A booklet for parents and general practitioners
by
Dr. Anil B. Jalan ( Chief Scientific Research Officer )
Ms. Prerna Desai ( Jr. Scientific Research Officer )
Introduction :-
SIDS is one of the most distressing conditions where loss of an innocent life takes place, without any prediction of any previous signs. Parents of infant who has had SIDS feel shocked , sad or angry about the death of their child. Many a times , Doctors are blamed for the tragedy . They still have many questions about the child's death " How could it happen ?"
Definition :-
SIDS is the unexpected sudden death of an apparently healthy infant that remains unexplained , after ther performance of an adequate postmortem exmination including -
1. Autopsy
2. Investigation of the scene and circumstances of the death
3. Exploration of medical history of the infant and family. Risk Factors Involved with SIDS :-
There are certain high risk factors , which means that as the number of risk factors increase, the risk of SIDS also increases with it. But it is also observed that most babies with all the risk factors LIVE & babies with no risk factors do die of SIDS.
The major risk factors are :-
A. Parental ( In father and mother of the baby ) Risk factors :-
1. Young parents < 20 yrs.
2. Poor prenatal ( before birth ) care.
3. Smoking & Drug ( substances of addiction like heroie , cocaine etc. ) abuse in parents , especially maternal smoking.
4. Short inter-pregnancy interval.
5. Illness during pregnancy.
6. Previous fetal loss.
B. Infant related risk factors :-
1. Preterm infant / I.U.G.R.
2. Low Birth Weight ( weight less than 2.5 kg at birth ).
3. Second born of twin pair.
4. Triplets ( Risk 8.3 per 1000 ).
5. Being 2nd or 3rd in birth order.
6. Need of oxygen & N.I.C.U at birth.
C. Other Perinatal ( around the time of birht ) factors :-
1. Third trimester ( Last three months of pregnancy ) bleeding.
2. Maternal Anesthesia.
3. Poor Breast feeding.
4. More common in male children.
5. More common in winter season.
6. More common in low socio-economic status.
7. More common during night , during sleep.
8. Respiratory Tract Infection.
( In case involved with high risk factors the physician & the parents must more careful & take the necessary steps.)
Management of Infnats with high risk factors of SIDS :-
1. Refrain form cigarette smoking / Drugs / Alcohol - intake during pregnancy and in post birth period.
2. Avoid sleeping & being in overcrowding ( decreased oxygen ) room.
3. Avoid prone ( i.e. face down ) sleeping , excess sleeping or prolonged sleeping.
4. Provide infant with maximum breast feeding.
5. Reduced chances for infection ( Specially RTI ).
6. Avoid excessive wrapping of the infants.
SIDS associated with certain disorders :-
Specific workup & therapy is required for infnats involved with high risk factors of SIDS associated with follwoing disorders.
1. Infants with severe sleep apnea
2. Infants with increased intracranial pressure & Seizures
3. Infants with pneumonia, infections & sepsis etc.
4. Infants with Hypoglycemia ( low blood sugar ) , Hypothermia ( low body temperature ), Cardiac Anomalies ( heart abnormalities ), Anemia ( low haemoblobin ). |
Facts about SIDS
1. SIDS cannot be predicted , prevented , or reversed
2. SIDS occurs with an incidence of 1 in 500 live births.
3. SIDS is one of the main cause for the death of the infants between 1 week to 1 yr.
4. Peak age for SIDS is around 2 to 4 months.
5. SIDS is not a disease nor can it be a diagnosis for a living baby.
6. 9 infants die each day of SIDS.
7. 90 % die before 6 months of age.
8. 98 % die before 12 months of age.
9. SIDS is not hereditary or contagious.
10. SIDS is not caused by suffocation or Apnea ( Breathing stops ).
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SIDS Protocol for Investigation
If a child dies due to SIDS , the possible cause can be investigated by following investigations :-
1. Complete autopsy by an expert.
2. GC / MS of urine , Cerebro Spinal Fluid ( CSF ) , Vitreous Humour.
3. Cis - 4 - decenoic acid in plasma
4. Carnitine and acylcarnitine profile
5. Assessment of fatty changes in liver , skeletal muscles , cardiac muscles etc.
6. Frozen skin biopsy - Fibroblast culture for study of fatty oxidation defect.
7. Urinary organic acid profile Upon death of an Infant due to SIDS
Constant monitering and checking of baby and constant worrying about the possibility of SIDS , will not safegaurd a child from SIDS.
Since SIDS is not a disease by itself , which can be prevented or reversed , possibility of infant's sudden death due to SIDS cannot be ruledout however if the SIDS was due to some Inborn Error of Metabolism ( IEM ) , some form of therapy may be tried, if the other sib is also suffering from the same IEM. |
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