Sudden infant death syndrome (SIDS) AKA cot death

In what % of sudden unexpected death in infancy does a post-mortem find a cause?

37%.

Best room temperature for babies to sleep at

16-20 degrees (also check them to make sure they feel a suitable temperature).

What % of SUID cases are due to SIDS?

80%.

The "Triple Risk Model" for SIDS

Proposes that SIDS occurs when 3 factors are present simultaneously: an underlying vulnerability in the infant (e.g. low birth weight or prematurity), a critical developmental period (usually 2-4 months of age) and an 'exogenous stressor' (e.g. sleeping prone).

What is deformational plagiocephaly?

Flattening of the occiput, due to sleeping supine. To try and prevent this, infants should have supervised "tummy time" when awake. There is no evidence for the use of helmets.

What must be done following a cot death?

Screen siblings for potential sepsis and inborn errors of metabolism.

Factors that reduce the risk of SIDS

Sleeping in separate moses basket or cot in parental bedroom (best place to sleep for first 6 months of life). Do not cover the baby's head. Infant sleeping bag rather than other types of bedding. If blankets are to be used, they should be thin and the infant should be placed with their feet at the foot of the cot. The blankets should be tucked in on 3 sides in such a way that they do not reach above the infant's armpits. Firm mattress. Breastfeeding. Dummies.

What do the terms 'sudden and unexpected infant death' (SUID) or 'sudden unexpected death in infancy' (SUDI) describe?

Sometimes used to describe all deaths in <1 year olds, regardless of cause.

What is sudden infant death syndrome (SIDS)?

Sudden and unexpected death of a child <1 years old, apparently occurring during sleep, which remains unexplained after a thorough investigation (including a complete autopsy and review of the circumstances of death). All other possible causes of death must be excluded for this diagnosis to be made.

What is apparent life-threatening event syndrome?

Used to be called near miss cot death but there is no association with or increased risk of SIDS. Predominantly affects <1 year olds. Frightening symptoms with some combination of apnoea, change in colour, change in muscle tone, coughing or gagging. 50% are diagnosed with an underlying condition that explains the event, most commonly GORD, LRTIs and seizures.

Epidemiology of SIDS

Most common cause of death of children from 1 month to 1 years old - almost 50%. 80% of unexplained infant deaths occur between 28 days and 1 year (the post-neonatal period), with the peak incidence being between 2 and 4 months of age. More common in males. Rates falling since intro of "Back to sleep" and "Reduce the risks" campaigns launched.

Have apnoea monitors been shown to prevent SIDS?

No.

Investigation of sudden infant death

Note the position that the child is lying in, the clothes they are wearing, any secretions etc. on the child's face and make an accurate recording of these observations ASAP. After allowing a little time for the parents to accept the fact of the death, it must be gently explained to them that all cases of sudden death from any cause must be reported to the coroner or, in Scotland, the procurator fiscal, that police officers will call and that this is a routine process and not because of any suspicious circumstances.

Best sleeping position for babies

On their back (the risk of aspiration is not increased by sleeping in this position).

Proposed mechanism of SIDS

It is thought that a combination of immature cardiorespiratory control systems and a failure to be roused from sleep lead to death.

RFs for SIDS

Maternal smoking in pregnancy. Passive smoking during infancy. Late or no antenatal care. Low pregnancy weight gain. Placental abnormalities. Maternal alcohol and substance abuse, especially if there is bed sharing with the infant. Maternal age <20yo. Poverty or lower socio-economic status. Single parent. Prematurity (partly related to the fact that preterm babies are often placed prone whilst in special care baby units in order to improve respiratory function). Low birth weight. Prone sleeping. Bed sharing. Falling asleep with a baby in a sofa or armchair. Bedding e.g. duvets, quilts, pillows (do not use).