CASE STUDY ON SUDDEN INFANT DEATH

SYNDROME

A Case Study presented to the faculty of

College of Nursing

Pamantasan ng Lungsod ng Marikina

In partial fulfillment of requirements for

NCM 109 (RLE)

I. INTRODUCTION

In pediatric nursing, nurses always have to consider all possible outcomes and problems that may

present after birth and as the child ages. Usually, most incidences can be explained by certain risk

factors that may have happened during prenatal or after birth; whether it be a disorder or anomaly.

However, in some cases there seems to be an unusual occurrence of unexplained death of an infant.

Sudden Infant Death Syndrome (SIDS) is the sudden death of an infant younger than 1 year that is

unexplained even after a complete investigation post mortem. This rare case is fairly documented;

however, it is still being studied as to how it happens and what are the risk factors present in SIDS

infants. It is considered as the 3rd leading cause of infant deaths, and is the leading cause of post

neonatal deaths overall. In 2008, it was documented to be at 55.4 every 100,000 live births. SIDS is

mostly documented in those with low socio-economic status, infants of Native-American or

Alaskan-Native parents, mothers who are exposed to narcotics and other illegal substances during

pregnancy, and adolescent mothers. Risk factors for infants include a number of possibilities such as

being born preterm, underweight, low APGAR scores, those with congenital or acquired

neurological, cardiovascular, and/or respiratory abnormalities, twins, or an infant with a sibling who

had SIDS. It is also more seen in male infants rather than females.

Infants who have also experienced recent viral illnesses, those with poor quality sleep, (i.e., sleeping

with parents on same bed, soft beddings, sleeping on non-infant beds, sleeping with multiple pillows

and heavy blankets, prone-lying or side-lying position, rooms with poor ventilation) infants who

have documented sleep apnea, and infants with poor immunization status are also shown to be risk

factors of SIDS.

There are multiple theories as to how sudden infant death syndrome happens, however its etiology

still remains unknown. One theory suggests that a genetic mutation on 6q 22.1-22.31 was positively

related to a syndrome of SIDS and dysgenesis of the testis. Another theory suggests that SIDS may
 be related to prolonged sleep apnea, increased frequency of brief inspiratory pauses, excessive

periodic breathing, and impaired arousal responsiveness to increased carbon dioxide in room and

lowered oxygen intake. However, it is still a known fact that sleep apnea or apnea is not the cause of

SIDS. The strongest probable causes include a brainstem abnormality in the neurologic regulation of

cardiorespiratory control which then affects arousal & physiological responses to a life-threatening

challenge/event during sleep, and prolonged Q-T interval.

Upon autopsy, SIDS patients are typically seen with petechiae in lungs, mild inflammation and

congestion in respiratory tract, laryngospasm with flecks of blood in sputum or vomitus. It is noted

that these presentations are present as a result of death, and not as a clear cause of the infant’s

demise.

Certain factors that may prevent SIDS include complete immunization after birth, consistent

breastfeeding during first 16 weeks of life, use of pacifier during nap time and bedtime. The most

important thing that can prevent SIDS is placing infant in supine position however plagiocephaly

may occur so it is pertinent to alternate head positions during sleep.

Sudden Infant Death Syndrome will be further discussed in this case including the proper therapeutic

and nursing management.

II. ANATOMY AND PHYSIOLOGY

Due to SIDS not having an exact etiology, this case study will focus on the neurological aspect as

well as the cardiovascular functions that are affected during SIDS.

Medulla Oblongata

Medulla oblongata or myelencephalon is a part of the brainstem included in the central nervous

system. Located in the lower half of the brainstem continuous with the spinal cord, it is responsible

for the cardiac, respiratory, vomiting, and vasomotor centers regulating heart rate, breathing, and

blood pressure. The entirety of the brainstem is a significant factor as to how an infant’s body would
react to a life-threatening event during sleep such as asphyxiation. Its most important functions

include cardiovascular system control, respiratory control, pain sensitivity control, alertness,

awareness, and consciousness.

Heart

Related to the functions of medulla oblongata, the heart of an infant may also show irregularities

concerning its electrical recharging system. The heart's chambers contract and relax to pump the

blood. This coordinated action is controlled by your heart's electrical system. Electrical impulses

sent by the brain (brainstem) trigger the heart to contract, therefore sending oxygen-rich blood

throughout the body.

III. PATHOPHYSIOLOGY
IV. LABORATORY AND DIAGNOSTIC EXAMINATIONS
LAB AND INDICATION
DIAGNOSTIC EXAM
Autopsy This test is performed by
pathologists, coroners, and
medical examiners to investigate
a cadaver for clues as to the
cause of death
Toxicology Tests for drug overdose and
poisoning (e.g., lead and carbon
monoxide) that may have clues
as to the cause of death
(Best performed on blood
specimen)
NURSING RESPONSIBILITIES
-Explain procedure to parents in a language
they can understand
-Obtain informed consent
-Assess parent’s understanding on procedure
and provide further education in cases of
deficient knowledge
-Encourage parents to verbalize
feelings/emotions regarding death of infant
and need for autopsy
-Educate parents that autopsy will not make
deformities on child
-Assist/perform postmortem care
-Assess family’s spiritual and religious
beliefs regarding death and give respect to
family’s final wishes and decision for tissue
or organ donation
-Explain the procedure and its necessity to
parents in a language they can understand.
-If the specimen is obtained for medicolegal
testing, ensure that the patient or family
member has signed a consent form
-Obtain a list of prescription medicines that
the patient is taking that may alter or
confuse screening results
-Inform parents that results may take days or
weeks after procedure was performed
-Provide emotional support and further
education regarding possible results
V. MEDICAL MANAGEMENT AND HEALTH TEACHINGS

MEDICAL MANAGEMENT

Medical management for sudden infant death syndrome includes the immediate interventions by emergency

medical responders. If death was called immediately by parents, resuscitation may be performed by

paramedics depending on parents’ request. If infant was not pronounced dead at the scene, infant will

immediately be transported to an emergency department for a physician to pronounce time of death.

Paramedics will also ask to preserve the scene for further investigation, as well as ask important questions to

parents or family present that may provide clues for cause of death in an inquisitive and unbiased manner.

The primary care provider of the infant should immediately be contacted to prevent miscommunication for

the parents.

The parents or family of the infant may request for an autopsy and toxicology report which shall be noted

and must be signed by them for informed consent. Autopsy results will be given as soon as it is available,

while toxicology results may take days or weeks to be finalized.

It is important for all health care providers to have proper bereavement training to assist parents in this

stressful situation such as making decisions for further investigation and for funeral services of infant.

Parents or guardians that may experience somatic symptoms that may occur with grief from death of infant

such as nausea, stomach pain, or vertigo shall be assessed by a physician for decision of needed

interventions and course of treatment.

Counselling or therapy for the grieving parents will be recommended for them to process the death in a

healthy manner and to help them cope with the situation.

HEALTH TEACHINGS
After the death of an infant with SIDS:

 Inform parents/guardians about SIDS.

 Inquire parents about factors that may have led to SIDS in a sensitive and unbiased

manner.

 Inform parents about necessity of autopsy and how the results of SIDS may not give

definitive answer which can help them accept the death of their child.

 Educate mother about abrupt disruption of lactation if she is still breastfeeding the infant.

 Inform the parents that SIDS is not contagious as they may have fear that the siblings of

the child will also experience death.

  Educate about seeking professional medical help regarding grieving such as counselling

or therapy

 Inform them about different coping mechanisms that may arise during the grieving

process and educate them about other possible coping mechanisms that will be helpful

and not harm them or cause marital distress.

 Educate parents who are planning for another child after a SIDS infant about possible

screening for newborns.

 Encourage parents to hold their child before leaving and allow them to say their

goodbyes’.

 Assist the parents to their car or arrange for someone to pick them up from hospital as

they may be too emotionally distressed to drive themselves home.

 Educate parents/family about possibility of experiencing somatic symptoms that may

occur with grieving and when to seek medical help.

 Encourage parents to express feelings or emotions regarding the situation.