SIDS, ALTE, apnea, and the use of home monitors.

Abstract

1. Paula A. Farrell, MD* 2. Gary M. Weiner, MD* 3. James A. Lemons, MD† 1. *Department of Pediatrics, Section of Neonatal-Perinatal Medicine, James Whitcomb Riley Hospital for Children 2. †Hugh McK. Landon Professor of Pediatrics; Director, Section of Neonatal-Perinatal Medicine, Indiana University, Indianapolis, IN. After completing this article, readers should be able to: 1. Describe the effects of the “Back to Sleep” campaigns on the incidence of sudden infant death syndrome (SIDS). 2. Delineate modifiable risk factors of SIDS. 3. Explain the relationship of apnea and SIDS. 4. Delineate recommendations for the prevention of SIDS. Sudden infant death syndrome (SIDS) has been the focus of extensive research over the past several decades. This review examines the epidemiologic aspects of this syndrome, potential prevention strategies, and the use of home monitoring. Also referred to as crib or cot death, SIDS has been defined by the National Institutes of Health Consensus Development Conference on Infantile Apnea and Home Monitoring as “the sudden death of an infant or young child, which is unexplained by history and in which a thorough postmortem evaluation fails to demonstrate an adequate cause of death.” A thorough postmortem evaluation includes a complete autopsy, review of the death scene, and review of the clinical history. The consensus statement defined an apparent life-threatening event (ALTE) as “an episode that is frightening to the observer and is characterized by some combination of apnea, color change, change in muscle tone, choking, or gagging.” It is noted in this statement that terminology used previously, such as “aborted crib death” or “near-miss SIDS,” should be abandoned because it implies a possibly misleadingly close association between this type of spell and SIDS. Apnea of infancy is defined as an unexplained episode of cessation of breathing for 20 seconds or longer or a shorter respiratory pause associated with bradycardia, cyanosis, pallor, or marked hypotonia. This generally is applied to infants who are older than 37 weeks’ gestation. This diagnosis usually is reserved for infants who have ALTE for which a specific cause has not been delineated that is believed to have been related to …