Name: Mupas, Grace Geraldine NCM 109 Lecture March 5, 2023

Yr. and Sec: BSN – 2B Mr. Jeff Leigh Reburon

Sudden Infant Death Syndrome

(SIDS)

Sudden infant death syndrome (SIDS) are deaths in infants younger than 12 months of

age that occur suddenly, unexpectedly, and without obvious cause.

What is Sudden Infant Death Syndrome? 

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”.

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 Name: Mupas, Grace Geraldine NCM 109 Lecture March 5, 2023
Yr. and Sec: BSN – 2B Mr. Jeff Leigh Reburon

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.

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Name: Mupas, Grace Geraldine NCM 109 Lecture March 5, 2023
Yr. and Sec: BSN – 2B Mr. Jeff Leigh Reburon

 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 deaths nationwide, for an incidence of 0.54 per 1000 live births.

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 Name: Mupas, Grace Geraldine NCM 109 Lecture March 5, 2023
Yr. and Sec: BSN – 2B Mr. Jeff Leigh Reburon

 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.

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 Name: Mupas, Grace Geraldine NCM 109 Lecture March 5, 2023
Yr. and Sec: BSN – 2B Mr. Jeff Leigh Reburon

 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.

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 Name: Mupas, Grace Geraldine NCM 109 Lecture March 5, 2023
Yr. and Sec: BSN – 2B Mr. Jeff Leigh Reburon

Nursing Management
The effects of SIDS on caregivers and families are devastating.

Nursing Assessment
Assessment of a child before an incidence of SIDS include:

 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.

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 Name: Mupas, Grace Geraldine NCM 109 Lecture March 5, 2023
Yr. and Sec: BSN – 2B Mr. Jeff Leigh Reburon

 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
Documentation in a child with SIDS include:

 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.

Identify the most significant risk factors associated with SIDS.

 Stomach sleeping - This is probably the most significant risk factor, and sleeping on the
stomach is associated with a higher incidence of SIDS. It is unknown exactly why
stomach sleeping increases the risk of SIDS, but doctors have hypothesized that either
anatomical pressure on the airways or the phenomenon of "rebreathing" exhaled air with

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 Name: Mupas, Grace Geraldine NCM 109 Lecture March 5, 2023
Yr. and Sec: BSN – 2B Mr. Jeff Leigh Reburon

less oxygen might play a role. It is also possible that some babies' brains may not respond
as well to internal cues and stimulate waking when lower levels of oxygen are present in
inhaled air.

Discuss the current recommendations for SIDS prevention, including safe

sleep practices.
Research shows that there are several ways to reduce the risk of SIDS and other sleep-related causes of
infant death. 

 Always Place Baby on His or Her Back To Sleep, for Naps and at Night, To Reduce
the Risk of SIDS. The back sleep position is the safest position for all babies, until they
are 1 year old. Babies who are used to sleeping on their backs, but who are then placed to
sleep on their stomachs, like for a nap, are at very high risk for SIDS. Preemies (infants
born preterm) should be placed on their backs to sleep as soon as possible after birth.
 Use a Firm and Flat Sleep Surface, Such as a Mattress in a Safety-Approved Crib*,
Covered by a Fitted Sheet With No Other Bedding or Soft Items in the Sleep
Area. Never place baby to sleep on soft surfaces, such as on a couch, sofa, waterbed,
pillow, quilt, sheepskin, or blanket. These surfaces can be very dangerous for babies. Do
not use a car seat, stroller, swing, infant carrier, infant sling or similar products as baby's
regular sleep area. Following these recommendations reduces the risk of SIDS and death
or injury from suffocation, entrapment, and strangulation.
 Breastfeed Your Baby To Reduce the Risk of SIDS. Breastfeeding has many health
benefits for mother and baby. Babies who breastfeed, or are fed breastmilk, are at lower
risk for SIDS than are babies who were never fed breastmilk. Longer duration of
exclusive breastfeeding leads to lower risk.

If you bring baby into your bed for feeding, put him or her back in a separate sleep area
when finished. This sleep area should be made for infants, like a crib or bassinet, and
close to your bed. If you fall asleep while feeding or comforting baby in an adult bed,
place him or her back in a separate sleep area as soon as you wake up.  Evidence shows
that the longer a parent and an infant bed share, the higher the risk for sleep-related
causes of infant death, such as suffocation.
 Share Your Room With Baby. Keep Baby in Your Room Close to Your Bed, But on
a Separate Surface Designed for Infants, Ideally for Baby's First Year, But at Least
for the First 6 Months. Room sharing reduces the risk of SIDS. Baby should not sleep in
an adult bed, on a couch, or on a chair alone, with you, or with anyone else, including
siblings or pets. Having a separate safe sleep surface for the baby reduces the risk of
SIDS and the chance of suffocation, strangulation, and entrapment. If you bring your
baby into your bed for feeding or comforting, remove all soft items and bedding from the
area. When finished, put baby back in a separate sleep area made for infants, like a crib or
bassinet, and close to your bed. Couches and armchairs can also be very dangerous for
babies, if adults fall asleep as they feed, comfort, or bond with baby while on these

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Name: Mupas, Grace Geraldine NCM 109 Lecture March 5, 2023
Yr. and Sec: BSN – 2B Mr. Jeff Leigh Reburon

surfaces. Parents and other caregivers should be mindful of how tired they are during
these times. There is no evidence for or against devices or products that claim to make
bed sharing "safer."
 Do Not Put Soft Objects, Toys, Crib Bumpers, or Loose Bedding Under Baby, Over
Baby, or Anywhere in Baby's Sleep Area. Keeping these items out of baby's sleep area
reduces the risk of SIDS and suffocation, entrapment, and strangulation. Because
evidence does not support using them to prevent injury, crib bumpers are not
recommended. Crib bumpers are linked to serious injuries and deaths from suffocation,
entrapment, and strangulation. Keeping these and other soft objects out of baby's sleep
area is the best way to avoid these dangers.
 To Reduce the Risk of SIDS, Women Should:
o Get regular prenatal care during pregnancy
o Avoid smoking, drinking alcohol, and using marijuana or illegal drugs during
pregnancy or after the baby is born.
 To Reduce the Risk of SIDS, Do Not Smoke During Pregnancy, and Do Not Smoke
or Allow Smoking Around Your Baby.
 Think About Giving Your Baby a Pacifier for Naps and Nighttime Sleep to Reduce
the Risk of SIDS. Do not attach the pacifier to anything—like a string, clothing, stuffed
toy, or blanket—that carries a risk for suffocation, choking, or strangulation. Wait until
breastfeeding is well established (often by 3 to 4 weeks) before offering a pacifier. Or, if
you are not breastfeeding, offer the pacifier as soon as you want. Don't force the baby to
use it. If the pacifier falls out of baby's mouth during sleep, there is no need to put the
pacifier back in. Pacifiers reduce the risk of SIDS for all babies, including breastfed
babies.  
 Do Not Let Your Baby Get Too Hot During Sleep. Dress your baby in sleep clothing,
such as a wearable blanket designed to keep him or her warm without the need for loose
blankets in the sleep area. Dress baby appropriately for the environment, and do not
overbundle. Parents and caregivers should watch for signs of overheating, such as
sweating or the baby's chest feeling hot to the touch. Keep the baby's face and head
uncovered during sleep.
 Follow Guidance from Your Health Care Provider on Your Baby's Vaccines and
Regular Health Checkups. Vaccines not only protect baby's health, but research shows
that vaccinated babies are at lower risk for SIDS.
 Avoid Products That Go Against Safe Sleep Recommendations, Especially Those
That Claim To Prevent or Reduce the Risk For SIDS. There is currently no known
way to prevent SIDS. Evidence does not support the safety or effectiveness of wedges,
positioners, or other products that claim to keep infants in a specific position or to reduce
the risk of SIDS, suffocation, or reflux. In fact, many of these products are associated
with injury and death, especially when used in baby's sleep area.
 Do Not Use Heart or Breathing Monitors in the Home to Reduce the Risk of SIDS. If
you have questions about using these monitors for other health conditions, talk with your
baby's health care provider, and always follow safe sleep recommendations.
 Give Your Baby Plenty of Tummy Time When He or She Is Awake and Someone Is
Watching. Supervised Tummy Time helps strengthen your baby's neck, shoulder, and
arm muscles. It also helps to prevent flat spots on the back of your baby's head.  Limiting

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 Name: Mupas, Grace Geraldine NCM 109 Lecture March 5, 2023
Yr. and Sec: BSN – 2B Mr. Jeff Leigh Reburon

the time spent in car seats, once the baby is out of the car, and changing the direction the
infant lays in the sleep area from week to week also can help to prevent these flat spots.

Evaluate the effectiveness of different prevention strategies.

Never let your baby sleep on their stomach

Back-sleeping reduces the risk of SIDS by increasing a baby's access to fresh air and making
them less likely to get overheated (another factor linked to SIDS). But some parents still practice
stomach-sleeping: 18% of Parents readers say they usually put their infants to sleep on their
stomachs, and another 13% do so some of the time.

 A Parent's Guide to Safe Sleep for Babies

"Some exhausted new parents may do it out of desperation because infants tend to sleep better
and more deeply on their stomachs," says Jodi Mindell, Ph.D., author of Sleeping Through the
Night: How Infants, Toddlers, and Their Parents Can Get a Good Night's Sleep.

But the truth is, stomach sleeping really is correlated with higher risks of SIDS: Infants who
normally sleep on their back are actually 18 times more likely to die of SIDS when placed down
on their tummy for a snooze. "Infants seem to have difficulty adjusting to the change," says Dr.
Moon.

Despite the dangers of stomach sleeping, though, you shouldn't worry if your little one begins to
flip over on their own. "Once a baby can roll over by themselves, their brain is mature enough to
alert them to breathing dangers," says Dr. Moon. "And by the time they are 6 months old, their
improved motor skills will help them to rescue themselves, so the SIDS risk is greatly reduced."

Keep in mind, however, that awake tummy time is still an important part of your baby's
development. Your baby should still have several supervised "tummy time" sessions every day.
This helps your baby's development, and it also prevents flat spots on their head from sleeping
on their back. "Babies need tummy time when parents are awake, alert, and observing carefully,"
advises Dr. Shapiro. "Tummy time is not sleep time—it's development time."

Don't put anything in the crib except a fitted sheet

Blankets, pillows, comforters, and stuffed toys can increase the risk of SIDS by hindering your
child's breathing; even soft or improperly fitting mattresses can be dangerous. So, wait until your
baby's first birthday to put a pillow and blanket in the crib.

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 Name: Mupas, Grace Geraldine NCM 109 Lecture March 5, 2023
Yr. and Sec: BSN – 2B Mr. Jeff Leigh Reburon

If you're worried that your little one may get chilly, swaddle them in a receiving blanket or use a
sleep sack. According to a 2017 study, swaddling helps fussy infants sleep better on their back
and may protect them from SIDS by causing them to startle more easily. But always practice
proper swaddling techniques, and don't swaddle too tight. "Your baby needs to be able to move
around and have the ability to kick and squirm," says Dr. Shapiro.

Maintain a comfortable temperature in the nursery

"A nursery that's too warm substantially increases an infant's SIDS risk," says Warren
Guntheroth, M.D., professor of pediatrics at the University of Washington, in Seattle. So, make
sure you don't overheat your baby with swaddling or a high room temperature.

The link between higher temperatures and SIDS might be because the warm baby falls into such
a deep sleep that it is difficult for them to awaken if they are in trouble. Set the thermostat at 68
degrees, don't put the crib near a radiator, and dress your child in light layers that you can
remove easily if they get hot.

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