Sudden Infant Death Syndrome Deaths Research Articles

Sudden infant death syndrome in an urban Aboriginal community

The study aims to understand sudden infant death syndrome (SIDS) risk and preventive practices in an urban Aboriginal community, through exploration of mothers' knowledge and practices and examination of coroner case records. Data were collected from the mothers of Aboriginal infants participating in the Gudaga Study, a longitudinal birth cohort study. At 2-3 weeks post-natal, mothers were asked about SIDS risk-reduction practices, infant sleeping position and smoking practices within the home. Questions were repeated when study infants were 6 months of age. During the first 18 months of the study, three infants within the cohort died. All deaths were identified as SIDS related. The Coroner reports for these infants were reviewed. At the 2-3 weeks data collection point, approximately 66.2% (n = 98) of mothers correctly identified two or more SIDS risk-reduction strategies. At this same data point, approximately 82% (n = 122) of mothers were putting their infants to sleep on their backs (supine). Higher maternal education was significantly associated (P < 0.01), with identification of two or more correct SIDS risk-reduction strategies and supine sleeping position at 2-3 weeks. The Coroner considered two infants who had been sleeping in an unsafe sleeping environment. Rates of SIDS deaths within the study community were much higher than the national average. Most mothers were putting their infant to sleep correctly even though they may be unaware that their practice was in accordance with recommended guidelines. Best practice safe sleeping environments are difficult to achieve for some families living in low socio-economic settings.

Investigation of the sudden infant death syndrome: a multidisciplinary approach is required

The concept of sudden infant death syndrome (SIDS) is defined as the sudden, unexpected death of an infant less than a year old which remains unexplained after in-depth investigations comprising a complete autopsy, biological analyses, and a clinical examination of the circumstances surrounding the death. This definition underlines the importance of finding the cause of this disease in order to improve preventative measures to reduce the number of deaths due to sudden infant death syndrome. Among the causes of SIDS, pediatric infectious diseases may be neglected and must be systematically sought after. We report upon a SIDS death case of a four and a half month-old that occurred during his sleep. Following the absence of an evident cause of death a scientific autopsy was performed. The histological examination of pulmonary tissue revealed broncolitic lesions associated with numerous micro-abscesses. The post mortem microbiological analyses revealed evidence of an infection by the respiratory syncytial virus complicated by a bacterial infection due to Haemophilus influenzae. The case underlines the necessity of a multidisciplinary approach to researching SIDS, involving both clinicians and biologists, in order to determine the causes of these deaths.

Socioeconomic Factors Affecting Infant Sleep‐Related Deaths in St. Louis

Though the Back to Sleep Campaign that began in 1994 caused an overall decrease in sudden infant death syndrome (SIDS) rates, racial disparity has continued to increase in St. Louis. Though researchers have analyzed and described various sociodemographic characteristics of SIDS and infant deaths by unintentional suffocation in St. Louis, they have not simultaneously controlled for contributory risk factors to racial disparity such as race, poverty, maternal education, and number of children born to each mother (parity). To determine whether there is a relationship between maternal socioeconomic factors and sleep-related infant death. This quantitative case-control study used secondary data collected by the Missouri Department of Health and Senior Services between 2005 and 2009. The sample includes matched birth/death certificates and living birth certificates of infants who were born/died within time frame. Descriptive analysis, Chi-square, and logistic regression. The controls were birth records of infants who lived more than 1 year. Chi-square and logistic regression analyses confirmed that race and poverty have significant relationships with infant sleep-related deaths. The social significance of this study is that the results may lead to population-specific modifications of prevention messages that will reduce infant sleep-related deaths.

Postmortem review and genetic analysis in sudden infant death syndrome: an 11-year review

Sudden infant death syndrome (SIDS) is the unexpected death of a child younger than 1 year that remains unexplained after thorough evaluation. The possibility of an underlying primary arrhythmogenic disorder has been proposed as a potential cause of SIDS. This study sought to review SIDS deaths and to perform genetic analysis in key genes that may contribute to sudden death. From 2000 to 2010, all postmortem records from the Department of Forensic Medicine in Sydney, Australia, were reviewed. Cases that gave the cause of death as "SIDS" or "undetermined" but consistent with SIDS were included. In a subset of cases, the hyperpolarization-activated cyclic nucleotide (HCN)-gated channel family of genes (HCN2 and HCN4) was analyzed. A total of 226 SIDS cases were identified; 61% were male, 41% occurred while bed sharing, and there was a peak in deaths between 2 and 4 months old. The incidence did not decrease over the study period. In a subgroup of SIDS cases (n = 46), genetic analysis identified 2 likely pathogenic variants (2/46; 4%). A novel nonsynonymous variant, HCN4-Ala195Val, predicted to be pathogenic, was identified in a female infant who died at age 4 months. A female infant aged 5 weeks carried a rare nonsynonymous variant, HCN4-Val759Ile, which is similar to previously described variants associated with cardiac arrhythmias. In conclusion, the incidence of SIDS remains constant, with no apparent decline in the last decade. The underlying cause of SIDS remains largely unknown. Mutations in cardiac ion channel genes including rare nonsynonymous HCN gene variants may play a role in the pathogenesis of some SIDS cases.

Covert homicide: When SIDS is not SIDS, reason for the missed identification

The sudden and unexpected death of a healthy infant requires a forensic and legal investigation. If the forensic investigation fails to identify a significant cause for the death, the death is labeled Sudden Infant Death Syndrome (SIDS). Among all the possible causes for the death murder is rarely considered in the differential diagnosis. Studies have reported that as many as 20% of SIDS deaths are in fact homicide. This paper will examine factors within the medicolegal and the law enforcement communities that seriously affect the detection of infant deaths that masquerade as SIDS. In addition, it examines how the preconceived portrayal of motherhood by society and societal pressures impede the detection of mothers that murder their children. Among the 2,500 SIDS deaths annually in the U.S., it is estimated that between 25 to 250 of these infants are killed by their mothers. In order to accurately as certain the number of infants that are murdered requires a significant shift in the mindset of all those involved in the investigation. This will result in justice for the infant, the future protection of other infants, and provide a more accurate representation of infants that truly die from SIDS. Conclusion – Therefore, to ensure that the true cause of the sudden and unexpected death of an infant is ascertained, all infant deaths must undergo a complete forensic and police investigation. In addition, this practice will ensure the integrity and accuracy of cases designated as SIDS.

Bed Sharing Deaths In Infancy - Sids or Asphyxia?

To the Editor: The paper by Yoo et al. (1) draws attention to the significant numbers of unexpected infant deaths that are occurring in shared sleeping situations. It is now well-recognized that the more comprehensively cases of unexpected infant death are investigated, the greater is the number of cases where deaths are attributed to something other than sudden infant death syndrome (SIDS) (2, 3). However, although bed sharing deaths are still often universally attributed to SIDS (1, 4), the possibility of an asphyxial mechanism of death in some cases must be recognised (5, 6). In support of this, a recent study in South Australia demonstrated that the male to female ratio in infants who died alone was approximately 2:1, as is typical of SIDS deaths. This was significantly different to the sex ratio of infants who died in shared sleeping situation which approached unity (7). One explanation for this marked difference is that although females are less vulnerable to SIDS than males, this protection does not extend to situations where lethal asphyxia may occur; i.e. gender does not protect an infant from accidental suffocation, or so-called 'overlaying'. A more detailed description of the nature of shared sleeping arrangements in Korea from the authors would be a useful addition to their data, in addition to a comparison of the sex ratio of the alone and shared sleepers, to see if the usual SIDS male to female ratio is present, or not, in this population.

Prone Sleeping Is a Risk for SIDS, Not for Suffocation

The Policy Statement “SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment” (http://pediatrics.aappublications.org/content/early/2011/10/12/peds.2011-2284) needs a comment. Although the Safe Infant Sleeping Environment campaign is a worthwhile endeavor for the Academy and its partners, the recommendations should have been listed as 2 separate columns: 1 for sudden infant death syndrome (SIDS) and 1 for accidental trauma to the infant. It is a stretch of the facts to say, in both the abstract and the introduction, that “many of the modifiable risks and …

Sleep position does not appear to influence the risk of extreme cardiorespiratory events in vulnerable infants

Implications for practice and research: Extreme cardiorespiratory events can be documented during sleep and are more common in immature preterm infants. The supine sleep position does not appear to decrease...

Now I lay you down to sleep: reducing suffocation risk in the infant sleep environment

BackgroundSuffocation is the leading cause of injury death among infants in the USA. Infant suffocation mortality rates increased from 2.8 to 12.5 deaths/100 000 live births between 1984 and 2004....

Do Infants Die of Sudden Infant Death Syndrome (SIDS) With Long QT Syndrome (LQTS) or From LQTS?

Letter to the Editor, Tester and Ackerman [4] discuss the use of a ‘‘molecular autopsy’’ for victims of sudden infant death syndrome (SIDS) to determine whether their deaths could have been caused by the long QT syndrome (LQTS). They estimate in their Fig. 1 that 10 % of all such SIDS deaths actually are caused by cardiac channelopathies resulting in LQTS. However, this estimate may be too high for the following two reasons:

Sudden Infant Death Syndrome: An Update

Sudden Infant Death Syndrome: An Update

Changing infant death rates: diagnostic shift, success story, or both?

Over the past 20 years there have been remarkable and gratifying falls in the rates of infant deaths in many Western countries due to declining numbers of cases attributed to sudden infant death syndrome (SIDS). This reduction in unexpected infant fatalities has been due in large part to the effects of the ‘‘Reduce the Risks’’ campaigns where community awareness programs were undertaken by local and national SIDS organizations to warn parents and carers of the potential dangers of prone sleeping, cigarette smoke exposure, head covering and overheating [1]. However, in the late 1970s changes in infant mortality had also been noted in a number of jurisdictions which were not due to a real reduction in lethal events, but were due instead to pathologists reassigning causes of death—in this instance from respiratory infections to SIDS [2]. This was termed a diagnostic shift and was clearly identified by a lack of change in overall infant mortality figures. Diagnostic shift was regarded as an unfortunate event which had the potential to influence the recording of mortality figures. Concerns were expressed that the fall in infant death rates in the early 1990s might be due to a similar diagnostic shift distorting mortality data [3, 4]. In this instance, however, studies revealed that the fall in numbers of SIDS deaths was matched by an associated fall in overall infant mortality, and that other causes of infant death had not significantly increased [4]. Thus, changing diagnostic practice by pathologists was not thought to be a factor in the initial change in patterns of infant death. In addition to identifying risk factors for SIDS, the 1990s was also characterized by moves to improve infant death investigations with the establishment of standardized protocols for both death scene and autopsy examinations [5, 6]. These protocols were aimed at improving diagnostic accuracy by providing additional information to enable more accurate determination of causes of death and to facilitate more meaningful comparisons of infant death rates between populations. In addition it was hoped that international guidelines would improve research in this area and further reduce infant death rates. The International Standardized Autopsy Protocol (ISAP) and Sudden Unexplained Infant Death Investigation Report Form (SUIDIRF) were subsequently formulated, endorsed by professional bodies, and published [5, 6]. Trends in infant deaths and diagnostic practices continued to be monitored throughout the 1990s and this subsequently showed that changes in diagnoses were occurring; i.e. the concerns that a diagnostic shift was present were realized. Pathologists had been identifying more cases of accidental asphyxia from dangerous sleeping environments [7, 8], in addition to detecting rarer forms of sudden death involving underlying metabolic and genetic conditions [9]. Although this was initially considered to be a problem, representing again a possible arbitrary reclassification of deaths, it was soon realized that this was in fact a positive finding. Changes in diagnoses in this instance endorsed the usefulness of protocols by demonstrating that they were providing useful information to help pathologists to identify conditions that would previously have been included under the umbrella of ‘‘SIDS.’’ In other words, protocols were allowing more cases of unexpected infant death to be removed from the ‘‘diagnostic dustbin’’ of SIDS [10]. As is often the case, however, improvements in medicine are often accompanied by opposing trends. In this case R. W. Byard (&) Discipline of Anatomy and Pathology, Level 3 Medical School North Building, The University of Adelaide, Frome Road, Adelaide 5005, Australia e-mail: roger.byard@sa.gov.au

Risk Factor Changes for Sudden Infant Death Syndrome After Initiation of Back-to-Sleep Campaign

To test the hypothesis that the profile of sudden infant death syndrome (SIDS) changed after the Back-to-Sleep (BTS) campaign initiation, document prevalence and patterns of multiple risks, and determine the age profile of risk factors. The San Diego SIDS/Sudden Unexplained Death in Childhood Research Project recorded risk factors for 568 SIDS deaths from 1991 to 2008 based upon standardized death scene investigations and autopsies. Risks were divided into intrinsic (eg, male gender) and extrinsic (eg, prone sleep). Between 1991-1993 and 1996-2008, the percentage of SIDS infants found prone decreased from 84.0% to 48.5% (P < .001), bed-sharing increased from 19.2% to 37.9% (P < .001), especially among infants <2 months (29.0% vs 63.8%), prematurity rate increased from 20.0% to 29.0% (P = .05), whereas symptoms of upper respiratory tract infection decreased from 46.6% to 24.8% (P < .001). Ninety-nine percent of SIDS infants had at least 1 risk factor, 57% had at least 2 extrinsic and 1 intrinsic risk factor, and only 5% had no extrinsic risk. The average number of risks per SIDS infant did not change after initiation of the BTS campaign. SIDS infants in the BTS era show more variation in risk factors. There was a consistently high prevalence of both intrinsic and especially extrinsic risks both before and during the Back-to-Sleep era. Risk reduction campaigns emphasizing the importance of avoiding multiple and simultaneous SIDS risks are essential to prevent SIDS, including among infants who may already be vulnerable.

The Clinical and Translational Science Institute at Children's National: Improving Health through pediatric Research

The Clinical and Translational Science Institute at Children's National: Improving Health through pediatric Research

SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment

Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death that occur during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from focusing only on SIDS to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths, including SIDS. The recommendations described in this policy statement include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunizations, consideration of using a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in the accompanying "Technical Report--SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment," which is included in this issue of Pediatrics (www.pediatrics.org/cgi/content/full/128/5/e1341).

SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment

Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death occurring during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from being only SIDS-focused to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths including SIDS. The recommendations described in this report include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunization, consideration of a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in this technical report. The recommendations are published in the accompanying "Policy Statement--Sudden Infant Death Syndrome and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment," which is included in this issue (www.pediatrics.org/cgi/doi/10.1542/peds.2011-2220).

Screening for Sudden Cardiac Death in the Young

Sudden cardiac death (SCD) in the young (SCDY) has a devastating impact on families, care providers, and the community and attracts significant public and media attention. Sudden cardiac death is defined as an abrupt and unexpected death due to a cardiovascular cause, typically occurring 1 hour from the onset of symptoms. Depending on the source, “young” is variably defined as those less than 25, 30, 35, or 40 years of age. Estimates of the incidence of SCDY (not including infants) vary broadly from 0.6 to 6.2 per 100 000 persons. 1–3 Sudden infant death syndrome (SIDS) may be related to SCD in some infants. Sudden infant death syndrome is defined as the sudden death of an infant 1 year of age that cannot be explained after a thorough investigation is conducted, including an autopsy, death scene evaluation, and review of the clinical history. The incidence of SIDS ranges from 50 to 100 in 100 000,4 and emerging data suggest that as many as 10% to 15% of SIDS deaths are associated with functional cardiac ion channelopathy gene variants.5 The most common diagnoses that increase risk for SCDY include hypertrophic cardiomyopathy (HCM), coronary artery anomalies of wrong sinus origin, myocarditis, arrhythmogenic right ventricular cardiomyopathy, and ion channelopathies.6 The latter category includes hereditary diseases such as the congenital long-QT syndromes (LQTS), catecholaminergic polymorphic ventricular tachycardia, and Brugada syndrome, among other less common channelopathies. These diseases are typically undetected before the SCD event. Estimated prevalence rates of these conditions range from 1 per 500 persons for HCM to 1 per 2500 for the LQTS. SCD related to these diagnoses has been documented in infancy and during competitive athletics. In addition, prescription stimulant use for treatment of attention deficit hyperactivity disorder (ADHD) has been postulated to be a trigger for SCD.7,8 Sudden cardiac death in the young is a critical public health issue. A young life cut short represents a devastating event for families, and is associated with many lost productive years. There is significant dissonance among experts in the field about the best approach to prevent SCDY in the United States. Some experts support the implementation of largescale cardiovascular screening programs in infants, in athletes, or in all children to identify at-risk individuals in an effort to prevent SCDY. Cardiovascular screening for SCDY typically involves the addition of an ECG to the current standard of care of history and physical examination. Echocardiography and genetic testing represent alternative or additional screening modalities. Observational data from the Veneto region of Italy suggest that ECG screening can successfully identify at-risk cardiovascular diseases and dramatically reduce the incidence of SCD in competitive athletes.9,10 Proponents of ECG screening in the United States suggest that it can be effective, feasible, and cost-effective. 11 Critics of ECG screening cite a lack of evidence to support its effectiveness or feasibility in the United States; lack of clinical accuracy; cost implications; and the potential clinical, financial, and emotional consequences of falsepositive screening test results. 12 Cost estimates for a national ECG screening program in the United States for

Pacifier Use and Sids: Evidence for a Consistently Reduced Risk

Pacifier use at sleep time decreases sudden infant death syndrome (SIDS) risk. It is yet unclear whether pacifier use can modify the impact of other sleep-related factors upon SIDS risk. The objective of this study was to examine the association between pacifier use during sleep and SIDS in relation to other risk factors and to determine if pacifier use modifies the impact of these risk factors. Data source was a population based case-control study of 260 SIDS deaths and 260 matched living controls. Pacifier use during last sleep decreased SIDS risk (aOR 0.30, 95% CI 0.17-0.52). Furthermore, pacifier use decreased SIDS risk more when mothers were ≥20years of age, married, nonsmokers, had adequate prenatal care, and if the infant was ever breastfed. Pacifier use also decreased the risk of SIDS more when the infant was sleeping in the prone/side position, bedsharing, and when soft bedding was present. The association between adverse environmental factors and SIDS risk was modified favorably by pacifier use, but the interactions between pacifier use and these factors were not significant. Pacifier use may provide an additional strategy to reduce the risk of SIDS for infants at high risk or in adverse sleep environments.

Use of child death review to inform sudden unexplained infant deaths occurring in a large urban setting

ObjectiveTo illustrate the benefits and utility of the child death review (CDR) reporting system when examining risk factors associated with infant death occurring within two subgroups of sudden unexpected infant...

Critical diaphragm failure in sudden infant death syndrome

Sudden infant death syndrome (SIDS) is the leading cause of death in infants between the ages of 1 and 12 months in developed countries. SIDS is by definition a diagnosis of exclusion, and its mechanism of action is unknown. The SIDS–Critical Diaphragm Failure (CDF) hypothesis postulates that the cause of death in SIDS is respiratory failure caused by CDF. Four principal risk factors contribute to CDF in young infants: undeveloped respiratory muscles, non-lethal infections, prone resting position, and REM sleep. Even relatively minor infections can cause an acute and significant reduction in diaphragm force generation capacity that in conjunction with other risk factors can precipitate CDF. CDF-induced acute muscle weakness leaves few, if any pathological marks on the affected tissue.Understanding the underlying mechanism of SIDS may help in formulating new approaches to child care that can help to further reduce the incidence of SIDS.