SUDDEN INFANT DEATH SYNDROME (SIDS)

• Sudden and unexplained death of a baby younger than 1 year old

• Remains a leading cause of death in infants between 1 month and 1 year of age, 90%
occurring before 6 months of age
• a.k.a cot death or crib death
• SIDS is referred to as a syndrome because of his many varied autopsy and clinical
findings that characterize most infants who die of the disorder

ETIOLOGY
The “Triple-risk Model” for SIDS has been proposed to explain how SIDS occurs. The model
holds that SIDS occurs when three conditions exist simultaneously:

• The infant has an underlying (e.g. brainstem) abnormality that makes him unable to
respond to low oxygen or high carbon dioxide blood levels
• The infant is exposed to triggering event such as sleeping face down on its tummy
• These events occur during a vulnerable stage in the infant’s development, i.e., the first 6
months of life.

CLINICAL MANIFESTATIONS
The classic presentation of SIDS begins with an infant who is put to bed, typically after
breastfeeding or bottle-feeding. The observation most commonly reported with Brief Resolved
Unexplained Events (BRUEs: formerly Apparent Life-Threatening Events) are as follows:

• 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

ASSESSMENT AND DIAGNOSIS FINDINGS

Laboratory studies. For living patient, initial laboratory studies shall include a CBC, electrolyte
concentrations and urinalysis.
Radiography and compared tomography scans. Radiographs and CT scans of the skull may be
indicated if abuse is suspected or if signs of increased intracranial pressure are present
Histology. In series of 800 consecutive cases of SUID, (113) 6% of the infants had a
neuropathologic cause of death; almost all had clinical histories or gross brain findings at
autopsy suggesting the cause of death.

HOW IS SIDS DIAGNOSED?

• Cardiac arrest- 1st symptom

• Clinical findings: evidence of a struggle or change in position during sleep and presence
of frothy blood -tinge from the mouth and nares
• Typically parents finds the infant dead in the crib in the morning or after nap and report
having heard no cries or disturbances during the night
• A baby is determined to have died from SIDS if no cause of death can be identified
following a death scene investigation, an autopsy and a review of the clinical history

RISK FACTORS
INFANT

• Race: most common in Native Americans, Black, Hispanic, white and Asian infants
• Gender: more common in males
• Age: most common, 2 and 4 months old
• Time of the year: more prevalent in winter months
• Exposure to passive smoke
• Sleeping arrangement: Prone and side lying, turning to prone, sharing bed with others,
use of pillows or quilts with bedding
• Overheating d/t excessive blankets, clothing, room temperature
MATERNAL

• <20 y/o at first pregnancy

• Prenatal smoking, binge alcohol, illicit drug use
• Anemia
• Poor prenatal care
• Low weight gain during pregnancy
• History of STI and UTI

Prevention

• Place your baby on his back to sleep

• Keep fluffy blankets and stuffed animals out of his crib
 • Do not overheat the baby on his room when he sleeps
• Do not allow anyone to smoke around the baby
• Breastfeed the baby

MEDICAL MANAGEMENT

• Emergency care
• Management of apnea
• After death. If the infant is pronounced dead, inform the family in a quiet environment.
Refer to the child by name, not as “the baby”; detailing resuscitative efforts before
telling the parents of the death is not helpful and may engender parent’s resentment;
specifically and directly, tell parents that their child has died; use of words such as dead
or died avoids the confusion that may result from gentler terms

NURSING MANAGEMENT
NURSING DIAGNOSIS

• Dysfunctional grieving related to sudden, unpredictable death of the infant.

• Interrupted family processes related to crying
The major nursing care planning goals for the family care are:

• Family caregivers will seek appropriate support persons for assistance

• Family caregivers will use available support systems to assist in coping with fear
• Family caregivers will share feelings about the event
• Family caregivers will verbalize measures to prevent SIDS

NURSING INTERVENTION

• Allow expression of feelings

• Provide parents with a private area and support person
• Prepare family for viewing of the infant
• Allow parents to hold or touch the infant if desired
• Reinforce the physician’s explanation about the need of autopsy
• Refer to SIDS support group

EVALUATION
Goals are met as evidenced by:

• Family caregivers sought appropriate support persons for assistance

• Family caregivers used available support systems to assist in coping with fear
• Family caregivers shared feelings about the event
• Family caregivers verbalized measures to SIDS