Sudden Infant Death Syndrome (SIDS)

Description

 Sudden infant death syndrome (SIDS) has caused much grief and anxiety among families for centuries.

 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.
 SIDS is also commonly called as “crib death”.

Pathophysiology
 Although multiple hypotheses have been proposed as the pathophysiologic mechanisms responsible for
SIDS, none have been proven.

 Although both prolongation of the QT interval (long QT syndrome [LQTS]) and shortening of the QT
interval (short QT syndrome [SQTS]) are associated with increased risk of cardiac arrhythmia and sudden
death, it is QT prolongation that has received the greatest attention in SIDS.
 Clinically, these dysrhythmias may present as syncope, seizures, or sudden cardiac death.
 According to conservative estimates, 30-35% of infants who subsequently die of SIDS have prolongation
of the QT interval in the first week of life.
 Other evidence also implicates hypoxia (acute and chronic) in SIDS; hypoxanthine, a marker of tissue
hypoxia, is elevated in the vitreous humor of patients who die of SIDS as compared with control subjects
who die suddenly.
 Alveolar hypoxia stimulates pulmonary vasoconstriction and, eventually, pulmonary vascular
smooth muscle cell hyperplasia.
 Muscularity of the pulmonary vasculature causes pulmonary vasoconstriction, increased right ventricular
afterload, and heart failure with more tissue hypoxia.
 Another significant autopsy finding is pleural petechiae, whose formation reflects acute hypoxia in a
physiologically intact infant.

Statistics and Incidences

 One of the leading causes of infant mortality worldwide, SIDS claims an estimated 2,500 lives annually in the
United States alone.

 Although there has been a dramatic drop in the incidence of deaths during the past 20 years, SIDS is still
the leading cause of death in infants between 7 and 365 days of age.
 Since 1992, SIDS rates have fallen by approximately 58% in the United States.
 n 1992, the incidence of SIDS was 1.2 cases per 1000 live births; in 2004, the incidence had dropped to
0.51.
 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 death 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.
  Ninety percent of deaths occur in children younger than 6 months, and 95% of deaths occur in children
younger than 8 months; few occur in children younger than 1 month or older than 8 months.
 Approximately 60-70% of SIDS deaths occur in males.

Contributing Factors

 Varying theories have been suggested about the cause of SIDS; over the years, much research has been
done, but no single cause has been identified. Several authors classify risk factors into groups such as the
following:

 Prematurity and low birth weight. Low birth weight, whether resulting from premature birth or from other
causes, is associated with a maturational delay in the ability to turn the head to the face-down position.
 Apnea. Regurgitation of gastric contents with acidic pH can cause reflexive apnea with resultant hypoxia.
 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. A study from New Zealand suggests that infants who are not breastfed are at increased
risk for SIDS.
 Maternal smoking. Cigarette smoking during pregnancy is highly significant as a risk factor in the
pathogenesis of SIDS.
 Sleeping position and bedtime environment. According to Gilbert-Barness et al, unequivocal evidence
indicates that a substantial number (by some estimates, as many as 73.7%) of deaths from SIDS can be
prevented by avoiding the prone sleeping position, particularly on any type of soft bedding.
Clinical Manifestations

 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. 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 Diagnostic Findings

 A diagnosis of sudden infant death syndrome (SIDS) is established by excluding recognizable causes of
sudden unexplained infant death (SUID).

 Laboratory studies. For a living patient, initial laboratory studies include a complete blood count (CBC),
electrolyte concentrations, and urinalysis.
 Radiography and computed tomography scans. Radiographs and computed tomography (CT) scans of
the skull may be indicated if abuse is suspected or if signs of increased intracranial pressure are present.
 Histology. In a 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.

Medical Management
 The following measures are done for an infant who experiences SIDS or almost falls victim to it:

 Emergency care. For the infant found in cardiorespiratory arrest, the first priority is life support via
attention to the ABCs (Airway, Breathing, Circulation) and other medical interventions as appropriate; in
the absence of postmortem lividity or other signs of obvious death, infants must be transported to the
hospital to ensure full resuscitative attempts.
 Management of apnea. All infants presenting with nontrivial apnea or apparent life-threatening event
(ALTEs) associated with cyanosis or alterations in mental status or tone should be admitted.
 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 parents’ 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
The effects of SIDS on caregivers and families are devastating.

 Physical examination. It is not uncommon for the infant to have been recently examined by a physician
and found to be in excellent health.

Nursing Diagnoses
Based on the assessment data, the major nursing diagnoses for a child with SIDS are:
  Dysfunctional grieving related to sudden, unpredictable death of the infant.
 Interrupted family processes related to grieving.

Nursing Care Planning and Goals

The major nursing care planning goals for the family 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 Interventions
Grief is coupled with guilt, even though SIDS cannot be predicted; disbelief, hostility, and anger are common
reactions.

 Allow expression of feelings. The immediate reaction of the staff should be to allow the family to express
their grief, encouraging them to say goodbye to their infant, and providing a quiet, private place for them
to do so.
 Appropriate referrals. Referrals should be made to the local chapter of the National SIDS Foundation
immediately; Sudden Infant Death Alliance is another resource for help.
 Encourage use of community resources. In some states, specially trained community health nurses who are
knowledgeable about SIDS are available; these nurses are prepared to help families and can provide
written materials, as well as information, guidance, and support in the family’s home.
 Monitoring subsequent infants. 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.

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 prevent SIDS.

Documentation Guidelines

 Availability and use of support systems and community resources.

 Plan of care.
 Teaching plan.
 Attainment or progress toward desired outcomes.
 Deviations from normal parenting expectations.