Sudden unexpected infant death including SIDS: Initial management
- Michael J Corwin, MD
Michael J Corwin, MD
- Associate Professor of Pediatrics and Epidemiology
- Boston University Schools of Medicine and Public Health
- Mary McClain, RN, MS
Mary McClain, RN, MS
- Consultant, SMART Study
- Slone Epidemiology Center, Boston University
- Section Editors
- George B Mallory, MD
George B Mallory, MD
- Section Editor — Pediatric Pulmonology
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Teresa K Duryea, MD
Teresa K Duryea, MD
- Section Editor — General Pediatrics
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Adrienne G Randolph, MD, MSc
Adrienne G Randolph, MD, MSc
- Section Editor — Pediatric Critical Care Medicine
- Professor of Anaesthesia and Pediatrics
- Harvard Medical School
Sudden unexpected infant death (SUID), or sudden unexpected death in infancy (SUDI), describes all unexpected infant deaths and includes deaths caused by sudden infant death syndrome (SIDS). SIDS is the leading cause of death in infants between one month and one year of age in the United States. SIDS probably has more than one cause, although the final process appears to be similar in most cases .
The clinical management of an SUID including SIDS is discussed in this topic review. Mechanisms, risk factors, and measures to reduce the risk of SIDS and other sleep-related infant deaths are discussed separately. (See "Sudden infant death syndrome: Risk factors and risk reduction strategies".)
Sudden unexpected infant deaths (SUID) can be subdivided into explained SUID and unexplained SUID:
●Unexplained SUID includes those deaths considered to be sudden infant death syndrome (SIDS) by the medical examiner. SIDS is defined as the sudden death of an infant younger than one year of age, which remains unexplained after a thorough case investigation [2,3]. Unexplained SUID also includes some cases that are not considered SIDS, but lack a clear explanation due to uncertain circumstances.
●Explained SUID includes deaths for which the medical examiner determines that there is a specific cause, including deaths caused by fatal child abuse or underlying medical disorders including metabolic disease. It also includes deaths that are deemed to be caused by accidental suffocation or entrapment during sleep. (See 'Differential diagnosis' below.)
- McClain M. Sudden unexpected infant and child death: A guide for emergency department personnel. Boston, MA: Massachusetts Center for Sudden Infant Death Syndrome 2008. Available at: http://www.bmc.org/Documents/bmc-SIDSguideforEDpersonnel.pdf (Accessed on March 28, 2012).
- Centers for Disease Control and Prevention (CDC). Sudden infant death syndrome--United States, 1983-1994. MMWR Morb Mortal Wkly Rep 1996; 45:859.
- Willinger M, James LS, Catz C. Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institute of Child Health and Human Development. Pediatr Pathol 1991; 11:677.
- Task Force on Sudden Infant Death Syndrome. SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Pediatrics 2011; 128:1030.
- American Academy of Pediatrics, Hymel KP, Committee on Child Abuse and Neglect, National Association of Medical Examiners. Distinguishing sudden infant death syndrome from child abuse fatalities. Pediatrics 2006; 118:421.
- Reece RM. Fatal child abuse and sudden infant death syndrome: a critical diagnostic decision. Pediatrics 1993; 91:423.
- Smialek JE, Lambros Z. Investigation of sudden infant deaths. Pediatrician 1988; 15:191.
- Bass M, Kravath RE, Glass L. Death-scene investigation in sudden infant death. N Engl J Med 1986; 315:100.
- Byard RW, Krous HF. Sudden infant death syndrome: overview and update. Pediatr Dev Pathol 2003; 6:112.
- Krous HF, Byard RW. International standardized autopsy protocol for sudden infant death. Appendix 1. In: Sudden Infant Death Syndrome: Problems, Progress, Possibilities, Byard RW, Krous HF (Eds), Arnold, London 2001. p.319.
- Centers for Disease Control and Prevention. Sudden unexpected infant death reporting form. Available at: http://www.cdc.gov/SIDS/SUIDRF.htm (Accessed on October 25, 2011).
- Shapiro-Mendoza CK, Camperlengo LT, Kim SY, Covington T. The sudden unexpected infant death case registry: a method to improve surveillance. Pediatrics 2012; 129:e486.
- Task Force on Sudden Infant Death Syndrome, Moon RY. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 2011; 128:e1341.
- Valdes-Dapena M. The sudden infant death syndrome: pathologic findings. Clin Perinatol 1992; 19:701.
- Berry PJ. Pathological findings in SIDS. J Clin Pathol 1992; 45:11.
- Meadow R. Suffocation, recurrent apnea, and sudden infant death. J Pediatr 1990; 117:351.
- McClain PW, Sacks JJ, Froehlke RG, Ewigman BG. Estimates of fatal child abuse and neglect, United States, 1979 through 1988. Pediatrics 1993; 91:338.
- Southall DP, Plunkett MC, Banks MW, et al. Covert video recordings of life-threatening child abuse: lessons for child protection. Pediatrics 1997; 100:735.
- Kukull WA, Peterson DR. Sudden infant death and infanticide. Am J Epidemiol 1977; 106:485.
- Meadow R. Unnatural sudden infant death. Arch Dis Child 1999; 80:7.
- Carpenter RG, Waite A, Coombs RC, et al. Repeat sudden unexpected and unexplained infant deaths: natural or unnatural? Lancet 2005; 365:29.
- Guntheroth WG, Lohmann R, Spiers PS. Risk of sudden infant death syndrome in subsequent siblings. J Pediatr 1990; 116:520.
- Beal SM, Blundell HK. Recurrence incidence of sudden infant death syndrome. Arch Dis Child 1988; 63:924.
- Oyen N, Skjaerven R, Irgens LM. Population-based recurrence risk of sudden infant death syndrome compared with other infant and fetal deaths. Am J Epidemiol 1996; 144:300.
- Boles RG, Buck EA, Blitzer MG, et al. Retrospective biochemical screening of fatty acid oxidation disorders in postmortem livers of 418 cases of sudden death in the first year of life. J Pediatr 1998; 132:924.
- Olpin SE. The metabolic investigation of sudden infant death. Ann Clin Biochem 2004; 41:282.
- Centers for Disease Control and Prevention (CDC). Contribution of selected metabolic diseases to early childhood deaths--Virginia, 1996-2001. MMWR Morb Mortal Wkly Rep 2003; 52:677.
- Rosenthal NA, Currier RJ, Baer RJ, et al. Undiagnosed metabolic dysfunction and sudden infant death syndrome--a case-control study. Paediatr Perinat Epidemiol 2015; 29:151.
- van Rijt WJ, Koolhaas GD, Bekhof J, et al. Inborn Errors of Metabolism That Cause Sudden Infant Death: A Systematic Review with Implications for Population Neonatal Screening Programmes. Neonatology 2016; 109:297.
- Shekhawat PS, Matern D, Strauss AW. Fetal fatty acid oxidation disorders, their effect on maternal health and neonatal outcome: impact of expanded newborn screening on their diagnosis and management. Pediatr Res 2005; 57:78R.
- Seashore MR, Rinaldo P. Metabolic disease of the neonate and young infant. Semin Perinatol 1993; 17:318.
- Howat AJ, Bennett MJ, Variend S, Shaw L. Deficiency of medium chain fatty acylcoenzyme A dehydrogenase presenting as the sudden infant death syndrome. Br Med J (Clin Res Ed) 1984; 288:976.
- Chace DH, DiPerna JC, Mitchell BL, et al. Electrospray tandem mass spectrometry for analysis of acylcarnitines in dried postmortem blood specimens collected at autopsy from infants with unexplained cause of death. Clin Chem 2001; 47:1166.
- Gessner BD, Gillingham MB, Birch S, et al. Evidence for an association between infant mortality and a carnitine palmitoyltransferase 1A genetic variant. Pediatrics 2010; 126:945.
- Bennett MJ, Powell S. Metabolic disease and sudden, unexpected death in infancy. Hum Pathol 1994; 25:742.
- Scalais E, Bottu J, Wanders RJ, et al. Familial very long chain acyl-CoA dehydrogenase deficiency as a cause of neonatal sudden infant death: improved survival by prompt diagnosis. Am J Med Genet A 2015; 167A:211.
- The unexpected death of an infant or child: Standards for services to families. Association of SIDS and Infant Mortality Programs 2001. http://www.asip1.org/images/ASIP_Standards.pdf (Accessed on March 28, 2012).
- Bronheim S. Infusing cultural and linguistic competence into the multiple systems encountered by families following the sudden, unexpected death of an infant. Policy Brief, Georgetown University Center for Child and Human Development, 2003. Available at: http://gucchd.georgetown.edu/72886.html (Accessed on March 28, 2012).
- Mitchell JT. When disaster strikes...the critical incident stress debriefing process. JEMS 1983; 8:36.
- McClain M, Arnold J, Longchamp E, et al. Bereavement counseling for sudden infant death syndrome (SIDS) and infant mortality: Core competencies for the health care professional. Associations of SIDS and Infant Mortality Programs 2004. http://www.asip1.org/images/BerCouns--CoreComp.pdf (Accessed on March 28, 2012).
- American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, American College of Emergency Physicians, et al. Joint policy statement--guidelines for care of children in the emergency department. Pediatrics 2009; 124:1233.
- Death of a child in the emergency department. American Academy of Pediatrics Committee on Pediatric Emergency Medicine. Pediatrics 1994; 93:861.
- Silva JN, Canter CE, Singh TP, et al. Outcomes of heart transplantation using donor hearts from infants with sudden infant death syndrome. J Heart Lung Transplant 2010; 29:1226.
- Warner J, Metcalfe C, King M. Evaluating the use of benzodiazepines following recent bereavement. Br J Psychiatry 2001; 178:36.
- CASE INVESTIGATION
- Death scene investigation
- Clinical and family history
- DIFFERENTIAL DIAGNOSIS
- Fatal child abuse
- Metabolic disease
- FAMILY COMMUNICATION AND SUPPORT
- Emergency response
- Responding to a death in day care
- Hospital emergency department intervention
- - Medical care and data collection
- - Interactions with the family
- Resources and information
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS