about 22,000 deaths as of 2010[update], down from xxx,000 deaths in 1990.[79] Rates vary significantly past population from 0.05 per m in Hong Kong to 6.seven per g in Native Americans.[80]

SIDS was responsible for 0.54 deaths per i,000 live births in the US in 2005.[35] Information technology is responsible for far fewer deaths than congenital disorders and disorders related to brusk gestation, though information technology is the leading cause of death in salubrious infants after i month of historic period.

SIDS deaths in the US decreased from 4,895 in 1992 to two,247 in 2004, a 54% subtract.[81] During a similar time period, 1989 to 2004, SIDS as the cause of death for sudden infant death (SID) decreased from 80% to 55%, a 31% subtract.[81] According to John Kattwinkel, chairman of the Centers for Disease Control and Prevention (CDC) Special Task Force on SIDS "A lot of us are concerned that the rate (of SIDS) isn't decreasing significantly, simply that a lot of it is just code shifting".[81]

Race [edit]

Rates of SIDS by race/ethnicity in the U.S., 2009, CDC, 2013

In 2013, there were persistent disparities in SIDS deaths among racial and indigenous groups in the U.S. In 2009, the rates of expiry range from xx.3 per 100,000 live births for Asian/Pacific Islander to 119.2 per 100,000 live births for Native Americans/Alaska Native. African American infants have a 24% greater take chances of having a SIDS-related decease, compared to the U.South. population as a whole,[82] and experience a 2.5 greater incidence of SIDS than in Caucasian infants.[83] Rates are calculated per 100,000 live births to enable more accurate comparison beyond groups of dissimilar total population size.

Research suggests that factors which contribute more directly to SIDS risk—maternal age, exposure to smoking, safe sleep practices, etc.—vary by racial and ethnic group and therefore risk exposure also varies by these groups.[2] Run a risk factors associated with prone sleeping patterns of African American families include mother'south historic period, household poverty index, rural/urban condition of residence, and infant'due south age. More than 50% of African American infants were placed in not-recommended sleeping positions, according to a 2012 written report completed in South Carolina, [84] indicating that cultural factors can be protective every bit well as problematic.[85]

The rate of SIDS per 1000 births varies amidst indigenous groups in the United States:[27] [86]

  • Central Americans and South Americans: 0.20
  • Asian/Pacific Islanders: 0.28
  • Mexicans: 0.24
  • Puerto Ricans: 0.53
  • Whites: 0.51
  • African Americans: 1.08
  • Native American: one.24

Lodge and civilisation [edit]

The rate of SIDS varies vastly among dissimilar cultures and countries around the world, with SIDS rates lowest amidst Asian and Pacific Islander infants. Some bear witness supports the hypothesis that SIDS is non an aboriginal phenomenon and that it appears more commonly in western societies.

Much of the popular media portrayals of infants shows them in non-recommended sleeping positions.[five]

Run into as well [edit]

  • Newborn care and prophylactic
  • Sudden unexpected death syndrome
  • Sudden unexplained death in childhood

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Further reading [edit]

  • Ottaviani, G. (2014). Crib death – Sudden infant Decease Syndrome (SIDS). Sudden infant and perinatal unexplained expiry: the pathologist'south viewpoint. Berlin Heidelberg, Deutschland: Springer. ISBN978-3-319-08346-nine.
  • Joan Hodgman; Toke Hoppenbrouwers (2004). SIDS. Calabasas, Calif: Monte Nido Press. ISBN978-0-9742663-0-5. {{cite book}}: CS1 maint: multiple names: authors list (link)
  • Lewak N (2004). "Volume Review: SIDS". Curvation Pediatr Adolesc Med. 158 (iv): 405. doi:10.1001/archpedi.158.iv.405. Archived from the original on 17 Oct 2008.

External links [edit]

  • SIDS at Curlie
  • "Sudden Unexpected Infant Death and Sudden Infant Decease Syndrome". Data and Statistics. Middle for Disease Control and Prevention. Retrieved 26 March 2017.

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Source: https://en.wikipedia.org/wiki/Sudden_infant_death_syndrome

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