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Sudden Infant Death Syndrome

The most common cause of death in infants is sudden infant death syndrome (SIDS). SIDS is defined as "the sudden death of an infant under one year of age that remains unexplained after a thorough case investigation, including performance of a complete autopsy; examination of the death scene; and review of the clinical history." SIDS is a diagnosis of exclusion. No predictors for SIDS have been identified.

Pathophysiology

Sleeping in the prone position and exposure to cigarette smoke are associated with an increased risk of SIDS.

The SIDS rate is 0.85 SIDS deaths per 1,000 live births. There has been a 40% decline in the SIDS rate in the last two decades. This decline has been attributed to the 1992 recommendations.

Risk-reduction measures

Sleeping position

The prone (on the stomach) sleeping position is associated with the highest risk of SIDS; the supine position is associated with the lowest risk. Changing babies from the prone to the supine sleeping.

Cigarette smoke exposure. Maternal smoking during pregnancy and exposing the baby after birth to cigarette smoke increases the risk of SIDS. Mothers should not smoke during pregnancy.

Potentially hazardous sleeping environments

Approximately 30% of deaths diagnosed as SIDS-related have been related to unsafe sleeping environments or unsafe bedding material. Soft mattresses, soft bedding, thick blankets or comforters, pillows, bumpers and soft crib toys are associated with a higher SIDS risk.

Because of the potential hazards of overheating, it is recommended that for sleep, a baby should be lightly dressed and covered with a sheet or thin blanket, and the room temperature should be such that it would be comfortable for an adult in a short-sleeve shirt. Swaddling of infants is not recommended.

Infant home monitoring

Infant home monitoring is only recommended for use with any infant believed to be at risk of sudden death. This recommendation includes preterm infants still having abnormal apnea or bradycardia, infants with one or more episodes of severe apparent life-threatening event (ALTE) and infants with medical conditions (eg, central hypoventilation, tracheostomy) or on respiratory support.

The risk of SIDS is increased significantly in subsequent siblings. Home monitoring should be offered for subsequent siblings.

Home monitoring has little effect on the incidence of SIDS. The great majority of infants dying of SIDS are apparently healthy infants who do not meet the criteria.