Sudden infant death syndrome (SIDS)

Rationale

Sudden Infant Death Syndrome (SIDS) is a leading cause of death in infants between one month and one year of life. SIDS is defined as the sudden death of an infant, which remains unexplained after a complete clinical evaluation, including a complete autopsy and an examination of the death scene. Providing appropriate support to grieving parents is an important management step. Awareness of known risk factors for SIDS and proven preventive strategies is imperative.

Causal Conditions

(list not exhaustive)

By definition, the precise etiology of SIDS is currently unknown. Affected infants appear to have:

1. underlying genetic or anatomic (e.g., brainstem abnormality) predisposition
2. a trigger event (e.g., maternal smoking, airflow obstruction)
3. timing of a. and b. at a vulnerable stage of development.

Risk factors for SIDS and effective protective factors are known.

1. Risk factors:
   1. Maternal factors
      1. young maternal age (less than 20 years)
      2. maternal smoking during pregnancy
      3. maternal alcohol and drug abuse during pregnancy
      4. late or no prenatal care
   2. Infant factors
      1. preterm birth and/or low birth weight
      2. prone sleeping position
      3. sleeping on a soft surface and/or with bedding accessories such as blankets and pillows
      4. sibling of a SIDS victim
   3. Environmental factors
      1. exposure to second hand smoking
      2. bed sharing
      3. overheating
      4. swaddling
   4. Protective factors:
      1. Room sharing
      2. Pacifier use
      3. Breastfeeding
      4. Fan use
      5. Immunizations

Key Objectives

Given the arrival of a new infant in a family, the candidate will provide preventive counselling to every parent and caregiver about the known risk factors and preventive factors for SIDS.

Given the presentation of an infant with sudden infant death (SID), the candidate will evaluate fully the possible risk factors and/or causes and initiate an appropriate management plan including a detailed clinical evaluation, a request for a complete autopsy and involvement of the medical examiner (coroner).

The candidate will also counsel the infant’s parents/caregivers and family.

Enabling Objectives

Given the arrival of a new infant in a family, the candidate will

1. Counsel parents/caregivers about preventative measures (e.g., smoking cessation during pregnancy and during infancy, proper sleep attire/position of newborn);

Given an infant presenting with sudden unexpected infant death, the candidate will

1. list and interpret critical clinical findings, including those derived from
   1. a detailed history of the event;
   2. an evaluation of maternal, infant and environmental risk factors;
2. include in the acute management a request for a complete autopsy and communication with the medical examiner;
3. effectively communicate the death of the infant to parents and families;
4. initiate bereavement support.