SUDDEN INFANT DEATH SYNDROME
SIDS is defined as unexplained and sudden death in an infant younger
than 1 year. It is the third leading cause of infant mortality in the United States
and was stable at an annual rate of 2 to 3 deaths per 1000 live births until the
advent of the "Back to Sleep" campaign in 1994. The rate has since fallen to 0.7
deaths per 1000 live births. The incidence peaks at 3 to 4 months of age and can
be
temporally but not causally associated with an intercurrent event such as an upper
respiratory tract infection, recent immunization, and rarely, anesthesia and surgery.
Potential causes of SIDS include abnormalities in the cardiac conduction system,
such as prolonged QT interval syndrome and Wolff-Parkinson-White syndrome, and abnormalities
in the respiratory system, such as central or peripheral chemoreceptor abnormalities,
upper airway obstruction, and central hypoventilation associated with sleep.[363]
In most cases, SIDS appears to be a "quiet" death in that breathing appears to stop
without evidence of arousal or struggle. Occasionally, an infant is observed to
be apneic and cyanotic and responds to tactile stimulation or to more vigorous resuscitative
efforts. These infants of an unexplained apparent life-threatening event are often
admitted to the PICU for intensive monitoring and observation. Infants who are discovered
close to death may require treatment of multiorgan system hypoxicischemic injury.
Future treatment and monitoring of survivors of unexplained apparent
life-threatening events remain controversial; cardiorespiratory monitoring at home
has not been demonstrated to decrease the incidence of SIDS. All caretakers should
be thoroughly instructed in infant cardiopulmonary resuscitation (CPR) techniques.
Parent groups and the National Foundation for Sudden Infant Death have proved helpful
to some families.
