Introduction

This is also known as sudden unexplained infant death (SUID) – aka Sudden Infant Death Syndrome (SIDS). It is defined as:

“The sudden and unexpected death of a child under 1 for which no adequate case is found after a thorough post mortem and case report”

SUIDs cause 40% of deaths in infants over a week old. This makes them the leading cause of mortality in children that age.

There are many risk factors, but these are summarised well into the triple risk model

Risk Factors

Child Related

  • Age 1-6 months (peaking at 12 weeks)
  • Preterm or very low birth weight
  • Boys are affected more than girls
  • Multiple Births
  • + Family History
  • Maternal age (increased risk if mother under 20)

Environmental

  • Household in Lower socioeconomic group
  • Single parents
  • Smoking in the household
  • Co-sleeping
  • Winter
  • Baby sleeps lying on its front ( 8x risk)
  • Baby sleeps lying on its side (2 risk)
  • Coexistent illness (cold)
  • Baby overheats at night*
*The face is an important area of heat loss in infants. If this is covered, either by blankets/lying prone/hats then often infants can overheat.
In recent years there has been a large reduction in the rates of SUIDs ( decrease of >50%!!) as a result of the BACK TO SLEEP campaign which started in 1991.
Information on the back to sleep campaign :
Main points of the back to sleep campaign are
  1. Infants should sleep on their backs with their feet at the foot of the bed
  2. Infant overheating should be avoided, don’t use pillows and avoid blankets/hats (yes…even if it looks cute)
  3. Infant should sleep in parents room for 6 months
  4. Don’t smoke near the infant
  5. Don’t bring the infant into bed with you
  6. Don’t sleep with the infant in a chair
  7. Seek help promptly if the infant is unwell

After a SU​ID

  • Document everything
  • Notify the relevant people (consultant, child protection agency, police, GP, coroner)
  • Do bloods (cultures, fbc, u+e’s, clotting, blood sugar), Lumbar puncture, urine and stool cultures.
  • Samples of infant’s clothing and bedding may be needed
  • An autopsy and coroner’s inquest is a legal requirement, however distressing for the family it may be
  • The family need to be reassured that this is no ones fault.
  • Non-accidental injury must be on your radar, although extreme care must be taken if you peruse this route near a grieving family
  • Advice about the grieving process should be given
  • Suppression of lactation (although not always needed/wanted) can be given
  • CABERGOLINE- PO 250μg every 12hours for 48 hours.
  • In an attempt at preventing recurrence within the same family, there is a ‘care of the next infant’ project (commonly known as CONI)

Flashcard

References

  • Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
  • Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
  • Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy

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