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Sudden unexplained death of a kid of less than one year of age

Medical condition

Sudden infant death syndrome
Other names Cot decease, crib expiry
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Safety to Sleep logo
Specialty Pediatrics
Symptoms Death of a child less than i year of age[one]
Usual onset Sudden[one]
Causes Unknown[1]
Risk factors Sleeping on the stomach or side, overheating, exposure to tobacco smoke, bed sharing[2] [3]
Diagnostic method No cause constitute after an investigation and autopsy[4]
Differential diagnosis Infections, genetic disorders, heart problems, child abuse[2]
Prevention Putting newborns on their dorsum to sleep, pacifier, breastfeeding, immunization[five] [6] [7]
Treatment Support for families[2]
Frequency one in 1,000–x,000[2]

Sudden infant death syndrome (SIDS), also known as cot death or crib expiry, is the sudden unexplained death of a child of less than ane year of age.[1] Diagnosis requires that the death remain unexplained even after a thorough autopsy and detailed death scene investigation.[4] SIDS usually occurs during sleep.[2] Typically expiry occurs between the hours of midnight and 9:00 a.m.[eight] At that place is usually no noise or evidence of struggle.[9] SIDS remains the leading crusade of baby bloodshed in Western countries, contributing to half of all post-neonatal deaths.[ten]

The exact cause of SIDS is unknown.[three] The requirement of a combination of factors including a specific underlying susceptibility, a specific fourth dimension in development, and an environmental stressor has been proposed.[2] [3] These environmental stressors may include sleeping on the breadbasket or side, overheating, and exposure to tobacco smoke.[3] Adventitious suffocation from bed sharing (besides known as co-sleeping) or soft objects may also play a role.[2] [xi] Some other hazard cistron is beingness born before 39 weeks of gestation.[seven] SIDS makes up almost 80% of sudden and unexpected infant deaths (SUIDs).[2] The other xx% of cases are often caused past infections, genetic disorders, and heart problems.[ii] While child corruption in the form of intentional suffocation may be misdiagnosed as SIDS, this is believed to make up less than 5% of cases.[ii]

The nearly effective method of reducing the risk of SIDS is putting a child less than one year quondam on their back to sleep.[7] Other measures include a firm mattress separate from only close to caregivers, no loose bedding, a relatively cool sleeping environment, using a pacifier, and avoiding exposure to tobacco smoke.[5] Breastfeeding and immunization may also be preventive.[five] [half-dozen] Measures not shown to be useful include positioning devices and babe monitors.[5] [6] Evidence is non sufficient for the utilize of fans.[5] Grief support for families affected by SIDS is important, as the death of the infant is sudden, without witnesses, and often associated with an investigation.[2]

Rates of SIDS vary nearly tenfold in developed countries from 1 in a m to 1 in ten grand.[2] [12] Globally, it resulted in nigh 19,200 deaths in 2015, downward from 22,000 deaths in 1990.[13] [14] SIDS was the third leading cause of decease in children less than one twelvemonth old in the Usa in 2011.[15] It is the most common cause of decease between ane month and one yr of age.[7] About 90% of cases happen earlier six months of age, with information technology being nigh frequent between ii months and iv months of historic period.[2] [7] It is more common in boys than girls.[seven] Rates of SIDS accept decreased in areas with "rubber sleep" campaigns by upwardly to eighty%.[12]

Definition [edit]

SIDS is a diagnosis of exclusion and should exist applied to just those cases in which an infant'south decease is sudden and unexpected, and remains unexplained afterwards the performance of an adequate postmortem investigation, including:

  1. an autopsy (by an experienced pediatric pathologist, if possible);
  2. investigation of the decease scene and circumstances of the death; and
  3. exploration of the medical history of the infant and family.

Later on investigation, some of these infant deaths are found to be caused by suffocation, hyperthermia or hypothermia, fail or another divers cause.[sixteen]

Australia and New Zealand are shifting to the term "sudden unexpected death in infancy" (SUDI) for professional person, scientific, and coronial clarity.

The term SUDI is now often used instead of sudden infant death syndrome (SIDS) because some coroners adopt to use the term 'undetermined' for a death previously considered to be SIDS. This modify is causing diagnostic shift in the mortality data.[17]

In addition, the U.Southward. Centers for Disease Control and Prevention (CDC) has recently proposed that such deaths be called "sudden unexpected baby deaths" (SUID) and that SIDS is a subset of SUID.[18]

Age [edit]

SIDS has a four-parameter lognormal historic period distribution that spares infants shortly after birth — the time of maximal risk for almost all other causes of not-trauma infant death.

By definition, SIDS deaths occur under the age of one year, with the peak incidence occurring when the baby is two to four months former. This is considered a critical period because the infant's ability to rouse from slumber is non yet mature.[2]

Chance factors [edit]

The exact cause of SIDS is unknown.[iii] Although studies take identified risk factors for SIDS, such equally putting infants to bed on their bellies, there has been picayune understanding of the syndrome's biological process or its potential causes. Deaths from SIDS are unlikely to be due to a unmarried cause, but rather to multiple risk factors.[19] The frequency of SIDS does appear to be influenced past social, economic, or cultural factors, such as maternal teaching, race or ethnicity, or poverty.[20] SIDS is believed to occur when an infant with an underlying biological vulnerability, who is at a critical development historic period, is exposed to an external trigger.[2] The post-obit risk factors generally contribute either to the underlying biological vulnerability or represent an external trigger:

Tobacco smoke [edit]

SIDS rates are higher in babies of mothers who smoke during pregnancy.[21] [22] Betwixt no smoking and smoking i cigarette a day, on average, the chance doubles. About 22% of SIDS in the United states of america is related to maternal smoking.[23] SIDS correlates with levels of nicotine and its derivatives in the baby.[24] Nicotine and derivatives cause alterations in neurodevelopment.[25]

Sleeping [edit]

Placing an infant to sleep while lying on the belly or side rather than on the back increases the risk for SIDS.[five] [26] This increased take a chance is greatest at two to iii months of historic period.[5] Elevated or reduced room temperature also increases the risk,[27] every bit does excessive bedding, clothing, soft sleep surfaces, and stuffed animals in the bed.[28] Bumper pads may increase the risk of SIDS due to the take a chance of suffocation. They are not recommended for children under one year of age, as this gamble of suffocation profoundly outweighs the risk of head bumping or limbs getting stuck in the bars of the crib.[5]

Sharing a bed with parents or siblings increases the take a chance for SIDS.[29] This take a chance is greatest in the first 3 months of life, when the mattress is soft, when ane or more than persons share the infant'southward bed, especially when the bed partners are using drugs or alcohol or are smoking.[5] The take a chance remains, even so, even in parents who do non smoke or utilize drugs.[30] The American Academy of Pediatrics thus recommends "room-sharing without bed-sharing", stating that such an arrangement can decrease the risk of SIDS past up to 50%. Furthermore, the Academy has recommended against devices marketed to make bed-sharing "safe", such as "in-bed co-sleepers".[31]

Room sharing equally opposed to solitary sleeping is known to decrease the gamble of SIDS.[32]

Breastfeeding [edit]

Breastfeeding is associated with a lower risk of SIDS.[33] It is not articulate if co-sleeping among mothers who breastfeed without any other run a risk factors increases SIDS adventure.[34]

Pregnancy and baby factors [edit]

SIDS rates decrease with increasing maternal age, with teenage mothers at greatest hazard.[21] Delayed or inadequate prenatal care besides increases risk.[21] Low birth weight is a meaning risk cistron. In the United States from 1995 to 1998, the SIDS death rate for infants weighing k–1499 g was 2.89/1000, while for a birth weight of 3500–3999 chiliad, it was only 0.51/1000.[35] [36] Premature nascency increases the hazard of SIDS death roughly fourfold.[21] [35] From 1995 to 1998, the U.S. SIDS rate for births at 37–39 weeks of gestation was 0.73/1000, while the SIDS rate for births at 28–31 weeks of gestation was two.39/grand.[35]

Anemia has likewise been linked to SIDS[37] (nonetheless, per item 6 in the listing of epidemiologic characteristics below, extent of anemia cannot be evaluated at autopsy because an infant'southward total hemoglobin can only exist measured during life[38]). SIDS incidence rises from zero at nascency, is highest from two to four months of age, and declines toward zero later the babe'south get-go year.[39]

Genetics [edit]

Genetics plays a function, equally SIDS is more prevalent in males.[twoscore] [41] There is a consistent 50% male excess in SIDS per m alive births of each sex. Given a 5% male backlog birth rate, in that location appears to be three.15 male SIDS cases per 2 female cases, for a male fraction of 0.61.[40] [41] This value of 61% in the Usa is an average of 57% black male SIDS, 62.two% white male SIDS and 59.iv% for all other races combined. Notation that when multiracial parentage is involved, infant race is arbitrarily assigned to one category or the other; almost oft information technology is chosen by the female parent. The X-linkage hypothesis for SIDS and the male excess in infant mortality have shown that the 50% male excess might be related to a dominant X-linked allele, occurring with a frequency of 1⁄3 that is protective confronting transient cerebral anoxia. An unprotected male would occur with a frequency of 2⁄3 and an unprotected female would occur with a frequency of 4⁄9 .

About x to 20% of SIDS cases are believed to exist due to channelopathies, which are inherited defects in the ion channels which play an important role in the wrinkle of the heart.[42]

Genetic bear witness published in Nov 2020 concerning the case of Kathleen Folbigg, who is in prison over the expiry of four of her children, showed that at least 2 of the children had genetic mutations in the CALM2 cistron that predisposed them to eye complications.[43]

Alcohol [edit]

Drinking of alcohol by parents is linked to SIDS.[44] Ane study plant a positive correlation between the two during New Years celebrations and weekends.[45] Another found that alcohol utilise disorder was linked to a more than than doubling of risk.[46]

Other [edit]

SIDS has been linked to common cold weather, with this association believed to be due to over-bundling and thus, overheating.[47] Premature babies are at four times the risk of SIDS, mayhap related to an underdeveloped ability to automatically control the cardiovascular system.[48]

A 1998 written report institute that antimony- and phosphorus-containing compounds used as burn down retardants in PVC and other cot mattress materials are not a cause of SIDS.[49] The written report also states that toxic gas cannot be generated from antimony in mattresses and that babies suffered SIDS on mattresses that did non contain the compound.

It has been suggested that some cases of SIDS may exist related to Staphylococcus aureus and Escherichia coli infections.[fifty]

Diagnosis [edit]

Differential diagnosis [edit]

Some atmospheric condition that are oftentimes undiagnosed and could be dislocated with or comorbid with SIDS include:

  • medium-chain acyl-coenzyme A dehydrogenase deficiency (MCAD deficiency);[51]
  • infant botulism;[52]
  • long QT syndrome (accounting for less than 2% of cases);[53]
  • Helicobacter pylori bacterial infections;[54]
  • shaken baby syndrome and other forms of kid abuse;[55] [56]
  • overlaying, kid smothering during carer's sleep[57]

For example, an babe with MCAD deficiency might die by "classical SIDS" if found swaddled and prone, with its caput covered, in an overheated room where parents were smoking. Genes indicating susceptibility to MCAD and Long QT syndrome do non protect an infant from dying of classical SIDS. Therefore, the presence of a susceptibility gene, such as for MCAD, ways the baby might have died either from SIDS or from MCAD deficiency. It is currently incommunicable for a pathologist to distinguish between them.

A 2010 written report looked at 554 autopsies of infants in N Carolina that listed SIDS as the cause of decease, and suggested that many of these deaths may have been due to accidental suffocation. The study constitute that 69% of autopsies listed other possible risk factors that could have led to death, such as unsafe bedding or sleeping with adults.[58]

Several instances of infanticide have been uncovered in which the diagnosis was originally SIDS.[59] [60] The estimate of the percentage of SIDS deaths that are really infanticide varies from less than 1% to up to 5% of cases.[61]

Some have underestimated the risk of two SIDS deaths occurring in the aforementioned family; the Royal Statistical Society issued a media release refuting good testimony in one UK instance, in which the conviction was afterwards overturned.[62]

Prevention [edit]

A number of measures have been found to be effective in preventing SIDS, including changing the sleeping position to supine, breastfeeding, limiting soft bedding, immunizing the baby and using pacifiers.[v] [63] The employ of electronic monitors has not been found to be useful as a preventative strategy.[5] The effect that fans might have on the hazard of SIDS has not been studied well enough to make any recommendation about them.[5] Evidence regarding swaddling is unclear regarding SIDS.[five] A 2016 review constitute tentative evidence that swaddling increases the risk of SIDS, especially among babies placed on their bellies or sides while sleeping.[64]

Measures not shown to be useful include positioning devices and babe monitors.[5] [half-dozen] Companies that sell the monitors do not accept FDA approval for them as medical devices.[65]

Sleep positioning [edit]

SIDS rate from 1988 to 2006

Sleeping on the back has been found to reduce the run a risk of SIDS.[66] It is thus recommended by the American University of Pediatrics and promoted as a best exercise past the US National Constitute of Child Health and Human Development (NICHD) "Safe to Sleep" campaign. The incidence of SIDS has fallen in a number of countries in which this recommendation has been widely adopted.[67] Sleeping on the back does not announced to increase the risk of choking, even in those with gastroesophageal reflux affliction.[5] While infants in this position may sleep more than lightly, this is not harmful.[five] Sharing the aforementioned room equally the parents but in a different bed may decrease the SIDS take a chance by half.[five]

Pacifiers [edit]

The use of pacifiers appears to decrease the chance of SIDS, although the reason is unclear.[5] The American University of Pediatrics considers pacifier use to prevent SIDS to be reasonable.[v] Pacifiers do not appear to bear on breastfeeding in the showtime four months, fifty-fifty though this is a common misconception.[68]

Bedding [edit]

Product condom experts advise against using pillows, overly soft mattresses, sleep positioners, bumper pads (crib bumpers), stuffed animals, or fluffy bedding in the crib, and recommend instead dressing the child warmly and keeping the crib "naked."[69]

Blankets or other article of clothing should non exist placed over a baby's head.[70]

The employ of a "baby slumber bag" or "sleep sack", a soft pocketbook with holes for the baby's arms and head tin can be used as a blazon of bedding that warms the baby without covering its head.[71]

Vaccination [edit]

Infants typically receive several vaccinations between the ages of 2 and 4 months, which is also the meridian age for SIDS. Due to this coincidence, a number of studies take investigated the possible role of vaccinations as a cause of SIDS. These have found either no relation between vaccinations and SIDS, or a reduction of the take chances of SIDS post-obit vaccination.[72] [73] [74] [75] [76] [77] A 2007 meta-analysis found that vaccinations were associated with a halving of the gamble of SIDS, and argued that immunisation should be a part of SIDS prevention campaigns.[75] [78]

Epidemiology [edit]

Arcutio, a device designed to prevent baby death by suffocation, Philosophical Transactions 422 (1732)

Globally, SIDS resulted in near 22,000 deaths as of 2010[update], down from 30,000 deaths in 1990.[79] Rates vary significantly by population from 0.05 per 1000 in Hong Kong to half-dozen.7 per 1000 in Native Americans.[80]

SIDS was responsible for 0.54 deaths per 1,000 live births in the Usa in 2005.[35] It is responsible for far fewer deaths than congenital disorders and disorders related to brusk gestation, though it is the leading cause of decease in healthy infants later one calendar month of age.

SIDS deaths in the U.s. decreased from 4,895 in 1992 to 2,247 in 2004, a 54% decrease.[81] During a like time menstruum, 1989 to 2004, SIDS as the crusade of death for sudden baby decease (SID) decreased from 80% to 55%, a 31% subtract.[81] According to John Kattwinkel, chairman of the Centers for Affliction Control and Prevention (CDC) Special Job Forcefulness on SIDS "A lot of us are concerned that the charge per unit (of SIDS) isn't decreasing significantly, merely that a lot of information technology is just code shifting".[81]

Race [edit]

Rates of SIDS past race/ethnicity in the U.South., 2009, CDC, 2013

In 2013, in that location were persistent disparities in SIDS deaths among racial and ethnic groups in the U.Due south. In 2009, the rates of expiry range from twenty.three per 100,000 alive births for Asian/Pacific Islander to 119.2 per 100,000 live births for Native Americans/Alaska Native. African American infants have a 24% greater run a risk of having a SIDS-related death, compared to the U.S. population as a whole,[82] and feel a 2.5 greater incidence of SIDS than in Caucasian infants.[83] Rates are calculated per 100,000 live births to enable more authentic comparison across groups of different total population size.

Research suggests that factors which contribute more direct to SIDS risk—maternal age, exposure to smoking, safe sleep practices, etc.—vary by racial and indigenous group and therefore adventure exposure also varies by these groups.[two] Adventure factors associated with decumbent sleeping patterns of African American families include mother's age, household poverty index, rural/urban status of residence, and infant's historic period. More than than 50% of African American infants were placed in non-recommended sleeping positions, according to a 2012 study completed in South Carolina, [84] indicating that cultural factors can be protective too every bit problematic.[85]

The charge per unit of SIDS per 1000 births varies amongst ethnic groups in the United States:[27] [86]

  • Central Americans and South Americans: 0.20
  • Asian/Pacific Islanders: 0.28
  • Mexicans: 0.24
  • Puerto Ricans: 0.53
  • Whites: 0.51
  • African Americans: 1.08
  • Native American: 1.24

Society and culture [edit]

The charge per unit of SIDS varies vastly among different cultures and countries effectually the world, with SIDS rates lowest among Asian and Pacific Islander infants. Some evidence supports the hypothesis that SIDS is not an ancient phenomenon and that information technology appears more usually in western societies.

Much of the popular media portrayals of infants shows them in non-recommended sleeping positions.[5]

See also [edit]

  • Newborn care and safe
  • Sudden unexpected decease syndrome
  • Sudden unexplained death in babyhood

References [edit]

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Further reading [edit]

  • Ottaviani, G. (2014). Crib death – Sudden babe Death Syndrome (SIDS). Sudden babe and perinatal unexplained death: the pathologist's viewpoint. Berlin Heidelberg, Germany: Springer. ISBN978-3-319-08346-9.
  • Joan Hodgman; Toke Hoppenbrouwers (2004). SIDS. Calabasas, Calif: Monte Nido Press. ISBN978-0-9742663-0-5. {{cite book}}: CS1 maint: multiple names: authors listing (link)
  • Lewak N (2004). "Volume Review: SIDS". Curvation Pediatr Adolesc Med. 158 (iv): 405. doi:10.1001/archpedi.158.4.405. Archived from the original on 17 October 2008.

External links [edit]

  • SIDS at Curlie
  • "Sudden Unexpected Infant Death and Sudden Infant Decease Syndrome". Data and Statistics. Heart for Disease Control and Prevention. Retrieved 26 March 2017.

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Source: https://en.wikipedia.org/wiki/Sudden_infant_death_syndrome

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