Sudden Infant Death Syndrome (SIDS)

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Wendy woke up in the wee hours of the morning to give her baby daughter her scheduled bottle. As she picked her baby up, the baby fell limp in her arms. Wendy panicked and shouted for her husband. The couple drove to the nearest emergency department, and their baby daughter was given emergency care. Unfortunately, the baby was not saved despite the insistence of her parents that she was perfectly healthy, and they just had their regular checkup last week. Wendy’s baby is one of the victims of Sudden Infant Death Syndrome or SIDS. 

Description


Sudden infant death syndrome (SIDS) has caused much grief and anxiety among families for centuries.

  • Sudden infant death syndrome (SIDS) are deaths in infants younger than 12 months of age that occur suddenly, unexpectedly, and without obvious cause.
  • SIDS cannot be explained despite a thorough investigation, including a complete autopsy, examination of the death scene, and review of the clinical and social history.
  • SIDS is also commonly called as “crib death”.

Pathophysiology


Although multiple hypotheses have been proposed as the pathophysiologic mechanisms responsible for SIDS, none have been proven.

  • Although both prolongation of the QT interval (long QT syndrome [LQTS]) and shortening of the QT interval (short QT syndrome [SQTS]) are associated with increased risk of cardiac arrhythmia and sudden death, it is QT prolongation that has received the greatest attention in SIDS.
  • Clinically, these dysrhythmias may present as syncope, seizures, or sudden cardiac death.
  • According to conservative estimates, 30-35% of infants who subsequently die of SIDS have prolongation of the QT interval in the first week of life.
  • Other evidence also implicates hypoxia (acute and chronic) in SIDS; hypoxanthine, a marker of tissue hypoxia, is elevated in the vitreous humor of patients who die of SIDS as compared with control subjects who die suddenly.
  • Alveolar hypoxia stimulates pulmonary vasoconstriction and, eventually, pulmonary vascular smooth muscle cell hyperplasia.
  • Muscularity of the pulmonary vasculature causes pulmonary vasoconstriction, increased right ventricular afterload, and heart failure with more tissue hypoxia.
  • Another significant autopsy finding is pleural petechiae, whose formation reflects acute hypoxia in a physiologically intact infant.

Statistics and Incidences


One of the leading causes of infant mortality worldwide, SIDS claims an estimated 2,500 lives annually in the United States alone.

  • Although there has been a dramatic drop in the incidence of deaths during the past 20 years, SIDS is still the leading cause of death in infants between 7 and 365 days of age.
  • Since 1992, SIDS rates have fallen by approximately 58% in the United States.
  • n 1992, the incidence of SIDS was 1.2 cases per 1000 live births; in 2004, the incidence had dropped to 0.51.
  • In 2004, 2246 deaths were certified as SIDS, accounting for 8% of infant deaths.
  • In 2006, the National Center for Health Statistics reported a total of 2323 SIDS deaths nationwide, for an incidence of 0.54 per 1000 live births.
  • In many Asian countries, the current incidence of SIDS is 0.04 per 1000 live births.
  • Ninety percent of deaths occur in children younger than 6 months, and 95% of deaths occur in children younger than 8 months; few occur in children younger than 1 month or older than 8 months.
  • Approximately 60-70% of SIDS deaths occur in males.

Contributing Factors


Varying theories have been suggested about the cause of SIDS; over the years, much research has been done, but no single cause has been identified. Several authors classify risk factors into groups such as the following:

  • Prematurity and low birth weight. Low birth weight, whether resulting from premature birth or from other causes, is associated with a maturational delay in the ability to turn the head to the face-down position.
  • Apnea. Regurgitation of gastric contents with acidic pH can cause reflexive apnea with resultant hypoxia.
  • Infection. At the time of death, 30-50% of otherwise healthy infants have an acute infection, such as gastroenteritis, otitis media, or, in particular, upper respiratory tract infection (URTI); infantile botulism may be the cause of 5-10% of sudden infant deaths.
  • Breastfeeding. A study from New Zealand suggests that infants who are not breastfed are at increased risk for SIDS.
  • Maternal smoking. Cigarette smoking during pregnancy is highly significant as a risk factor in the pathogenesis of SIDS.
  • Sleeping position and bedtime environment. According to Gilbert-Barness et al, unequivocal evidence indicates that a substantial number (by some estimates, as many as 73.7%) of deaths from SIDS can be prevented by avoiding the prone sleeping position, particularly on any type of soft bedding.

Clinical Manifestations


The classic presentation of sudden infant death syndrome (SIDS) begins with an infant who is put to bed, typically after breastfeeding or bottle-feeding. The observations most commonly reported with Brief Resolved Unexplained Events (BRUEs: formerly Apparent Life-Threatening Events) are as follows:

  • Cyanosis. About 50-60% of infants manifests cyanosis.
  • Breathing difficulties. Half of the infants who had SIDS experience breathing difficulties before death.
  • Abnormal limb movements. Although most of infants are apparently healthy, many parents state that their babies “were not themselves” in the hours before death.

Assessment and Diagnostic Findings


A diagnosis of sudden infant death syndrome (SIDS) is established by excluding recognizable causes of sudden unexplained infant death (SUID).

  • Laboratory studies. For a living patient, initial laboratory studies include a complete blood count (CBC), electrolyte concentrations, and urinalysis.
  • Radiography and computed tomography scans. Radiographs and computed tomography (CT) scans of the skull may be indicated if abuse is suspected or if signs of increased intracranial pressure are present.
  • Histology. In a series of 800 consecutive cases of SUID, [113] 6% of the infants had a neuropathologic cause of death; almost all had clinical histories or gross brain findings at autopsy suggesting the cause of death.

Medical Management


The following measures are done for an infant who experiences SIDS or almost falls victim to it:

  • Emergency care. For the infant found in cardiorespiratory arrest, the first priority is life support via attention to the ABCs (Airway, Breathing, Circulation) and other medical interventions as appropriate; in the absence of postmortem lividity or other signs of obvious death, infants must be transported to the hospital to ensure full resuscitative attempts.
  • Management of apnea. All infants presenting with nontrivial apnea or apparent life-threatening event (ALTEs) associated with cyanosis or alterations in mental status or tone should be admitted.
  • After death. If the infant is pronounced dead, inform the family in a quiet environment. Refer to the child by name, not as “the baby”; detailing resuscitative efforts before telling the parents of the death is not helpful and may engender parents’ resentment; specifically and directly, tell parents that their child has died; use of words such as “dead” or “died” avoids the confusion that may result from gentler terms.

Nursing Management


The effects of SIDS on caregivers and families are devastating.

Nursing Assessment

Assessment of a child before an incidence of SIDS include:

  • Physical examination. It is not uncommon for the infant to have been recently examined by a physician and found to be in excellent health.

Nursing Diagnoses

Based on the assessment data, the major nursing diagnoses for a child with SIDS are:

  • Dysfunctional grieving related to sudden, unpredictable death of the infant.
  • Interrupted family processes related to grieving.

Nursing Care Planning and Goals

The major nursing care planning goals for the family are:

  • Family caregivers will seek appropriate support persons for assistance.
  • Family caregivers will use available support systems to assist in coping with fear.
  • Family caregivers will share feelings about the event.
  • Family caregivers will verbalize measures to prevent SIDS.

Nursing Interventions

Grief is coupled with guilt, even though SIDS cannot be predicted; disbelief, hostility, and anger are common reactions.

  • Allow expression of feelings. The immediate reaction of the staff should be to allow the family to express their grief, encouraging them to say goodbye to their infant, and providing a quiet, private place for them to do so.
  • Appropriate referrals. Referrals should be made to the local chapter of the National SIDS Foundation immediately; Sudden Infant Death Alliance is another resource for help.
  • Encourage use of community resources. In some states, specially trained community health nurses who are knowledgeable about SIDS are available; these nurses are prepared to help families and can provide written materials, as well as information, guidance, and support in the family’s home.
  • Monitoring subsequent infants. Caregivers are particularly concerned about subsequent infants; recent studies have indicated that the risk for these infants for the first few months of life to help reduce the family’s stress; monitoring is usually maintained until the new infant is past the age of the SIDS infant’s death.

Evaluation

Goals are met as evidenced by:

  • Family caregivers sought appropriate support persons for assistance.
  • Family caregivers used available support systems to assist in coping with fear.
  • Family caregivers shared feelings about the event.
  • Family caregivers verbalized measures to prevent SIDS.

Documentation Guidelines

Documentation in a child with SIDS include:

  • Availability and use of support systems and community resources.
  • Plan of care.
  • Teaching plan.
  • Attainment or progress toward desired outcomes.
  • Deviations from normal parenting expectations.

Practice Quiz: Sudden Infant Death Syndrome


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1. Which of the following infants is least probable to develop sudden infant death syndrome (SIDS)?

A. Baby Angela who was premature.
B. A sibling of Baby Angie who died of SIDS.
C. Baby Gabriel with prenatal drug exposure.
D. Baby Gabby who sleeps on his back.

1. Answer: D. Baby Gabby who sleeps on his back.

  • Option D: Infants who sleep on their back are least likely to develop SIDS. However, SIDS has been associated with infants who sleep on their abdomens.
  • Options A, B, C: Being premature, having a sibling who died of SIDS, and being prenatally exposed to drugs all place the infant at high risk for developing SIDS.

2. Which of the following actions is NOT appropriate in the care of a 2-month-old infant?

A. Place the infant on her back for naps and bedtime.
B. Allow the infant to cry for 5 minutes before responding if she wakes during the night as she may fall back asleep.
C. Talk to the infant frequently and make eye contact to encourage language development.
D. Wait until at least 4 months to add infant cereals and strained fruits to the diet.

2. Answer: B. Allow the infant to cry for 5 minutes before responding if she wakes during the night as she may fall back asleep.

  • Option B: Infants under 6 months may not be able to sleep for long periods because their stomachs are too small to hold adequate nourishment to take them through the night.
  • Option A: Infants should always be placed on their backs to sleep. Research has shown a dramatic decrease in sudden infant death syndrome (SIDS) with back sleeping.
  • Option C: Eye contact and verbal engagement with infants are important to language development.
  • Option D: The best diet for infants under 4 months of age is breast milk or infant formula.

3. The nurse teaches the mother of a newborn that in order to prevent sudden infant death syndrome (SIDS) the best position to place the baby after nursing is (select all that apply):

A. Prone.
B. Side-lying.
C. Supine.
D. Fowler’s.

3. Answer: B and C

  • Options B and C. Research demonstrate that the occurrence of SIDS is reduced with these two positions.
  • Options A and D: Both are inappropriate positions for infants.

4. Sudden infant death syndrome (SIDS) is one of the most common causes of death in infants. At what age is the diagnosis of SIDS most likely?

A. At 1 to 2 years of age.
B. At 1 week to 1 year of age, peaking at 2 to 4 months.
C. At 6 months to 1 year of age, peaking at 10 months.
D. At 6 to 8 weeks of age.

4. Answer: B. At 1 week to 1 year of age, peaking at 2 to 4 months.

  • Options B: SIDS can occur anytime between 1 week and 1 year of age.
  • Options A, C, D: The incidence peaks at 2 to 4 months of age.

5. During a community visit, volunteer nurses teach stress management to the participants. The nurses will most likely advocate which belief as a method of coping with stressful life events?

A. Avoidance of stress is an important goal for living.
B. Control over one’s response to stress is possible.
C. Most people have no control over their level of stress.
D. Significant others are important to provide care and concern.

5. Answer: B. Control over one’s response to stress is possible.

  • Options B: When learning to manage stress, clients find it helpful to believe that they have the ability to control their response to it. It is impossible to avoid stress, which is a normal life experience.
  • Options A: Stress can be positive and growth-enhancing as well as harmful.
  • Options C: The belief that one has some control is the significant factor in minimizing stress response.
  • Options D: Significant others are a good source of support, but coping with the utmost self-dedication is the most helpful.

See Also


Related topics to this study guide:

Further Reading


Recommended resources and books for pediatric nursing:
  1. PedsNotes: Nurse's Clinical Pocket Guide (Nurse's Clinical Pocket Guides)
  2. Pediatric Nursing Made Incredibly Easy
  3. Wong's Essentials of Pediatric Nursing
  4. Pediatric Nursing: The Critical Components of Nursing Care

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