Sudden Infant Death Syndrome in Emergency Medicine Treatment & Management

  • Author: Lynn Barkley Burnett, MD, EdD, LLB(c); Chief Editor: Richard G Bachur, MD   more...
 
Updated: Mar 9, 2011
 

Prehospital Care

  • Paramedics and other EMS personnel should be familiar with the historical factors and observations indicative of an apparent life-threatening event (ALTE). Infants who have experienced an ALTE must be transported to the ED; this is true even of infants who appear well when examined by EMS personnel.
  • For the infant found in cardiorespiratory arrest, the first priority is life support via attention to the ABCs and other medical interventions as appropriate.
  • Absent postmortem lividity or other signs of obvious death, transport infants to the hospital to ensure full resuscitative attempts.
  • Observations made by EMS personnel at the scene may assist in the investigation. EMS personnel should observe the location and position of the infant, including the type of surface on which the body lies and the body's temperature, degree of rigor mortis, and marks and bruises. Other relevant information includes the type of bed or crib and any defects; amount and position of clothing and bedding materials; presence of toys, pillows, or other objects that may cause asphyxiation; condition of the residence; temperature of the room in which the infant was found; type of ventilation and heating; the presence of children or others; and reactions of caretakers and others at the scene.
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Emergency Department Care

For the infant presenting to the ED following an apparent life-threatening event (ALTE), care includes resuscitation and general stabilization. Place the patient on cardiac and respiratory monitors, including arterial oxygen saturation. Determine the blood glucose level, since hypoglycemia may be associated with apnea, with or without seizure.

The objectives of the workup are to identify "serious" ALTEs and to attempt to establish the cause of the ALTE. ALTE is not a definitive diagnosis; therefore, the preferred final diagnosis is one of specificity (eg, ALTE secondary to seizure). The final diagnosis, however, is often idiopathic ALTE or ALTE of undetermined etiology. On a cautionary note, the diagnosis of ALTE secondary to reflux is one of exclusion. Preferably, make this diagnosis only after a period of observation and reflux monitoring.

If the infant is pronounced dead, inform the family in a quiet environment. Refer to the child by name, not as "the baby." Detailing resuscitative efforts before telling the parents of the death is not helpful and may engender parents' resentment.

Specifically and directly tell parents that their child has died; use of words such as dead or died avoids confusion that may result from gentler terms such as "passed on." Expressions of sorrow and sympathy are appropriate and desirable, but avoid statements such as, "I know how you feel."

Follow the protocol of the local medical examiner or coroner's office concerning retention or removal of an endotracheal tube or lines for vascular access.

The family may see the infant after pronouncement of death. Some coroner or medical examiner offices do not want the infant's body left alone with the family, and they also do not want family members to hold the infant, until arrival of a medicolegal death investigator. Local policy should be followed and, where appropriate, diplomatically explained to the family. Issues such as baptism, grief counseling, religious support, reactions of surviving siblings, and risk of SIDS in subsequent siblings may have to be addressed. Return clothes or personal belongings to the parents, after receipt of permission from the coroner or medical examiner. In addition, a physical memento may be offered (eg, a lock of the child's hair, a handprint or footprint).

Spend time with families to offer comfort, answer questions, and provide information.

Health professionals must be compassionate, empathic, supportive, and nonaccusatory, while simultaneously conducting a thorough investigation.

Absent indications of significant antecedent illness, inconsistencies in the history offered, or obvious evidence of injuries, the parents may be told that their child's demise is a sudden unexpected death in infancy (SUDI), and that classification of the type of SUDI can be established only through review of records, thorough scene investigation, and complete postmortem examination. While sudden infant death syndrome (SIDS) is one category of SUDI, it should be emphasized that such a final diagnosis may only be made through exclusion of all other causes of death.

A comprehensive infant death investigation may require the coroner or medical examiner to use the expertise of emergency physicians, pediatricians, pediatric pathologists, radiologists, pediatric neuropathologists, and other medical specialists, in addition to the medicolegal death investigator and forensic pathologist.

Parents' reactions encompass the spectrum of negative human emotion, and may range from silence to hysteria. Parents often experience intense feelings of guilt, including most cases in which there is no reason for such recriminations. Conversely, many abusive parents are charming and attractive people who can evade and deceive professionals representing multiple disciplines. They may appear to be caring and kind in the presence of professionals, although video surveillance may show them becoming cruel and sadistic within seconds of being alone with a child.

The death of a child in the ED is not a common event; thus, most emergency physicians do not have a depth of experience in telling parents their child is dead. Furthermore, only 14% of emergency physicians, in one study, recalled having received any training in notifying parents of the death of a child. Health professionals experience many of the same emotions as the parents (eg, guilt, anger, sadness, self-reproach, shock). Consideration should be given to critical incident stress debriefing following an infant death or other particularly stressful case.

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Consultations

Consult with pediatric subspecialists as indicated.

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Contributor Information and Disclosures
Author

Lynn Barkley Burnett, MD, EdD, LLB(c)  Medical Advisor, Fresno County Sheriff's Office; Attending Consultant-in-Chief and Chairman, Medical Ethics, Community Medical Centers; Adjunct Assistant Clinical Professor of Emergency Medicine and Forensic Pathology, Touro University College of Osteopathic Medicine, California; Core Graduate Adjunct Professor of Forensic Pathology, National University Master of Forensic Science Program; Core Graduate Adjunct Professor of Leadership in Healthcare, Health Law and Healthcare Ethics, Kaplan University Graduate School of Healthcare Administration

Lynn Barkley Burnett, MD, EdD, LLB(c) is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Association for the Advancement of Science, American Association of Suicidology, American Cancer Society, American College of Sports Medicine, American Heart Association, American Professional Society on the Abuse of Children, American Public Health Association, American Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, American Stroke Association, Association of Military Surgeons of the US, Christian Medical & Dental Society, European Society for Trauma and Emergency Surgery, European Society of Cardiology, European Society of Intensive Care Medicine, European Society of Paediatric and Neonatal Intensive Care, Faculty of Forensic and Legal Medicine of the Royal College of Physicians of London, International Homicide Investigators Association, New York Academy of Sciences, Royal College of Surgeons of Edinburgh, Royal Society of Medicine, Society for Academic Emergency Medicine, Society of Critical Care Medicine, and World Association for Disaster and Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Jonathan Adler, MD  Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School

Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: eMedicine.com Honoraria Editorial Board

Specialty Editor Board

Garry Wilkes  MBBS, FACEM, Director of Emergency Medicine, Calvary Hospital, Canberra, ACT; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

  1. Rhodes TE, Abraham RL, Welch RC, et al. Cardiac potassium channel dysfunction in sudden infant death syndrome. J Mol Cell Cardiol. Mar 2008;44(3):571-81. [Medline].

  2. Meny RG, Carroll JL, Carbone MT, Kelly DH. Cardiorespiratory recordings from infants dying suddenly and unexpectedly at home. Pediatrics. Jan 1994;93(1):44-9. [Medline].

  3. Robb MP, Crowell DH, Dunn-Rankin P, Tinsley C. Cry features in siblings of SIDS. Acta Paediatr. Oct 2007;96(10):1404-8. [Medline].

  4. Leiter JC, Bohm I. Mechanisms of pathogenesis in the Sudden Infant Death Syndrome. Respir Physiol Neurobiol. Nov 15 2007;159(2):127-38. [Medline].

  5. Rand CM, Berry-Kravis EM, Zhou L, Fan W, Weese-Mayer DE. Sudden infant death syndrome: rare mutation in the serotonin system FEV gene. Pediatr Res. Aug 2007;62(2):180-2. [Medline].

  6. Van Norstrand DW, Tester DJ, Ackerman MJ. Overrepresentation of the proarrhythmic, sudden death predisposing sodium channel polymorphism S1103Y in a population-based cohort of African-American sudden infant death syndrome. Heart Rhythm. May 2008;5(5):712-5. [Medline].

  7. Wiemann M, Frede S, Tschentscher F, et al. NHE3 in the human brainstem: implication for the pathogenesis of the sudden infant death syndrome (SIDS)?. Adv Exp Med Biol. 2008;605:508-13. [Medline].

  8. Oyen N, Markestad T, Skaerven R, et al. Combined effects of sleeping position and prenatal risk factors in sudden infant death syndrome: the Nordic Epidemiological SIDS Study. Pediatrics. Oct 1997;100(4):613-21. [Medline].

  9. American Academy of Pediatrics Task Force on Infant Positioning and SIDS. Positioning and sudden infant death syndrome (SIDS): update. Pediatrics. Dec 1996;98(6 Pt 1):1216-8. [Medline].

  10. Heron M. National Vital Statistics Reports, Volume 56, Number 5, "Deaths: Leading Causes for 2004"; date of publication November 20, 2007. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_05.pdf.

  11. Pharoah PO, Platt MJ. Sudden infant death syndrome in twins and singletons. Twin Res Hum Genet. Aug 2007;10(4):644-8. [Medline].

  12. Moon RY, Horne RS, Hauck FR. Sudden infant death syndrome. Lancet. Nov 3 2007;370(9598):1578-87. [Medline].

  13. Centers for Disease Control and Prevention. Highlights in Minority Health & Health Disparities. October 2006. Available at http://www.cdc.gov/omhd/Highlights/2006/HOct06SIDS.htm.

  14. Southall DP, Plunkett MC, Banks MW, Falkov AF, Samuels MP. Covert video recordings of life-threatening child abuse: lessons for child protection. Pediatrics. Nov 1997;100(5):735-60. [Medline].

  15. Esani N, Hodgman JE, Ehsani N, Hoppenbrouwers T. Apparent life-threatening events and sudden infant death syndrome: comparison of risk factors. J Pediatr. Mar 2008;152(3):365-70. [Medline].

  16. Krous HF, Haas EA, Chadwick AE, et al. Delayed death in sudden infant death syndrome: a San Diego SIDS/SUDC Research Project 15-year population-based report. Forensic Sci Int. Apr 7 2008;176(2-3):209-16. [Medline].

  17. Berkowitz CD. Sudden infant death syndrome. In: Tintinalli JE, ed. Emergency Medicine: A Comprehensive Study Guide. 4th ed. New York: McGraw-Hill; 1996.

  18. Gausche M. Sudden infant death syndrome. In: Rosen, ed. Emergency Medicine: Concepts and Clinical Practice. 4th ed. Mosby: St. Louis; 1998.

  19. Reece RM. Fatal child abuse and sudden infant death syndrome: a critical diagnostic decision. Pediatrics. Feb 1993;91(2):423-9. [Medline].

  20. Bacon CJ, Hall DB, Stephenson TJ, Campbell MJ. How common is repeat sudden infant death syndrome?. Arch Dis Child. Apr 2008;93(4):323-6. [Medline].

  21. Gilbert-Barness EF, Barness LA. Sudden infant death syndrome. Is it a cause of death?. Arch Pathol Lab Med. Dec 1993;117(12):1246-8. [Medline].

  22. Lazoff M, Kauffman F. Sudden infant death syndrome--Part I: General features. Acad Emerg Med. Oct 1995;2(10):926-33. [Medline].

  23. Ackerman J, Gilbert-Barness E. Suspended rocking cradles, positional asphyxia, and sudden infant death. Arch Pediatr Adolesc Med. Jun 1997;151(6):573-5. [Medline].

  24. Hoppenbrouwers T, Hodgman JE, Ramanathan A, Dorey F. Extreme and conventional cardiorespiratory events and epidemiologic risk factors for SIDS. J Pediatr. May 2008;152(5):636-41. [Medline].

  25. Kahlert C, Rudin C, Kind C. Sudden infant death syndrome in infants born to HIV-infected and opiate-using mothers. Arch Dis Child. Nov 2007;92(11):1005-8. [Medline].

  26. Ford RP, Schluter PJ, Mitchell EA, Taylor BJ, Scragg R, Stewart AW. Heavy caffeine intake in pregnancy and sudden infant death syndrome. New Zealand Cot Death Study Group. Arch Dis Child. Jan 1998;78(1):9-13. [Medline].

  27. Machaalani R, Waters KA. Neuronal cell death in the Sudden Infant Death Syndrome brainstem and associations with risk factors. Brain. Jan 2008;131:218-28. [Medline].

  28. Howard LM, Kirkwood G, Latinovic R. Sudden infant death syndrome and maternal depression. J Clin Psychiatry. Aug 2007;68(8):1279-83. [Medline].

  29. Thompson JM, Thach BT, Becroft DM, Mitchell EA. Sudden infant death syndrome: risk factors for infants found face down differ from other SIDS cases. J Pediatr. Nov 2006;149(5):630-633. [Medline].

  30. Lazoff M, Kauffman F. Sudden infant death syndrome--Part III: Emergency department approach. Acad Emerg Med. Dec 1995;2(12):1077-80. [Medline].

  31. Samuels MP, Southall DP. Child abuse and apparent life-threatening events [letter; comment]. Pediatrics. Jul 1995;96(1 Pt 1):167-8. [Medline].

  32. Coleman-Phox K, Odouli R, Li DK. Use of a fan during sleep and the risk of sudden infant death syndrome. Arch Pediatr Adolesc Med. Oct 2008;162(10):963-8. [Medline].

  33. Towbin JA, Friedman RA. Prolongation of the QT interval and the sudden infant death syndrome [editorial; comment]. N Engl J Med. Jun 11 1998;338(24):1760-1. [Medline].

  34. American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics. Nov 2005;116(5):1245-55. [Medline].

  35. American Academy of Pediatrics. Committee on Child Abuse and Neglect. Addendum: Distinguishing Sudden Infant Death Syndrome From Child Abuse Fatalities. Pediatrics. 2001;108(3):812. [Medline].

  36. American Academy of Pediatrics. Committee on Child Abuse and Neglect. American Academy of Pediatrics: Distinguishing sudden infant death syndrome from child abuse fatalities. Pediatrics. Feb 2001;107(2):437-41. [Medline].

  37. AORN Journal. New study looks at sudden infant death syndrome. AORN Journal. Mar 1 2005.

  38. Barkin RM. Pediatrics. A potpourri of clinical pearls. Emerg Med Clin North Am. May 1997;15(2):381-8. [Medline].

  39. Barkin RM, Gausche-Hill M. Sudden Infant Death Syndrome. In: Rosen, ed. Emergency Medicine: Concepts and Clinical Practice. Mosby: St. Louis, MO; 2002.

  40. Bergman AB. Wrong turns in sudden infant death syndrome research. Pediatrics. Jan 1997;99(1):119-21. [Medline].

  41. Carmona M. Apnea. In: Harwood-Nuss AL, ed. The Clinical Practice of Emergency Medicine. 2nd ed. Philadelphia, Pa: Lippincott-Raven;. 1996.

  42. Carpenter RF. The prevalence and distribution of bruising in babies. Arch Dis Child. Apr 1999;80(4):363-6. [Medline].

  43. Carroll JL, Siska ES. SIDS: counseling parents to reduce the risk. Am Fam Physician. Apr 1 1998;57(7):1566-72. [Medline].

  44. Committee on Child Abuse and Neglect. American Academy of Pediatrics. Distinguishing sudden infant death syndrome from child abuse fatalities. Pediatrics. Jul 1994;94(1):124-6. [Medline].

  45. Committee on Fetus and Newborn. American Academy of Pediatrics. Apnea, sudden infant death syndrome, and home monitoring. Pediatrics. Apr 2003;111(4 Pt 1):914-7. [Medline].

  46. Dewolfe CC. Apparent life-threatening event: a review. Pediatr Clin North Am. Aug 2005;52(4):1127-46, ix. [Medline].

  47. Duhaime AC, Christian CW, Rorke LB, Zimmerman RA. Nonaccidental head injury in infants--the "shaken-baby syndrome". N Engl J Med. Jun 18 1998;338(25):1822-9. [Medline].

  48. Emery JL. Child abuse, sudden infant death syndrome, and unexpected infant death. Am J Dis Child. Oct 1993;147(10):1097-100. [Medline].

  49. Franco P, Seret N, Van Hees JN, Scaillet S, Groswasser J, Kahn A. Influence of swaddling on sleep and arousal characteristics of healthy infants. Pediatrics. May 2005;115(5):1307-11. [Medline].

  50. Freed GE, Steinschneider A, Glassman M, Winn K. Sudden infant death syndrome prevention and an understanding of selected clinical issues. Pediatr Clin North Am. Oct 1994;41(5):967-90. [Medline].

  51. Hall KL, Zalman B. Evaluation and management of apparent life-threatening events in children. Am Fam Physician. Jun 15 2005;71(12):2301-8. [Medline].

  52. Hart RG, Ahrens WR. Coping with pediatric death in the ED by learning from parental experience. Am J Emerg Med. Jan 1998;16(1):67-8. [Medline].

  53. Hunt CE. Sudden infant death syndrome and subsequent siblings. CHIME Steering Committee. Collaborative Home Infants Monitoring Evaluation. Pediatrics. Mar 1995;95(3):430-2. [Medline].

  54. Kinney HC, Thach BT. The sudden infant death syndrome. N Engl J Med. Aug 20 2009;361(8):795-805. [Medline].

  55. Knapp J, Mulligan-Smith D. Death of a child in the emergency department. Pediatrics. May 2005;115(5):1432-7. [Medline].

  56. Knazik SR, Gausche-Hill M, Dietrich AM, et al. The death of a child in the emergency department. Ann Emerg Med. Oct 2003;42(4):519-29. [Medline].

  57. Lazoff M, Kauffman F. Sudden infant death syndrome--Part II: Etiologic theories. Acad Emerg Med. Nov 1995;2(11):996-1000. [Medline].

  58. Leach CE, Blair PS, Fleming PJ, et al. Epidemiology of SIDS and explained sudden infant deaths. CESDI SUDI Research Group. Pediatrics. Oct 1999;104(4):e43. [Medline].

  59. MacDorman MF, Atkinson JO. Infant mortality statistics from the 1997 period linked birth/infant death data set. Natl Vital Stat Rep. Jul 30 1999;47(23):1-23. [Medline].

  60. Malloy MH. Effectively delivering the message on infant sleep position [editorial; comment]. JAMA. Jul 22-29 1998;280(4):373-4. [Medline].

  61. Malloy MH, MacDorman M. Changes in the classification of sudden unexpected infant deaths: United States, 1992-2001. Pediatrics. May 2005;115(5):1247-53. [Medline].

  62. Mathews TJ, Menacker F, MacDorman MF. Infant mortality statistics from the 2002 period: linked birth/infant death data set. Natl Vital Stat Rep. Nov 24 2004;53(10):1-29. [Medline].

  63. Ostrea EM Jr, Ostrea AR, Simpson PM. Mortality within the first 2 years in infants exposed to cocaine, opiate, or cannabinoid during gestation. Pediatrics. Jul 1997;100(1):79-83. [Medline].

  64. Pamphlett R, Raisanen J, Kum-Jew S. Vertebral artery compression resulting from head movement: a possible cause of the sudden infant death syndrome. Pediatrics. Feb 1999;103(2):460-8. [Medline].

  65. Schwartz GR. Other pediatric emergencies: Asphyxiation, sudden infant death syndrome, and hyperpyrexia. In: Principles and Practice of Emergency Medicine. 2nd ed. Philadelphia, Pa: Lea & Febiger; 1992.

  66. Schwartz PJ, Stramba-Badiale M, Segantini A, et al. Prolongation of the QT interval and the sudden infant death syndrome. N Engl J Med. Jun 11 1998;338(24):1709-14. [Medline].

  67. Smock WS. Clinical forensic medicine. In: Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. 5th ed. Mosby: St. Louis; 2002.

  68. Stratton SJ, Taves A, Lewis RJ, Clements H, Henderson D, McCollough M. Apparent life-threatening events in infants: high risk in the out-of-hospital environment. Ann Emerg Med. Jun 2004;43(6):711-7. [Medline].

  69. Taylor JA, Sanderson M. A reexamination of the risk factors for the sudden infant death syndrome. J Pediatr. Jun 1995;126(6):887-91. [Medline].

  70. Thach BT. The brainstem and vulnerability to sudden infant death syndrome. Neurology. Nov 11 2003;61(9):1170-1. [Medline].

  71. Waters KA. Cytokines in sudden infant death syndrome. Lancet Neurol. Feb 2004;3(2):81. [Medline].

  72. Whitwell HL. 'Oxford University Press. Forensic Neuropathology. 2005;28.

  73. Willinger M, Hoffman HJ, Wu KT, et al. Factors associated with the transition to nonprone sleep positions of infants in the United States: the National Infant Sleep Position Study. JAMA. Jul 22-29 1998;280(4):329-35. [Medline].

 
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