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Sudden Infant Death Syndrome (SIDS)

A medical mystery of early infancy, sudden infant death syndrome (SIDS)­ commonly called crib death - kills apparently healthy infants, usually between ages 4 weeks and 7 months, for reasons that remain unexplained, even after an autopsy. Typically, parents put the infant to bed and later find him dead, often with no indications of a struggle or distress of any kind.

Some infants may have had signs of a cold, but such symptoms are usually absent. SIDS has occurred throughout history, all over the world, and in all climates.

Causes

SIDS accounts for 7,500 to 8,000 deaths annually in the United States, making it one of the leading causes of infant death. Most of these deaths occur during the winter, in poor families, and among underweight babies and those born to mothers under age 20.

Although infants who die from SIDS often appear healthy, research suggests that many may have had undetected abnormalities such as an immature respiratory system and respiratory dysfunction. In fact, the current thinking is that SIDS may result from an abnormality in the control of ventilation, which causes prolonged apneic periods with profound hypoxemia and serious cardiac arrhythmias.

Bottle-feeding instead of breast-feeding and advanced parental age don't cause SIDS.

Signs and symptoms

Although parents find some victims wedged in crib corners or with blankets wrapped around their heads, autopsies rule out suffocation as the cause of death. Even when frothy, blood-tinged sputum is found around the infant's mouth or on the crib sheets, an autopsy shows a patent airway, so aspiration of vomitus is not the cause of death.

Typically, SIDS babies don't cry out and show no signs of having been disturbed in their sleep, although their positions or tangled blankets may suggest movement just before death, perhaps from terminal spasm.

Depending on how long the infant has been dead, a SIDS baby may have a mottled complexion, with extreme cyanosis of the lips and fingertips, or pooling of blood in the legs and feet that may be mistaken for bruises. Pulse and respirations are absent, and the infant's diaper is wet and full of stools.

Diagnosis

The diagnosis of SIDS is given when the cause of death remains unexplained after a complete investigation, which includes the following:

• an autopsy
• examination of the death scene
• review of the symptoms or illnesses the infant had prior to dying
• any other pertinent medical history

Treatment

If the parents bring the infant to the emergency department, the doctor will decide whether to try to resuscitate him. An "aborted SIDS" is an infant who is found apneic and is successfully resuscitated. Such an infant, or any infant who had a sibling stricken by SIDS, should be tested for infantile apnea. If tests are positive, a home apnea monitor may be recommended.

Because most infants can't be resuscitated, however, treatment focuses on emotional support for the family.

Prevention

There's no guaranteed way to prevent SIDS, but you can help your baby sleep safely. Consider the latest guidelines from the American Academy of Pediatrics:

• A smoke-free environment is especially important during pregnancy and in your baby's first year of life. Infants whose mothers smoke during and after pregnancy are much more likely to die of SIDS than are infants of nonsmoking mothers.
• Consider keeping your baby's crib or bassinet in your room at first. Infants who sleep in the same room as their mothers have a lower risk of SIDS.
• Babies should be kept warm, but they should not be allowed to get too warm. An overheated baby is more likely to go into a deep sleep from which it is difficult to arouse. The temperature in the baby's room should feel comfortable to an adult and overdressing the baby should be avoided. Keep the temperature in your baby's room so that it feels comfortable to you.
• Place your baby to sleep resting on his or her back, rather than on the stomach or side. This isn't necessary when your baby's awake or able to roll over both ways without your help. By the time your baby has learned to roll over, the risk of SIDS has decreased.

Some parents feel more secure when their newborn's heart rate and breathing are monitored electronically. Unfortunately, monitoring is unlikely to prevent SIDS deaths. Positioning devices aren't effective either - or even proved safe.