Contents

Search

sudden infant death syndrome (SIDS); includes; accidental infant strangulations & suffocations

Etiology: 1) risk factors may be age-dependent [10] a) predominant risk factor for younger infants is bed-sharing b) whereas rolling to prone, with objects in the sleep area, is the predominant risk factor for older infants 2) other risk factors [6] a) lower socioeconomic class (74% vs. 47%) b) single mother (40% vs. 15%) c) mother younger than 20 (16% vs. 7%) d) mother smoked during pregnancy (86% vs. 57%) & after birth e) infants who slept with a parent (50% vs. 12%) f) preterm birth g) multiple births h) large families i) living above 8000 feet (2.3-fold risk) [13] j) brainstem serotonin deficiency [9]? k) swaddling (RR=1.4) [14] - risk highest for infants in the prone position - risk increases with age, (RR=2.5 > 6 months of age) [14] 3) accidental strangulation & suffocation [16] - mean age at death was 3.8 months - sleep location: crib or bassinet (31%), adult bed (23%), sofa or chair (19%) - position: wedged (43%), on top of an object (26%), covered (8%) - implicated objects: pillows (25%), mattresses (21%), blankets (13%), walls (12%) - sleep surface sharing - infant position was most frequently overlaying by an adult or child (51%) or wedging (45%) - location was usually a sofa or chair (74%) [16] Epidemiology: - incidence 76/100,000 live births in 1998 USA - incidence has increased from 12 to 28 per 100,000 people 1999-2015 [19] - > 50% of U.S. infants sleep with blankets, pillows, or other potentially dangerous bedding despite recommendations against this [12] - < 1/2 of women always place infant in supine position to sleep [17] - black (vs white) women & womwn who did not complete high school more likely to place infant in prone position [17] - unsafe infant sleep habits are still common [18] - 22% of mothers most often put infant to sleep on their side or stomach - nonsupine infant positioning highest among non-Hispanic blacks, younger & less educated mothers - 2/3 of mothers share bed with infant - 1/3 of mothers use soft bedding like bumpers in the crib Pathology: 1) nicotine present in lungs & increased relative to non-SIDS deaths 2) possibly increased serotoninergic neurons in brainstem & lower density of 5-HT receptors in brainstem [8] Genetics: - may be associated with mutations in SCN5A gene - other implicated genes FEV, CAV3 Differential diagnosis: child abuse [4] Management: 1) infant sleep in supine position on a firm surface [2,15,17] 2) avoid bed sharing for infants < 4 months of age, premature infants, & infants born small for gestational age [15] 3) remove objects from the sleep area - especially soft objects or loose bedding [15] 4) provide pacifier when laying infant down to sleep [4,5,15] 5) avoid overheating & head-covering during sleep [15] 6) routine use of infant home apnea monitors to prevent SIDS not indicated [10] 7) women should avoid smoking before, during, & after pregnancy - quitting or reducing smoking during pregnancy reduces risk of SIDS in offspring [20]

Related

Na+ channel protein type 5 subunit alpha; Na+ channel protein type V subunit alpha; voltage-gated Na+ channel subunit alpha Nav1.5; Na+ channel protein cardiac muscle subunit alpha; HH1 (SCN5A)

Specific

sudden infant death with dysgenesis of the testes syndrome (SIDDT)

General

neonatal disorder or disease

Database Correlations

OMIM correlations

References

  1. Journal Watch 22(8):62, 2002 McMartin KI et al, J Pediatr 140:205, 2002
  2. Journal Watch 23(13):105, 2003 Hunt CE et al, Arch Pediatr Adolesc Med 157:469, 2003
  3. Journal Watch 24(10):83, 2004 Getahun D, Amre D, Rhoads GG, Demissie K. Maternal and obstetric risk factors for sudden infant death syndrome in the United States. Obstet Gynecol. 2004 Apr;103(4):646-52. PMID: 15051553
  4. Hauck FR, Omojokun OO, Siadaty MS. Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics. 2005 Nov;116(5):e716-23. Epub 2005 Oct 10. PMID: 16216900
  5. Li D-K et al, Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome (SIDS): population based case-control study BMJ 2006; 332:18 PMID: 16339767
  6. Blair PS et al. Major epidemiological changes in sudden infant death syndrome: A 20-year population-based study in the UK. Lancet 2006 Jan 28; 367:314-9. PMID: 16443038
  7. Hymel KP. Distinguishing sudden infant death syndrome from child abuse fatalities. Pediatrics. 2006 Jul;118(1):421-7. PMID: 16818592 http://aappolicy.aappublications.org/cgi/content/full/pediatrics;118/1/421
  8. Paterson DS et al, Multiple serotonergic brainstem abnormalities in sudden infant death syndrome. JAMA 2006, 296:2124 PMID: 17077377 - Weese-Mayer DE, Sudden infant death syndrome: Is serotonin the key factor? JAMA 2006, 296:2143 PMID: 17077381
  9. Duncan JR et al. Brainstem serotonergic deficiency in sudden infant death syndrome. JAMA 2010 Feb 3; 303:430. PMID: 20124538
  10. Colvin JD et al Sleep Environment Risks for Younger and Older Infants. Pediatrics. July 2014 PMID: 25022735 http://pediatrics.aappublications.org/content/early/2014/07/09/peds.2014-0401.full.pdf+html
  11. Choosing Wisely American Academy of Pediatrics Ten Things Physicians and Patients Should Question. http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-pediatrics/
  12. Shapiro-Mendoza CK et al Trends in Infant Bedding Use: National Infant Sleep Position Study, 1993-2010 Pediatrics. Dec 1, 2014 PMID: 25452654 http://pediatrics.aappublications.org/content/early/2014/11/25/peds.2014-1793.abstract - Moon RY, Hauck FR Hazardous Bedding in Infants' Sleep Environment Is Still Common and a Cause for Concern. Pediatrics. Dec 1, 2014 PMID: 25452652 http://pediatrics.aappublications.org/content/early/2014/11/25/peds.2014-3218.full.pdf+html
  13. Katz D, Shore S, Bandle B et al Sudden Infant Death Syndrome and Residential Altitude. Pediatrics. May 25, 2015 PMID: 26009621 http://pediatrics.aappublications.org/content/early/2015/05/20/peds.2014-2697.abstract
  14. Pease AS, Fleming PJ, Hauck FR et al Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis/ Pediatrics May 2016 PMID: 27244847
  15. Kassa H, Moon RY, Colvin JD Risk Factors for Sleep-Related Infant Deaths in In-Home and Out-of-Home Settings. Pediatrics Oct 2016, e20161124 PMID: 27940776 - TASK FORCE ON SUDDEN INFANT DEATH SYNDROME SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics Oct 2016, e20162938; PMID: 27940804 - Moon RY, TASK FORCE ON SUDDEN INFANT DEATH SYNDROME SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment. Pediatrics Oct 2016, e20162940 PMID: 27940805
  16. Gaw CE, Chounthirath T, Midgett J, Quinlan K, Smith GA. Types of objects in the sleep environment associated with infant suffocation and strangulation. Acad Pediatr 2017 Jul 16; PMID: 28723589
  17. Colson ER, Geller NL, Heeren T, Corwin MJ Factors Associated With Choice of Infant Sleep Position. Pediatrics. August 2017 PMID: 28827382 http://pediatrics.aappublications.org/content/early/2017/08/17/peds.2017-0596 - Goodstein MH, Ostfeld BM Improvements in Infant Sleep Position: We Can Do Better! Pediatrics. August 2017 PMID: 28827378 http://pediatrics.aappublications.org/content/early/2017/08/17/peds.2017-2068
  18. Bombard JM, Kortsmit K, Warner L, et al. Vital Signs: Trends and Disparities in Infant Safe Sleep Practices - United States, 2009-2015. MMWR Morb Mortal Wkly Rep. ePub: 9 January 2018 PMID: 29324729 Free PMC Article https://www.cdc.gov/mmwr/volumes/67/wr/mm6701e1.htm
  19. Gao Y, Schwebel DC, Hu G Infant Mortality Due to Unintentional Suffocation Among Infants Younger Than 1 Year in the United States, 1999-2015. JAMA Pediatr. Published online February 19, 2018. PMID: 29459979 https://jamanetwork.com/journals/jamapediatrics/article-abstract/2672731
  20. Anderson TM, Lavista Ferres JM, Ren SY et al. Maternal smoking before and during pregnancy and the risk of sudden unexpected infant death. Pediatrics 2019 Mar 11; PMID: 30858347 https://pediatrics.aappublications.org/content/early/2019/03/07/peds.2018-3325