Sudden Infant Death Syndrome 報告者 : 吳孟書

Definition  The sudden death of an infant under one year of age remains unexplained after a through case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history of the infant and the family.  SIDS was first formally defined in 1969 and the definition was revised in  Not caused by child abuse, suffocation, aspiration or immunization.

Apparent Life-Threatening Episode  ALTE characterized by a combination of:  Apnea  Color change(usually cyanosis but occasionally erythema)  Marked change in muscle tone (usually limp)  Choking or gagging  Severe unexplained apneic episodes during sleeping, requiring vigorous stimulation or resuscitation to terminate the event.  Only very small overlap with SIDS.  50% have identifiable cause:  Infection  Airway obstruction  Congenital heart disease  Seizure, choking  Breath-holding

Description  Predominant age: Rare in first month of life, peak occurs in infants between 2 and 4 months, 80% of death occur by 6 months.  Predominant sex: Male> Female  These babies generally are healthy, or may have had a minor upper respiratory or GI infection in the last 2 weeks of life.

Possible causes  Abnormalities in respiratory control and arousal responsiveness  Central and peripheral nervous system abnormalities  Cardiac arrhythmias  Rebreathing in face down position on soft surface leading to hypoxia and hypercarbia  Infection agents  Climatic change  Environmental factors such as hyperthermia or hypo--

Risk factors  Race  Season- late fall and winter months  Time of day- between midnight and 6 AM  Activity-during sleep  Low birth weight; intrauterine growth retardation (IUGR)  Poverty

Risk factors  Maternal factors: teenage mothers; maternal use of cigarettes or drugs(cocaine, opiates) during pregnancy; higher parity; maternal anemia during pregnancy.  Respiratory or GI infection in recent past  Sleep practices- prone and side sleep position, heavier clothing and bedding, soft bedding  Passive cigarette smoke exposure after birth

Diagnosis  Diagnosis of exclusion  Investigation of the scene of death  Where baby was  How it was sleeping  Who was with it  What it was doing  Exploration of medical history  Prenatal and perinatal history  Baby’s medical history since birth

Diagnosis  Laboratory:  CBC/DC  ELECTROLYTE  LFT  TOXICOLOGY SCREEN  SEPTIC WORK UP  U/A AND TESTS FOR INBORN ERROES OF METABOLISM  EKG  RADIOLOGICAL SKELETAL SURVEY  Autopsy

AUTOPSY  Should be done  Helps parents through their grieving process and helps them to understand prevention  Nonspecific postmortem findings used to establish the Dx: 1) Retention of periadrenal fat 2) Hepatic erythropoiesis 3) Brain stem gliosis

Treatment  Begin resuscitation unless rigor mortis or livedo reticularis are present  According to NALS and PALS guideline  Look for obvious sings of trauma  Parents should not be told that the cause of death is SIDS, if no obvious diagnosis is found at the termination of resuscitation  Allow the family to grieve  Help family to express feeling

Disposition  Admit all infants who have ALTE for evaluation and monitoring after initial stabilization and resuscitation  Discharge: none

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