A medical mystery of early infancy, sudden infant death syndrome (SIDS) — commonly called crib death — kills apparently healthy infants, usually between ages 1 month and 1 year, for reasons that remain unexplained, even after an autopsy. Typically, parents put the infant to bed and later find him dead, often with no indications of a struggle or distress of any kind.
Some infants may have had signs of a cold, but such symptoms are usually absent. SIDS has occurred throughout history, all over the world, and in all climates.
SIDS is one of the leading causes of infant death. Most of these deaths occur during the winter, in poor families, and among underweight babies and those born to mothers younger than age 20.
Although infants who die from SIDS often appear healthy, research suggests that many may have had undetected abnormalities, such as an immature respiratory system and respiratory dysfunction. In fact, the current thinking is that SIDS may result from an abnormality in the control of ventilation, which causes prolonged apneic periods with profound hypoxemia and serious cardiac arrhythmias.
Risk factors for the infant include sleeping on the stomach (up to age 4 months), soft bedding in the crib (up to age 1 year), premature birth, having a history of a sibling who had SIDS, and being born into poverty. Maternal risk factors include multiple births, smoking or illicit drug use, teenage motherhood, short intervals between pregnancies, and late prenatal care.
Although parents find some victims wedged in crib corners or with blankets wrapped around their heads, autopsies rule out suffocation as the cause of death. Even when frothy, blood-tinged sputum is found around the infant’s mouth or on the crib sheets, an autopsy shows a patent airway, so aspiration of vomitus isn’t the cause of death.
Typically, SIDS babies don’t cry out and show no signs of having been disturbed in their sleep, although their positions or tangled blankets may suggest movement just before death, perhaps from terminal spasm.
Depending on how long the infant has been dead, a SIDS baby may have a mottled complexion, with extreme cyanosis of the lips and fingertips, or pooling of blood in the legs and feet that may be mistaken for bruises. Pulse and respirations are absent, and the infant’s diaper is wet and full of stools.
An autopsy rules out other causes of death. Characteristic histologic findings on autopsy include small or normal adrenal glands and petechiae over the visceral surfaces of the pleura, within the thymus (which is enlarged), and in the epicardium.
An autopsy also reveals extremely well-preserved lymphoid structures and certain pathologic characteristics that suggest chronic hypoxemia, such as increased pulmonary artery smooth muscle. Examination also shows edematous, congestive lungs fully expanded in the pleural cavities, liquid (not clotted) blood in the heart, and curd from the stomach inside the trachea.
If the parents bring the infant to the emergency department, the physician will decide whether to try to resuscitate him. An “aborted SIDS” is an infant who is found apneic and is successfully resuscitated. Such an infant, or any infant who had a sibling stricken by SIDS, should be tested for infantile apnea. If tests are positive, a home apnea monitor may be recommended.
Because most infants can’t be resuscitated, however, treatment focuses on emotional support for the family
❑ Make sure that both parents are present when the child’s death is announced. The parents may lash out at emergency department personnel, the babysitter, or anyone else involved in the child’s care — even at each other. Stay calm and let them express their feelings. Reassure them that they weren’t to blame.
❑ Let the parents see the baby in a private room. Allow them to express their grief in their own way. Stay in the room with them, if appropriate. Offer to call clergy, friends, or relatives.
❑ After the parents and family have recovered from their initial shock, explain the necessity for an autopsy to confirm the diagnosis of SIDS (in some states, this is mandatory). At this time, provide the family with some basic facts about SIDS, and encourage them to give their consent for the autopsy. Make sure they receive the autopsy report promptly.
❑ Find out whether there’s a local counseling and information program for SIDS parents. Participants in such a program will contact the parents, ensure that they receive the autopsy report promptly, put them in touch with a professional counselor, and maintain supportive telephone contact.
❑ Find out whether there’s a local SIDS parents’ group; such a group can provide significant emotional support. Contact the National Sudden Infant Death Foundation for information about such local groups.
❑ If your facility’s policy is to assign a public health nurse to the family, she will provide the continuing reassurance and assistance the parents will need.
CLINICAL TIP: If the parents decide to have another child, make sure they receive information and counseling to help them deal with the pregnancy and the 1st year of the new infant’s life.
❑ Teach new parents to place the infant on his back to sleep; this position reduces the risk of SIDS.
Review other book chapters online related to Death:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5 
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