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Continuity Clinic Notebook:

 Chapter IV. Ethics, Dealing with Death

Chapter 3 Index

A. Ethics:

B. The Pediatrician’s Role in a Child’s Death

  

SIDS - A 1998-99 Update

Definition of SIDS: The sudden death of an infant under 1 year of age which remains unexplained after a complete evaluation including an autopsy, examination of the death scene, and a review of the clinical history.

Incidence of SIDS: The leading cause of death in children between 1 week and 1 year of life with a rate of 1.3 per 1000 in the US.  The peak incidence is 2-4 months old with 95% occurring < 6 mos old.  The pathophysiology of Sudden Infant Death Syndrome or crib death has never been completely understood.  The most likely underlying cause might be a brain stem developmental abnormality or maturational delay of cardiorespiratory control and sleep-wake regulation.  Prolongation of the QT interval now well documented (NEJM June 98) in SIDS.  If a sib has died of SIDS, an EKG should be performed on the newborn.

Risk Factors for SIDS:

  • Prone and side positions during sleep; Family history of SIDS
  • Maternal and antenatal risk factors: intrauterine hypoxia, IUGR, UTI, smoking, asthma, anemia, drug exposure, nutritional deficiency, poor prenatal care, low socioeconomic status, decreased age and education, increased parity
  • Neonatal Risk Factors: IUGR, asphyxia, prematurity, apnea of prematurity or of infancy
  • Postneonatal risk factors: age, male, bottle-feeding, thermal stress, noncentral heating, co-sleeping*, recent febrile illness, smoking exposure (increased cotinine - derivative of nicotine found in pericardial fluid of victims of SIDS), soft sleeping surface, swaddling, no pacifier, prone sleep position.
  • Others: geographic factors, colder season and climate, race/ethnicity
  • Co-Sleeping: *Article Peds 97;100;272 by AAP Task Force: co-sleeping does not decrease SIDS and may increase its incidence.  Soft bedding, pillows, comforters should never be used, and baby should be asleep on the back even if in parents’ bed. Peds 97;100:835-840: If mother smokes and child is co-sleeping definite risk factor. Another article indicating that co-sleeping promotes infant arousals, which might be protective to infants   at risk for SIDS because of the hypothesized arousal defect.  (Peds 97;100:841- 845).

Protective Factors: Breastfeeding (though study from New Zealand - no benefit); Back to sleep but no difference in SIDS rates in VLBW infants (500 - 1500 gms). 

Prospective Identification- Not Good:

  1. Prospective pneumogram and polysomnographic screening studies are not useful.
  2. Home monitoring of those at risk: new technologies that include respiratory pattern, heart rate EKG and oxygenation are available, but not certain that they help.  Many babies have died while being on the monitor.
  3. Medications: caffeine and theophylline for apnea of prematurity and infancy - may help.

What Pediatrician Might Do When Child Dies of SIDS:

At the time of death: express condolences to the family; encourage parents to see and hold infant; explain need for autopsy since a sudden unexpected death; if think SIDS reassure that they could not have prevented.

Early support following the death: refer family to local SIDS program; attend viewing and/or funeral and send a card; listen empathetically; discuss sibling reactions; review autopsy.

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Department of Pediatrics  |  Medical College of Georgia
 Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004