39. Sudden Unexpected Death in Infancy Flashcards
What is SUDI? What happens following one, and what are the outcomes?
What are some trends of infant death?
What could be some reasons for a baby found dead in a cot?
Sudden unexpected death in a child <1 year old. Autopsy: abnormality or SIDS.
Due to immaturity = carribbean highest b/c lots premature, due to congeintal abnormalities = pakistani b/c incest. Highest in unemployed and manual workers.
Heart disease (or cardiac malformation, coronary arteritis/myocarditis, cardiomyopathy, arrhythmia), respiratory infections (or e.g. laryngeal cyst), CNS infections, septicaemia, intoxication, seizure disorders, SIDS, suffocation and NAI (non-accidential injury).
Distinguish between transposition of great arteries and truncus arteriosis.
What recognised illnesses could cause rapid death?
Why is a post-mortem doen in SUDI?
ToTGV: aorta connected to R ventricle and pulmonary artery connected to L ventricle. Cyanosis. TA: aorta and pulmonary artery not seperated = common outflow tract). Cyanosis.
Respiratory infections, CNS infections, gastroenteritis, other infections, Reye’s syndrome (liver failure), CNS haemorrhage, congenital adrenal hypoplasia.
Establish whether death was natural or not, elucidate cause of death, provide basis for counselling, accurate certification of death for epidemiological and research purposes.
Define SIDS.
Why has SIDS decreased?
What are some common features?
What are some risk factors?
Sudden unexpected death of an infant <1 year old, which remains unexplained after a thorough case investigation, including a complete autopsy, examination of the death scene and review of the clinical history. Incidence has fallen.
Back to sleep campaign. Better autopsy.
Between 4-20w, winter, baby dead in cot or co-sleeping, silent death during sleep.
Main: co-sleeping, male (60%), maternal smoking, low birth weight (premature, IUGR). Others: social class, unmarried mum, young mum, high parity, high birth order, short inter pregnancy interval, city dweller, maternal opiate addiction, maternal infection in pregnancy, twins, minor malformations.
What is the Triple Risk Hypothesis of SIDS? Describe each one.
SIDS arises via a combination of 3 risk factors:
1. Critical developmental period (age): more common 4-10w, developmental immaturity, rapid changes between 2-4m, SIDS could be due to delayed development of arousal, cardio-respiratory control or CDV control and thermoregulation, laryngeal spasm with GOR, or failure to autoresuscitate from apnoea.
2. Vulnerable infant (physiologic responses): slower responses to changes (increase in HR or breathing) -> alterations in heart ion channels: low QT syndrome - heart vulnerable to stopping with activity -> SIDS risk.
3. Exogenous stressor (environment): minor URTI, prone position (more carbon monoxide and if immature autoresus may not be developled), bed-sharing, overheating, hyperthermia.
What is autoresuscitiation?
What must be explained to the family regarding the post-mortem?
What are some typical external and internal findings?
CO2 builds up and O2 drops -> baby triggered to sigh -> arousal and change of position relieves CO2 build up and replenishes O2. If arousal fails, the baby gasps after the sign -> autoresuscitation. If that fails -> SIDS.
Purpose and importance of PM for the family, what tissue blocks and slides are, why organ retention and for how lonng (e.g. brain takes a few days to set) and options. Limited examination for specific questions.
External: Body well developed/nourished, frothy fluid around nose, cyanosis of lips and nail beds. Internal: large thymus with petechiae (minor bleed from broken capillaries), petechiae in pleura, epicardial petechiae, full lung expansion, liquid heart blood, empty bladder, prominent LN and peyer’s patches.
Aside from post-mortem, what additional tests could be done?
What microscopic findings may you see?
How do you distinguish between SIDS and suffocation?
Microbiology (CSF, lungs, blood, spleen, urine), virology (CSF, heart), freezing (heart, liver, kidney, skeletal muscle), metabolic studies (bile, urine, Guthrie), fibroblasts (skin), biochemistry (e.g. vit D deficient = dilated cardiomyopathy), toxicology (blood, liver), EW, swabs (nasopharyngeal, rectal).
Pulmonary congestion and oedema, mild URTI, focal fibrinoid necrosis of vocal chords, persistent haemopoiesis in liver.
Impossible. Controversial cases. Missed genetic/metabolic disease? Consider suspicious circumstances… ‘unascertained’ if unsure.
What are some mimics of abuse in young babies. and possible reasons for them?
What actions should you take in a SIDS case?
Fractures (sometimes from vaginal delivery, osteopenia or prematurity, vit D deficiency esp. in breastfed babies, resuscitation), subdural haemorrhage (25-46% of asymptomatic newborns), retinal haemorrhages (34% of newborns), bruising could be due to Ehlers-Danlos syndrome (CT).
Let family see/hold infant, have protocol of investigations, religious support, grief counselling, funeral arrangements, local support groups. Bear in mind post-mortems and religion e.g. diff between orthadox and reformed Jews.
What is this condition?
Acute myocarditis - can see lots of neutrophils.
What can you see on this thymus?
Petechiae - small (1–2 mm) red or purple spot on the skin, caused by a minor bleed from broken capillary blood vessels
What is this condtion?
Waterhouse-Friderichsen - bilateral necrosis of adrenals. Commonly caused by severe bacterial infection.
What are these 2 lung conditions?
L: bronchiolitis, R: haemorrhage
What is this lung condition?
Oedema
What is this kidney condition?
DIC (disseminated intravascular coagulation): blood constantly clotted and fibrolysed so lots of haemorrhages and clots at the same time; clots hard to find (destroyed fast) but haemorrhages stay.
