Sudden Infant Death Syndrome (SIDS)

Basics

Description

Sudden, unexpected infant death (infant <1 yr old) (SUID) who was typically well before being placed down to sleep
SUID includes sudden infant death syndrome (SIDS) as well as accidental suffocation and strangulation in bed (ASSB) and unknown cause of death in infants <1 yr of age
SIDS deaths remain unexplained after being thoroughly investigated by autopsy, exam of the death scene, investigation of the circumstances, and review of the family and infant medical histories
SIDS is distinct from ASSB which occurs when something limits a baby's breathing such as a blanket against the face or the baby is trapped between two objects (e.g., mattress and wall) which has increased since 1995.
If nonfatal, known as BRUE (brief resolved unexplained event). Previously called ALTE (apparent life-threatening event)
Leading cause of death in infants 1 mo–1 yr of age; the incidence has declined markedly since the initiation of the “Back to Sleep” program in 1994:
- 1992: 120 deaths/100,000 live births (US)
- 2001: 56 deaths/100,000 live births (US)
- No change from 2001–2008
- 2009: 54 deaths/100,000 live births (US)
- 2013: 40 deaths/100,000 live births (US)
- 2015: 39 deaths/100,000 live births (US)
Peak occurrence of SIDS is 1–4 mo of age:
- 90% occur <6 mo of age
- 2% occur >10 mo of age
Ethnic differences: Using 2010–2013 data, SIDS rates for non-Hispanic black and American Indian/Alaska Native populations were much higher than non-Hispanic whites, while SID rates for Asian/Pacific Islander and Hispanic populations were much lower than non-Hispanic whites
Sleeping on back (supine) reduces incidence significantly (“Back to Sleep”). Practice of infants sleeping on their backs began initially in Europe and then in the U.S.

Etiology

SIDS deaths are most likely multifactorial
SIDS infants likely have predisposing conditions that make them more vulnerable to both internal and external stressors
Potential stressors include anemia, congenital diseases, dysrhythmias, electrolyte abnormalities, genetic defects, infection, metabolic disorders, neurologic events, suffocation, trauma, and upper airway obstruction
Maternal and antenatal risk factors:
- Alcohol and illicit drug use
- Intrauterine growth restriction
- Lower socioeconomic status
- Poor prenatal care
- Prior sibling death secondary to SIDS
- Shorter interval between pregnancies
- Smoking
- Younger age
Infant risk factors:
- Bed sharing
- Exposure to environmental smoking
- Gastroesophageal reflux (GER)
- Hyperthermia
- Low birth weight, prematurity
- Male gender
- Soft bedding, soft sleeping surface
- Recent febrile illness
Supine sleeping position, breastfeeding, room sharing without bed sharing (especially in the first 6 mo), and pacifier use are protective
Home monitoring has not been shown to prevent SIDS

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