SIDS Flashcards
What is Sudden Infant Death Syndrome (SIDS)?
SIDS is the sudden, unexplained death of an infant, often occurring during sleep.
It may occur in infants experiencing an apparent life-threatening event (ALTE) and premature infants with apnea.
What does ALTE stand for?
Acute Life-Threatening Events
ALTE is defined as an episode that is frightening to the observer, characterized by apnea, color change, marked change in muscle tone, choking, or gagging.
What is BRUE?
Brief Resolved Unexplained Event
BRUE refers to an event in an infant under 1 year characterized by sudden, brief, and now resolved episodes of specific symptoms.
List the symptoms that define a BRUE.
- Cyanosis or pallor
- Absent, decreased, or irregular breathing
- Marked change in tone (hypertonia or hypotonia)
- Altered level of responsiveness
What is the difference between BRUE and ALTE?
BRUE is defined as both brief and resolved, while ALTE does not have this requirement.
Events that have not returned to baseline health do not qualify as BRUE.
What is the incidence of ALTE?
0.6 and 4.1 per 1000 live births
The true incidence of ALTEs is unknown, but they account for 0.6%–1.7% of ER visits for children under 1 year.
What are the low-risk criteria for diagnosing BRUE?
- Age more than 60 days
- Gestational age ≥32 weeks and postconceptional age ≥45 weeks
- First BRUE
- Duration of event less than 1 minute
- No CPR required
- No concerning historical features
- No concerning physical examination findings
What is Laryngeal ChemoReflex Apnea (LCRA)?
A reflex that occurs in infants triggered by stimuli in the larynx, leading to prolonged apnea and bradycardia.
It involves sensory nerve endings that respond to irritants or changes in fluid composition.
What are the clinical features of an apparent life-threatening event?
- Majority of infants are asymptomatic
- History of the event including timing, nature, and caregiver actions
- Physical exam findings are often normal
What are common physical exam findings in infants presenting with ALTE?
Vital signs may show fever, tachypnea, hypotension, or hypoxemia, indicating underlying illness.
Growth parameters and neurological findings may also provide clues to underlying issues.
What is the management guideline for BRUE?
Guidelines apply only to low-risk infants who have returned to baseline health.
Any abnormal findings should warrant further investigation.
What are the recommendations for imaging and laboratory findings in BRUE?
Minimal testing for low-risk infants; routine tests such as blood cultures or imaging are discouraged unless criteria are exceeded.
Tests may include hemoglobin, WBC count, and cultures for RSV and pertussis.
What are the indications for home apnea monitors in infants?
- Family history of SIDS
- Apnea of prematurity
- History of previous ALTE
- Choking episodes
What is the AAP’s stance on home monitoring for infants with ALTE?
Routine monitoring is NOT recommended for infants with an ALTE or siblings of SIDS victims.
The recommendation remains controversial despite common practice.
What defines Apnea of Prematurity (AOP)?
Cessation of airflow for 10–20 seconds or longer, or shorter pauses associated with desaturation.
This occurs in premature infants and may require interventions.
What is Apnea of Prematurity (AOP)?
Cessation of airflow for 10–20 seconds or longer, or shorter pauses in respiration associated with desaturation <90% or bradycardia <100
AOP is common in premature infants and often requires monitoring and intervention.
What percentage of premature infants weighing <1500 g will require interventions due to apnea?
50%–100%
This indicates the high prevalence of apnea in this vulnerable population.
List some differential diagnoses of Apnea of Prematurity.
- Immaturity of ventilatory control
- Intracranial hemorrhage
- Sedation crossing the placenta
- Sepsis with or without meningitis
- Heat or cold stress
- PDA
- Hypoglycemia
- Electrolyte abnormalities
- Anemia
- Necrotizing enterocolitis
- Feeding-related apnea
- Heart block or heart failure
- Excessive sedation given to the infant directly
These conditions can complicate the diagnosis of AOP.
What is the primary etiology of apnea in premature infants?
Idiopathic, attributed to immaturity of ventilatory control
This immaturity significantly impacts respiratory function.
What types of apnea are described in preterm infants?
- Central apnea
- Obstructive apnea
- Mixed apnea
Mixed apnea is the most common type among premature infants.
What is the most common type of apnea among premature infants?
Mixed apnea
Mixed apnea often involves both central and obstructive components.
What physiological mechanism is suggested to explain mixed apnea in premature infants?
- Upper airway obstruction
- Inability to compensate for increased CO2
- Asynchronous activity of diaphragm and genioglossus
These mechanisms perpetuate the cycle of apneic events.
What is Laryngeal ChemoReflex Apnea (LCRA)?
A type of mixed apnea that may play a role in AOP, where swallowing interrupts the reflex
Premature infants swallow more frequently during apnea.
What is the prognosis of Apnea of Prematurity?
Natural history is unclear; apneic pauses longer than 5 seconds are common in early days of life
The resolution of apnea and bradycardia is age-dependent.
