Sudden Infant Death Syndrome in Emergency Medicine Workup

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

Laboratory Studies

Obtain a rapid bedside glucose reading, followed by serum determination of glucose if indicated. Hypoglycemia, which is common in sepsis, may cause a confusing presentation.

Initial labs include a complete blood count (CBC), electrolytes, and urinalysis.

Hypocalcemia, hypomagnesemia, and hyperkalemia may cause respiratory dysfunction.

Blood urea nitrogen (BUN), creatinine, phosphate, or serum ammonia tests may be helpful.

Specific metabolic studies may be indicated if the patient is hypoglycemic, acidotic, or hyperammonemic.

Toxicologic screen can be helpful if suspected exposure to medications (potentially intentional) or drugs of abuse (occasionally bystander inhalational routes).

Perform a sepsis workup, with blood and urine culture, although, in the absence of suggestive findings (eg, fever), sepsis is unlikely. When clinically suspected, pertussis and chlamydial cultures are appropriate. Consider respiratory syncytial virus (RSV), particularly in very young infants or premature infants with respiratory symptoms. Stool may be sent for clostridial culture and for botulinum toxin testing, particularly if hypotonia is found. Infant botulism, a risk not limited to the ingestion of honey, is probably more frequent than generally believed.

Arterial blood gas may be helpful for severely ill infants or those with persistent symptoms on presentation. This may reveal metabolic acidosis unexplained other than by clearance of a large lactic acid load from a clinically significant apparent life-threatening event (ALTE). Metabolic acidosis raises the possibility of sepsis or metabolic deficiencies. Blood and urine toxicology screens and a carbon monoxide level test are appropriate in many cases.

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Imaging Studies

  • A chest x-ray (CXR) is indicated in most cases.
  • The presence of fractures in a child younger than a year, irrespective of the site, should prompt a thorough investigation to exclude child abuse.
  • It is extremely difficult to fracture the ribs of an infant during resuscitation; however, fractures do occur with relative ease when an infant's thorax is grasped abnormally.
  • Obtain anteroposterior and lateral soft tissue films of the neck if upper airway obstruction is suspected.
  • A barium swallow may be ordered if indicated by history or physical examination.
  • Skull films and CT scans may be indicated if abuse is suspected or if signs of increased intracranial pressure are present.
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Other Tests

  • Obtain a 12-lead electrocardiogram (ECG).
  • Consider electroencephalogram (EEG) if indicated by history or physical examination.
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Procedures

  • Patients younger than 2 months and those with significant evidence of infection should have a complete septic workup, including lumbar puncture and empiric antibiotics.
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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.

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