Chapter 5

• Sudden infant death syndrome (SIDS) is defined as the sudden death of an infant younger than 1 year which remains unexplained after a thorough case investigation, including a complete autopsy, examination of the death scene, and review of the clinical history.
• Typically, the SIDS victim is brought to the emergency department by ambulance after a caregiver finds the unresponsive infant. The child has usually been asleep for a variable length of time and it is unclear how long the infant has been pulseless and apneic.
• As soon as possible, the parents should be informed of the resuscitation and interviewed regarding the events leading up to the discovery of the infant. Information solicited should include past medical history, present illnesses, current medications, and any history of trauma.
• Prevention is the key to reducing mortality secondary to SIDS and risk reduction is the most important measure in preventing SIDS. Parents should be given specific risk reduction strategies such as nonprone sleeping, avoiding maternal smoking in pregnancy, decreasing environmental smoke exposure, maintaining comfortable ambient temperature, providing a safe sleep environment, and fully immunizing the child.
• To help with the grieving process, the parents should be allowed to see and hold the baby and details of the resuscitation should be explained. Immediate social work and pastoral support will help the family to cope with the difficult and confusing situation.
• An apparent life-threatening event (ALTE) is defined as an episode that is frightening to the observer and is characterized by some combination of apnea (central or obstructive), color change (cyanosis, pallor, erythema, or plethora), marked change in muscle tone (rigidity or limpness), or unexplained choking or gagging.
• The differential diagnosis is extensive because ALTE is primarily a historic description of the event rather than a single, unifying pathophysiologic process. Even after a thorough evaluation, a definitive diagnosis of the ALTE is found in only approximately 50% of patients.
• The history often provides the most important information in the evaluation of an ALTE, especially when the infant appears well and has a normal physical examination. The first step is to determine whether a true ALTE has occurred.
• True apnea must be distinguished from the normal periodicity of breathing that occurs during infancy. Normal periodic breathing is not associated with skin color changes.
• An infant may be discharged from the emergency department if a detailed history and physical examination do not indicate that a true ALTE has occurred, provided the infant continues to do well and the parents are comfortable with the situation and capable of observing the infant at home.
• Any infant with a history of apnea, pallor, cyanosis, limpness or unresponsiveness requiring vigorous physical stimulation, or cardiopulmonary resuscitation is excluded from outpatient consideration.

SIDS is defined as the sudden death of an infant younger than 1 year which remains unexplained after a thorough case investigation, including a complete autopsy, examination of the death scene, and review of the clinical history.1 The emergency department physician should be prepared to ...

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