Sleep-related risk and worrying behaviours: a retrospective review of a tertiary centre's experience.

Abstract

This retrospective study aims at helping physicians select babies considered at risk for fatal events during sleep. It does so by describing the clinical features and outcome of worrying infants' behaviour during sleep, with the activation of an emergency medical service and/or emergency department, subsequently referred to the Centre for Paediatric Sleep Medicine and sudden infant death syndrome, Regina Margherita Children's Hospital, Turin, Italy. We analysed the medical records of infants < 12months whose parents reported they had worrying behaviour during sleep in the period 1 January 2009- 31 December 2015. Regional guidelines suggest performing anamnesis and capillary blood gas analysis in case of apparent life-threatening events. There were 33 males, average age 55 ± 54.37days. On arrival at the emergency medical service/emergency department 97% infants were asymptomatic; 61% patients had a capillary blood gas analysis as suggested by the regional guidelines. A clear acid-base disorder was observed in two infants, asymptomatic at medical evaluation, that had assumed an unsafe sleeping position. Two patients presented recurrence of the episode at 3months.Conclusions: Most worrying infant behaviour during sleep can be related to paraphysiological phenomena; capillary blood gas analysis and anamnesis are pivotal to identify the cases at risk of fatal events.What is Known:• Events that happen during sleep often frighten the parents of newborns. This fear may be induced by the fact that Sudden Infant Death Syndrome typically occurs during sleep.• This tragic event is unpredictable by any clinical features or findings in instrumental examinations and cannot be prevented with an early resuscitation.What is New:• In our retrospective study, most worrying infant behaviour during sleep can be related to paraphysiological phenomena.• Capillary blood gas analysis and anamnesis collection were crucial to identify the only two life-threatening events.