Sudden Unexplained Infant Death

Question 1

What is SIDS defined as?

Answer 1

It is an unidentified cause of death after other explanations for death of the infant are eliminated.
ex. infection, child abuse, lethal congenital abnormalities

Question 2

What is the age cut-off for SIDS?

When do most of these deaths occur?

Answer 2

SIDS is the unexpected death of an infant <1year old and older than 1 month.
The onset of the fatal event is usually during sleep

Question 3

What age range do 85% of SIDS cases occur in?

What is the suspected reason?

Answer 3

Between 2 and 4 months.
SIDS is thought to be associated with sleep position and at 5 months on the baby is usually able to roll or move out of a dangerous sleep position

Question 4

What is the “triple risk” model for SIDS?

Answer 4

1. a vulnerable infant
2. external stressors such as prone sleep position, hyperthermia, passive smoke inhalation
3. critical developmental period of homeostatic control

Question 5

What are the parental factors that increase the risk of SIDS?

Answer 5

1. young maternal age
2. maternal smoking during pregnancy
3. parental drug abuse
4. short inter-gestational periods
5. poor prenatal care
6. low socioeconomic status
7. AA or American Indian

Question 6

What are infant factors that increase the risk of SIDS?

Answer 6

1. premature
2. male
3. multiple gestation pregnancy
4. SIDS in prior sibling
5. respiratory infection
6. prone sleeping/bed sharing/ co-sleeping/overwrapping/blanketing
7. brain stem abnormalities

Question 7

What are the postmortem signs of SIDS?

Answer 7

there are none which is why the manner of death is “undetermined”

Question 8

What is a common thing the literature will claim is a postmortem sign of SIDS?
What is more likely the cause of death?

Answer 8

Congestion in the lungs and petechiae on the pleural surface, thymus and epicardium

Most likely these correlate with an asphyxia death

Question 9

What is the “Back to Sleep” campaign?

What did it help us determine about many of deaths we thought were unexplained?

Answer 9

It started in 1992 and encouraged caregivers to place infants on their backs to sleep which reduced SIDS by 50% since then.
This leads us to believe that SIDS is causes by hypoxia or hypercarbia which makes them asphyxia cases

Question 10

What are the 5 ways the baby can be asphyxiated in sleep?

Answer 10

1. overlay due to co-sleeping
2. wedging
3. smothering (obstruction of nose and mouth)
4. re-breathing
5. neck compression

Question 11

What are five things that can be found postmortem during the autopsy that would remove the baby from the SIDS category?

Answer 11

1. bronchopneumonia
2. myocarditis or meningitis
3. congenital heart defect
4. fatty liver suggestive of MCAD
5. hypoplasia of the arcuate nucleus in the brainstem

Question 12

What are the 4 causes of death that can be put on a death certificate for an unexpected infant death?

Answer 12

1. known cause
2. “classic SIDS” with no symptoms
3. SIDS-like with stressors
4. not SIDS but case unknown (ex. baby gets lethargic, goes to hospital and dies there)